How do you position patients during surgery?
Shoulder surgeons position patients in an upright (beach chair) position or a lateral decubitus (lying on the side) position. There are advantages and disadvantages to both positions. The beach chair position is traditionally the way surgeons operated on the shoulder before arthroscopy and is a more familiar position for most surgeons. That being said, many advanced arthroscopists have become familiar with shoulder surgery in the lateral decubitus position and it has been shown to be safer for patients and more versatile for repairs of everything from the labrum to the rotator cuff. A recent study in Anesth. Analg, 8/10 showed that 80% of patients in the beach chair position had periods of low blood flow to their brain during surgery vs. 0% in the lateral position. They correlated this to a higher incidence of nausea and vomiting.
I perform all shoulder arthroscopy procedures in the lateral position as I feel more comfortable with the technical portions of the procedure in that position and I believe that it is safer for my patients.
Do you do shoulder surgery with the scope or through open incisions?
I repair rotator cuff tears with the scope through small incisions for the following reasons:
- I can better evaluate the tissue, see it more clearly and perform soft tissue releases than can be done with open incisions.
- I can see all aspects of the joint and address them with the scope. Rotator cuff repairs through traditional incisions do not permit visualization of shoulder disease within the shoulder joint.
- Arthroscopic surgery hurts less, is a quicker and easier recovery and is done as a same day procedure.
- Arthroscopic surgery leaves smaller and more cosmetic incisions.
- The repairs are biomechanically as strong as open repairs if not stronger.
- If performed in the lateral position, it is safer for the patient as it avoids cerebral ischemia.
What is Arthroscopy?
Arthroscopy is a surgical procedure during which the internal structure of a joint is examined for diagnosis and treatment of problems inside the joint.
What conditions are treated with arthroscopic surgery?
Arthroscopic examination of joints is helpful in diagnosis and treatment of the following conditions:
- Inflammation: Synovitis, the inflammation of the lining of the knee, shoulder, or ankle.
- Acute or chronic injury: Injuries to the shoulder, knee and wrist joint such as cartilage tears, tendon tears, carpal tunnel syndrome.
- Osteoarthritis: A type of arthritis caused by cartilage loss in a joint.
- Removal of loose bodies of bone or cartilage that becomes logged within the joint.
How is arthroscopy performed?
During arthroscopic surgery, either a general, spinal, or a local anesthesia will be given depending on the condition. A small incision of the size of a buttonhole is made through which the arthroscope is inserted. Other accessory incisions will be made through which specially designed instruments are inserted. After the procedure is completed, arthroscope is removed and incisions are closed.
What are the possible complications associated with arthroscopy?
Some of the possible complications after arthroscopy include infection, phlebitis (clotting of blood in vein), excessive swelling, bleeding, blood vessel, or nerve damage and instrument breakage.
What is the recovery process after arthroscopic surgery?
It may take several weeks for the puncture wounds to heal and the joint to recover completely. A rehabilitation program may be advised for a speedy recovery of normal joint function. You can resume normal activities and go back to work within a few days. You may be instructed about the incision care, activities to be avoided, and exercises to be performed for faster recovery.
Will physical therapy be required after surgery?
Getting a full range of motion, strength, and flexibility back after surgery usually takes time. That is where pre-operative exercise, education, and post-operative physical therapy programs come in – to ensure you are physically and emotionally prepared for surgery and to maximize your recovery after surgery.
What should I bring with me when I come for an appointment?
When you come for your appointment remember to bring the following:
- Insurance information
- Referral Letter (if required)
- Copies of results, X-rays, MRI’s, CT scans etc and any other relevant information
- List of medications (if any)
How do I schedule an appointment?
You can schedule an appointment by calling us 435-628-9393 directly during our working hours.