Arthroscopic treatment is usually performed under general anesthesia. Two incisions are usually made around the joint, about 1 cm in size, then the shoulder joint is filled with physiological fluid. A probe with a camera and arthroscopic surgical instruments are inserted through the incisions. The doctor who performs the operation uses special anchors to fix the torn off acetabular helix.
The number of anchors depends on how extensive the trauma is. During the operation, the doctor also removes the hypertrophied synovium, smoothes the damaged fragments of the articular cartilage, and also – if necessary – plasticizes the capsule. Arthroscopic treatment is a minimally invasive procedure, the incisions are small, so the postoperative scar will also be hardly visible. Usually, the patient is discharged home a few hours after the surgery. Arthroscopic treatment of shoulder instability also allows the patient to recover faster.
This operation requires a larger incision to be made to allow the clinician to better reach the site of the injury. During the operation, the surgeon transfers the coracoid process of the scapula to the defect of the acetabular edge, in order to protect the humerus against anterior dislocation. Together with the coracoid process, a fragment of the biceps tendon is transplanted along with blood vessels. This prevents the occurrence of bone necrosis and the tendon additionally stabilizes the head of the humerus. The doctor also performs the plastic of the articular capsule, shortening it, which is aimed at additional stabilization of the joint. Open surgery is performed under general anesthesia.
In both cases – both after arthroscopy and open surgery – the patient receives painkillers. Cold compresses are also used to reduce pain and swelling. The swelling usually resolves 48 hours after the operation. The sutures are removed on the 10-14th day after the procedure.
Rehabilitation after surgery
In order for the patient to regain full fitness, rehabilitation after surgery is necessary. The aim of rehabilitation is to restore the dynamic stability of the shoulder. Immediately after the procedure, the patient’s shoulder is immobilized in an orthosis, which will protect the operated shoulder joint and limit the possibility of uncontrolled movements. The patient wears the orthosis for about 2 – 6 weeks, taking it off only for the duration of rehabilitation.
During this time, the patient should exercise with a physical therapist. Initially, exercises are performed based on passive movements and isometric muscle contractions. The limb should not be overloaded, as this may damage the suturing site of the labrum. The physiotherapist will also recommend performing exercises that mobilize the shoulder blade. The patient should also actively exercise the elbow joint, wrist and fingers.
This will avoid the formation of contractures due to the immobilization of the limb. Rehabilitation may be supported by physical therapy. In particular, treatments such as electrostimulation, magnetic field, and cryotherapy are recommended. The orthosis is removed when the doctor allows it. Rehabilitation in this period consists of active exercises of the shoulder joint, exercises that mobilize the shoulder blade and strengthen the muscles of the shoulder girdle. After 12 weeks, most patients can exercise alone at home and drive. Recovery takes place between 6 and 9 months after the surgery. Then the patients can also return to practicing sports.