Minimally Invasive Arthroscopic Surgeries and Their Rehabilitation

In our day to day life, most of us do encounter Shoulder Problems such as persistent pain, decreased/restricted movements. Frozen Shoulder, Instability - Dislocations and Arthritis, which hinder our lifestyle and activities of daily living.

The shoulder joint is formed by the articulation of the glenoid and the humerus Head, Stabilised by the rim of labrum and group of muscles which help in stabilisation and movement in different planes and direction.

Common Conditions Encountered

Rotator Cuff Tear

The rotator cuff is a group of muscles and their tendons form a cuff over Shoulder Joint. They hold the Joint and help in the movement in different directions. They are torn due to overuse or Trauma.

Impingement Syndrome / Stiffness - Frozen Shoulder

It can be due to inflammatory response, post-trauma, our bony spur, which causes pain and severely restricted movements. Even the Activities of Daily Living are hindered combing -bathing etc. Most commonly seen in Diabetics.

Instability and Recurrent Dislocations

The labrum which reinforces/stabilises the Shoulder may be torn in Bankart’s and Slap lesions. In Bankart’s the tear is in the lower part and Slap in the top part of the Shoulder Joint.

In Arthroscopy of the Shoulder, 3 - 5 portals of about 5mm are made for the visualisation (Seeing) and the working (Repair/Reconstruction) will be done through the same portals. A scope will be introduced to see in the Joint and with the help of shaver debridement (cleaning) will be done and with the help of specific instrumentation, the repair will be done.

In Impingement, the inflammatory tissue and adhesions are debrided and a free space is created for the better, pain-free movement of the Shoulder. Using a burr bony spur (overgrowth) and Joint decompression will bed one.

In Rotator Cuff Tears, the chronic torn part will be debrided and the torn part of the tendon is pulled back to its insection/footprint and fixed over there with the Suture Anchors - which can be bio absorbable or Metallic (Titanium), will be followed by the rehab protocol for the strengthening of the group of muscles In Instability, either the injury to the labrum can be at the top (superior) - SLAP or towards the bottom (BANKART) - More common, because of them injury the stability of the Shoulder is lost and becomes moreprone for dislocation as the patient will be feared of dislocation with the certain activities or over head activities. Thus the portion of the injury/tear has to be reconstructed using the Suture Anchors and has to be stabilised for the better functionality.

Arthritis is one condition which is pretty rare in the Shoulder Joint if in the early stage Debridement can be done and if there is an anatomical deformation with the change in the shape of the head, the replacement would be the final go in severe Arthritis. For a pain-free and better movements with the stable joint.

All Shoulder rehab with reconstruction repair will be started with a gentle assisted range of movements followed by the active range of movement exercises and the strengthening exercises depending on the severity of the case and the amount of repair done. The Rehab protocol may vary from 1to 6 months, even based on the needs of the patient.

To get back to work - office/household - 4-6 weeks time For Driving or riding - 6-8 weeks For getting back to sports - around 6 months With the advent of the science, Instrumentation and Minimally invasive arthroscopic techniques, recovery has been fasts and rehab has been quicker with less scarring.