Shoulder Arthroscopy

Shoulder arthroscopy is a minimally invasive surgery using a small camera (arthroscope) and narrow instruments through small incisions ("portals") to diagnose and treat problems inside and around the shoulder joint.⁶

Indications

Main reasons this surgery is recommended:

• Persistent shoulder pain or loss of function despite appropriate non-surgical care (activity modification, medications, injections, physical therapy).⁶
• Rotator cuff tear needing repair or debridement.
• Labral tear and instability (recurrent dislocations/subluxations) needing stabilization.
• Biceps tendon pain/tearing (tenotomy or tenodesis).
• Subacromial bursitis/impingement, acromioclavicular (AC) arthritis, or calcific tendinitis requiring arthroscopic treatment.
• Adhesive capsulitis (frozen shoulder) requiring capsular release after prolonged nonoperative failure.

Common reasons to delay or avoid surgery:

• Absolute: active infection (skin, joint, dental, urinary, or systemic).
• Relative: poor medical optimization (uncontrolled diabetes, severe cardiopulmonary disease), active nicotine use, or inability to participate in rehabilitation.

Benefits and alternatives

Benefits:

• Smaller incisions, typically less soft-tissue disruption than open surgery.⁶
• Pain reduction and improved function when the underlying diagnosis is addressed.
• Ability to treat multiple problems during one procedure (for example: cuff tear plus biceps pathology).

Alternatives:

• Physical therapy focused on rotator cuff/scapular strengthening and motion.
• Anti-inflammatory strategies (topical or oral NSAIDs if safe), acetaminophen.
• Corticosteroid injection (subacromial or glenohumeral) for selected conditions.
• Activity modification, ergonomics, and gradual return-to-sport program.
• Other surgery (open repair, tendon transfer, arthroplasty) when arthroscopy is unlikely to succeed (large irreparable tears, advanced arthritis, major bone loss instability).

Surgical procedure

• The surgeon inserts an arthroscope and inspects the cartilage, labrum, rotator cuff, biceps tendon, and joint lining.
• Saline fluid is used to improve visualization and control bleeding.
• Common treatments include debridement (cleaning frayed tissue), bursectomy, bone spur removal, cuff repair, labral repair, biceps tenotomy/tenodesis, distal clavicle excision, and capsular release.
• Repairs typically use suture anchors placed into bone to reattach tendon or labrum.
• Portals are closed with small sutures or skin adhesive; a dressing is applied.

Key variants: arthroscopy may be diagnostic only, debridement only (faster recovery), or include tissue repair (slower recovery and longer protection).

Implant or graft specifics and MRI considerations

• Many shoulder arthroscopies use no permanent implant. When repairs are done, suture anchors and sutures are commonly used.
• Anchor types vary (metal, PEEK, or bioabsorbable/biocomposite); removal is uncommon and usually only for complications (infection, prominent hardware, failure).
• Most modern anchors are MRI-conditional; MRI is usually possible but may create image artifact near the shoulder. Inform radiology that you have shoulder implants.
• Metal detectors may occasionally alarm depending on implant type and sensitivity.

Typical anesthesia

• Most commonly general anesthesia, often combined with a regional nerve block (interscalene or similar) for early pain control.
• Nerve block effects can include temporary arm numbness/weakness; some patients have temporary hoarseness or shortness of breath.
• Most cases are outpatient; some patients may stay overnight based on pain control, medical risk, or the specific procedure.

Recovery timeline

Recovery depends on what is performed. Debridement/decompression typically progresses faster than cuff/labral repair.

Risks and complications

Common:

• Pain, swelling, bruising, and temporary stiffness.
• Temporary numbness/weakness (especially if a nerve block is used).

Less common:

• Infection (rare; risk is procedure- and patient-dependent). Modern series for arthroscopic rotator cuff repair report very low infection rates (for example ~0.11% in one large cohort).³
• Re-tear or incomplete healing after tendon repair.
• Persistent pain from arthritis or tendon degeneration not fully correctable by arthroscopy.

Rare but serious:

• Blood clot (DVT/PE). Symptomatic VTE rates are low overall (about 0.21% across shoulder arthroscopy; higher in rotator cuff repair cohorts in some studies).²
• Nerve or blood vessel injury, fracture, major stiffness requiring additional intervention.

Patient-specific risk modifiers:

• Higher risk with nicotine use, poorly controlled diabetes, obesity, immunosuppression, prior surgery, prolonged immobilization, and history of blood clots.

Durability and revision risk

• There is no single "years it lasts" number because shoulder arthroscopy is a technique used for different diagnoses.
• Short-term safety: in a large population study, the overall 90-day complication rate (including reoperation) was about 1.23%, and the 1-year reoperation rate was about 3.8% (procedure-dependent).¹
• Rotator cuff repair: long-term imaging re-tear rates vary widely by tear size, tissue quality, and age (reported 9.5% to 63.2% in studies with 10-18 years follow-up). Revision surgery rates at 10+ years were reported in the range of 3.8% to 15.4% across included studies.⁴
• Instability (arthroscopic Bankart repair): recurrence risk varies by bone loss, Hill-Sachs engagement, and anchor number. Recent series report recurrence around 9%-10% in some cohorts, while older long-term systematic reviews reported higher recurrence (around 31%) and revision around 17% at 10 years.⁵
• Common reasons for repeat surgery: re-tear or failed healing, recurrent instability, stiffness, infection, or progression of arthritis.

Practical instructions

• Pain control: use a multimodal plan (ice, acetaminophen, NSAID if safe, and limited opioid only as needed). Do not mix opioids with alcohol or sedatives.
• Constipation prevention if using opioids: hydration, fiber, stool softener, and an osmotic laxative if needed.
• Wound care: keep dressings clean and dry; follow surgeon instructions for showering; avoid soaking (pool/ocean/bath) until cleared.
• Sling: wear exactly as prescribed (repairs require protection to allow healing).
• Activity: no lifting, pushing, or pulling until cleared; avoid sudden reaching or overhead motion early.
• Driving: only when off opioids, alert, and able to control the wheel safely (often 1-2 weeks for debridement, longer for repairs and if the operated arm is dominant).
• Return to work (typical ranges): desk work 3-10 days (debridement) or 2-6 weeks (repairs); manual labor commonly 3-6+ months (repairs).
• Travel/flying: walk every 1-2 hours on long trips, hydrate, and do ankle pumps; follow your surgeon guidance on clot prevention based on your risk profile.
• Red flags (urgent): fever with increasing shoulder pain, worsening redness or drainage, chest pain/shortness of breath, new calf swelling/pain, sudden loss of arm/hand function, or uncontrolled pain.

FAQ

1. How much pain is normal? Highest in the first 2-3 days; improves over 1-2 weeks. Repairs remain sore longer.
2. When can I shower? Usually after 24-72 hours if permitted by your dressing; do not soak until cleared.
3. Why is my arm numb or weak? Often from a nerve block; typically resolves within 12-24 hours (sometimes longer).
4. When can I drive? When off opioids and you can safely control the vehicle; timing depends on repair vs debridement.
5. Do I need PT? Most patients do; repairs usually start with passive motion, then progress to strengthening.
6. Will an MRI be possible later? Usually yes; tell radiology about anchors/implants.
7. What are infection signs? Increasing redness, warmth, drainage, fever, or worsening pain.
8. What are clot warning signs? Calf swelling/pain, chest pain, shortness of breath.

Disclaimer: This handout is educational and not individualized medical advice. Follow your surgeon's specific instructions and rehabilitation protocol.

Bibliography

1. Rees JL, et al. Serious adverse event rates and reoperation after arthroscopic shoulder surgery: population-based cohort study. BMJ. 2022;378:e069901.
2. Triplet JJ, Everding NG, Dines JS, et al. Venothromboembolism following shoulder arthroscopy: a systematic review. Arthrosc Sports Med Rehabil. 2022;4(5):e1779-e1788.
3. Singh H, Isak I, Cregar WM, et al. Retrospective analysis of patients undergoing arthroscopic rotator cuff repair at a single institution yields a 0.11% postoperative infection rate. Arthrosc Sports Med Rehabil. 2021;3(6):e1989-e1995.
4. Davey MS, et al. Arthroscopic rotator cuff repair results in improved clinical outcomes and low revision rates at 10-year follow-up: a systematic review. Arthroscopy. 2023;39(1):e1-e12.
5. Asiri FAM, Alqhtani AA, Assiri AHA, et al. Systematic review of arthroscopic Bankart repair outcomes for anterior shoulder instability. Med Sci Monit. 2024;30:e945942.
6. American Academy of Orthopaedic Surgeons. Shoulder arthroscopy. OrthoInfo. Updated periodically.
7. American Academy of Orthopaedic Surgeons. Management of rotator cuff injuries: evidence-based clinical practice guideline. AAOS; 2025.
8. Li T, et al. Venous thromboembolism after arthroscopic shoulder surgery: a systematic review. J Orthop Surg Res. 2023;18:115.
9. Mercurio M, et al. Revision surgery for shoulder infection after arthroscopic rotator cuff repair: a systematic review. J Shoulder Elbow Surg. 2024;33(8):e381-e392.
10. Leroux T, et al. A systematic review and meta-analysis comparing clinical outcomes after long head of biceps tenodesis versus tenotomy. Sports Health. 2015;7(3):251-257.