Shoulder Surgery can be performed either via open incisions or
through an arthroscope.
At the Cape Shoulder Institute, arthroscopic surgery, being a minimally invasive diagnostic and treatment procedure utilising a small, lighted, optic tube, is performed regularly. Many procedures can be carried out utilising this technique, some of which may be undertaken in the consulting rooms using local anaesthesia, most often under ultrasound control. This method thus avoids the need for admission to hospital.
Arthroscopic Surgery
Arthroscopy or "key-hole" surgery is a method of performing operations through very small incisions. Specialised instruments are required to perform these operations during which the surgeon views the procedure on a large TV screen.
Although many operations can be carried out using this type of surgery, there are certain circumstances when it will not be possible. In those instances, an operation will need to be performed utilising the more conventional method of "open" incisions. Sometimes where, an arthroscopy is first performed to confirm the diagnosis and it would appear that an open procedure is required, it is then possible to immediately continue with the required operation.
Arthroscopy has been made possible through fibre-optic technology whereby a camera and light source mounted onto the arthroscope, are utilised to visualise the inside of a joint. The image is seen on a television screen.
During this procedure cold fluid is pumped into the joint to inflate it and allow improved observation. The cold temperature also reduces bleeding which would hamper good viewing. When a procedure is being performed, numerous very small incisions, called "portals" and measuring 3 – 5 mm are required. The number and position of these portals vary and they often heal with minimal scarring.
At the end of a procedure, the fluid may leak out into the tissues causing some swelling. This usually settles down very quickly and in most cases early movements can begin as no muscles have been cut in order to perform this surgery (in “open” operations, the healing of cut muscle determines when free movements can begin. This has a much longer time frame).
Arthroscopic surgery is a well established technique in which advances are continually being made. This minimally invasive surgery allows less discomfort and a substantially quicker recovery period.
Dr de Beer has contributed to several advances in arthroscopic techniques, some of which are:
- resurfacing of osteo-arthritic shoulder joints arthroscopically with biological material thus
often avoiding the need for conventional joint replacement.
- stronger fixation of rotator cuff tears enabling patients to mobilize their arms earlier and
more safely.
- making arthroscopic excision of the acrommio-clavicular joint even less invasive than before.
Open Surgery
Some operations can only be carried out through "open" incisions as it is not possible to perform them arthroscopically. Examples of such operations are a shoulder replacement or the Latarjet stabilization operation. Every effort is made to reduce the scarring. Achieving maximum function with minimal pain is the aim of surgery.
Open operations include:
- Joint replacement
- Tendon transfers
- Stabilization procedures where there is bone loss
- Rotator cuff repairs
- Treatment of fractures
See list of Surgical Procedures Performed.