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" means to "view a joint" derived from the Greek words "arthro-" is joint and "scope" is instrument for viewing. Arthroscopy can be done on most of the joints, including the shoulder, hip, knee, ankle, foot and wrist.
The arthroscope is an instrument which contains fibre optic elements which carry light into the joint and
the image back to the scope.
The small holes made through the skin to enter the joint with the arthroscope and instruments are called "portals measuring 3-5 mm
A new portal and a scar from a previous
operation can be seen
A cannula is inserted through the skin portal
The camera is attached to the cannula
The inside of the shoulder can be viewed
on the monitor- note the needle in the joint
Here the surgical instrument in the
joint is viewed by the surgeon on the
monitor
Using the arthroscope many different operations can be done in the joint:
The surgeons view the inside of the shoulder joint on the monitor overhead
and the instruments are passed through small holes in the skin through which
the repair work can be done
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.
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.
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.