Elbow arthroscopy: indications, preparation, rehabilitation
Shoulder arthroscopy is a diagnostic survey method and method of surgical intervention for the treatment of several pathologies inside the shoulder. This technique belongs to the category of minimally invasive. This means that while there is no full disclosure of the joint, and manipulation is done through 2 small holes. Such interference has a distinct advantage over conventional surgery because it allows to significantly reduce the rehabilitation period.
Arthroscopic intervention is carried out not only at the shoulder joint. The most common type of arthroscopy is the restoration of the ligaments and menisci of the knee joint. Then, according to statistics, «is» a shoulder and then ankle, elbow, wrist and hip, and joints of the spine.
Shoulder arthroscopy is the «gold standard» surgical intervention in the joint. For this procedure, both therapeutic and diagnostic, is used the following types of medical instruments:
- arthroscopy – varieties of rigid endoscopic instrument that allows the doctor to visually examine a joint cavity under different angles (0-70°), with the conclusion of the illuminated image on the screen of the computer monitor;
- arthroscopic probes – metal device for moving apart and «palpation» of intra-articular structures;
- the trocar is a three – edged needle pipe (Ø 10-20 mm) to penetrate the cavity and the introduction of the arthroscope and other instruments;
- cannula metal tube for insertion or removal of the articular cavity fluids.
The first doctor who proposed the technique of arthroscopy, was a Danish surgeon S. Nordentoft, and 7 years later, in 1919, Japanese K. Takagi spent the first arthroscopic diagnosis. The main «legislators» are considered modern astrologie M. Watanabe and H. Shahriari, who invented the prototype of the modern arthroscope. In the USSR the first arthroscopic surgery was performed in 1986.
The procedure shoulder arthroscopy is performed in the following order:
- Patient as comfortably placed on the surgery table and fix the limb.
- Performed local anaesthesia or immersed in a medicated sleep.
- Perform 2 mini-puncture and required surgical or diagnostic manipulations.
- The procedure itself can take from 1 to 3 hours.
After the procedure the joint immobilized, and the patient is transferred from operating room to the General ward, and, in most cases, after 3-4 hours will be discharged home. However, in complex cases the patient may offer hospitalization for 2-3 days.
Preparing for manipulation
Arthroscopy of the shoulder joint requires the patient to some training. First and foremost, you will need to be tested. In most cases it is the General analysis of blood and urine. In addition, the podiatrist may ask you to perform a «fresh» x-ray the joint and to undergo electrocardiography.
The choice of type of anesthesia that will be applied during diagnosis or surgery, be the responsibility of the attending specialist. Despite the fact that such manipulation is safer performed under local anesthesia, in most cases, when a prompt surgical intervention, General anesthesia is used because it allows the doctor to focus on the manipulation and not to think about «time corridor» of local anesthesia.
If you choose General anesthesia, the patient will need to undergo a consultation interview with the anesthesiologist who will be giving the anesthesia. In such cases, the doctor will warn that the last meal should be the evening of the day prior to arthroscopy.
Even in the case of arthroscopic surgery under local anesthesia, the patient needs to care about how he will get home. At the shoulder joint will wear a special fixing bandage, which will make it impossible to control a car.
Indications and contraindications for arthroscopy of the articular cavity of the shoulder
To perform a shoulder arthroscopy can offer in the following cases:
- primary diagnosis of pathology or the need for diagnosis;
- strong pain in the shoulder after surgery;
- performance evaluation and control of the course of treatment after surgery;
- pathology and injuries (tear, rupture) to the ligaments and/or tendons;
- fibromatosis (contracture) or stiffness of the joint;
- «pseudoparalytic shoulder» – capsulitis;
- syndrome «clicky shoulder» – SLAP-syndrome;
- cervical degenerative disc disease, accompanied by lesion of the rotator cuff;
- damage to the glenoid lip;
- habitual dislocation (instability) of the shoulder and dislocation of the clavicle;
- bursitis, including the necessity of removing the joint capsule;
- hypertrophy of the synovial membranes of the joint;
- the growth of bone tissue;
- osteosynthesis of fractures of the apophysis of the scapula;
- hemorrhage into the joint cavity;
- lime deposits in tendinte;
- the presence in the synovial fluid of free chondromatosis tel.
Contraindications to arthroscopy of the shoulder include severe pathology of the liver, kidneys, cardiovascular and pulmonary systems, infectious inflammation of the shoulder joint, and in some cases – the inability to perform General anesthesia.
Rehabilitation after the procedure, arthroscopy
After arthroscopy in the shoulder joint there is a restriction of movement. Especially its anatomical structure and biomechanics of the movements make the subsequent rehabilitation period the most difficult of all rehabilitation performed after the arthroscopy in other joints.
The time that will be spent on the restoration of motor function of the shoulder in full, individually. It depends on the «diligence» of the patient and his initial medical condition. A podiatrist working together with other people in advance make training and rehabilitation plan, which may be included: massage, biopuncture, physiotherapy, dosed therapy with the use of the tire and muscle stimulators, a complex of medical gymnastics.
In conclusion, it should be clarified that the result of treatment of pathologies of the shoulder in the first place, will depend on the choice of the clinic where you will be arthroscopy. Despite all the «low-impact» arthroscopic manipulation, these proceedings relate to complex, require experience and skill of the orthopedist, and the availability of modern equipment.