Minimally Invasive Shoulder Surgery: What You Need to Know

In recent years, the surgical treatment of shoulder disorders has made incredible progress, and today arthroscopy is the most widely used minimally invasive solution for treating various problems, including rotator cuff and labrum lesions, bursa degeneration and shoulder instability.

We asked Professor Francesco Franceschi, a surgeon specialising in Orthopaedics and Traumatology who works in the Shoulder Centre at UPMC Salvator Mundi International Hospital, to briefly explain what arthroscopic shoulder surgery consists of and when it is indicated.

Professor Franceschi, how is arthroscopic surgery performed?

Arthroscopic surgery uses tiny incisions, about half a centimetre to a little over 1 cm long, called ‘portals’. Using a tiny camera that magnifies everything three or four times, and small instruments, the joint is accessed from different angles to perform the operation. The arthroscopic approach is the least invasive technique for shoulder repair and is particularly effective for repairing or replacing ligaments or tendons in the joint.

What are the advantages of arthroscopic shoulder surgery?

Arthroscopic surgery is a matter of precision and technique. The surgeon must understand exactly how to manipulate the arthroscopic instruments. This precision benefits the patient, since less soft tissue is damaged during arthroscopic surgery. In the past, to repair a rotator cuff or labrum tear, an incision of about 10 cm had to be made. To reach the joint, it was often necessary to first cut the tendon and then repair it, thus lengthening the recovery time. With arthroscopic surgery, on the other hand, the damage to be healed is less, leading to a much faster functional recovery.

What are the most common arthroscopic shoulder surgeries?

The two most common arthroscopic shoulder surgeries are those for repairing the tear in the labrum and rotator cuff.

The glenoid labrum

The labrum is the ring of cartilage that holds the head of the humerus in the glenoid cavity of the shoulder, allowing smooth movement of the joint. This injury generally affects young people and athletes. The advantage of an arthroscopic repair of the tear is that it allows for more movement of the shoulder. There is less scar tissue, so one can move the arm better and rotate it externally, which is especially important for athletes.

The rotator cuff

The rotator cuff is composed of muscles and four tendons that surround it. It has a dual function: it holds the upper part of the humerus in the shoulder socket and aids rotation and movement. Generally, rotator cuff tears affect middle-aged and older people because the tendons wear out with age and repetitive movements, becoming less elastic and causing pain. In other cases, the cause of the rupture may be trauma. The recovery time for arthroscopic rotator cuff repair depends on the size of the tear, usually four to six months. As with most surgeries, the best results are obtained by practising physiotherapy as part of rehabilitation.