1Rehabilitation after arthroscopy of the shoulder joint
- 1.1Causes of pain in the shoulder
- 1.2Surgical procedure
- 1.3Features of the rehabilitation period
- 1.4Exercise stress
- 1.5Advantages of arthroscopy
2Arthroscopy of the shoulder joint: minimally invasive treatment of shoulder pain
- 2.1Advantages of arthroscopy of the shoulder joint
- 2.2Readers often study together with this material:
- 2.3The editor has found for you two more interesting materials:
- 2.4Preparing for an operation
- 2.5Arthroscopy of the shoulder joint
- 2.6Complications after surgery
- 2.8LFK after arthroscopic brachial diarrhea
- 2.9Therapeutic exercises with an immobilization bandage
- 2.10Exercises for the first three weeks of the postoperative period
- 2.11LFK after removing the bandage
- 2.12Hospital sheet after surgery
3Arthroscopy of the shoulder joint
- 3.1Advantages of arthroscopy
- 3.2Indications for arthroscopy
- 3.6Cost of arthroscopy
4Restoration after arthroscopy of the shoulder joint
- 4.1Features of the recovery period
- 4.2Rules for performing therapeutic exercises
5Arthroscopy of the shoulder joint (shoulder): surgery, rehabilitation after
- 5.1What do they do with arthroscopy of the shoulder?
- 5.2Indications for
- 5.4Possible complications after arthroscopy
- 5.5How is arthroscopy of the shoulder joint performed?
- 5.6Does it hurt, and under what anesthesia do?
- 5.7Joint arthroscopy (video)
- 5.8Where do and how much does it cost?
- 5.9Rehabilitation after arthroscopy of the shoulder: how to recover?
Rehabilitation after arthroscopy of the shoulder joint
Under arthroscopy of the shoulder joint implies a modern technique of minimally invasive surgery, during which the operation is performed by means of small incisions.
It allows to carry out therapy in such a way that the lesions in the surgical site significantly decrease, and the rehabilitation time after arthroscopy of the shoulder joint is much faster.
Causes of pain in the shoulder
To the loss of efficiency of the upper extremities and to significant painful sensations result in various injuries and lesions of the joint and shoulder.
Painful syndrome in the shoulder joint occurs with damage to the bile ducts, malfunctions in the circulation and osteochondrosis.
The main methods of examination are magnetic resonance imaging and x-ray of the shoulder and joint.
The most likely prerequisites for the formation of painful sensations are:
- syndrome of the shoulder joint transmission by means of the synovial bag - bursa;
- rupture or crack inside the rotational cuff;
- arthrosis of clavic and coracoid articulations;
- defeat of tendons in the muscle tissue of the upper limb;
- unstable joint behavior of a chronic nature;
- Affected joint arthritis or arthrosis.
When the expert properly characterizes the unpleasant sensations according to the indicated symptoms, it will help to establish the diagnosis accurately and in time to prescribe effective therapy.
The main tool used in the implementation is an arthroscope - a device containing a small camera to visualize the joint and all the processes inside it on the screen in an enlarged view.
If, during unstable behavior of the joint, its loss occurs - such manipulation is considered the only way to detect the processes occurring inside the joint.
The visualization technique makes it possible to see the tissues in the joint at the incision and in fact completely the inside..
In view of this, the doctor is able to accurately detect injuries of the cartilaginous lining, lesions in the tendons and ligaments, to reveal in the joint fluid free bodies..
Arthroscopy is not only the detection and diagnosis of a dislocation, but also an effective rehabilitation technique. It is considered to be one of the most effective and harmless for patients, in fact has no adverse adverse effects.
Usually, an anesthetic is selected depending on the degree of manifestation of painful sensations, but in general, local anesthesia is used. After the onset of anesthesia, the doctor begins the surgery itself.
The whole procedure consists of the following actions: the expert makes a small longitudinal section, where the arthroscope is inserted, in connection with which visualization is possible.
Elimination of damaged tissues, if necessary, is made through a similar incision near.
By means of an arthroscope, it is possible to perform the following types of surgical intervention:
- during lesions and displacements of the ligamentous apparatus, a secondary fixation of the device is made;
- during a slippery injury and displacement, a secondary fixation is made and the cartilaginous liner is cut with further grinding;
- when the tendon or ligaments between the bone formations are pinched, truncation of the ligaments, further fixation and fusion with each other are carried out;
- when there is damage to the rotator cuff, it is initially performed by arthroscopy and visualization damaged areas, then the cuff itself can be reconstructed (truncated and re-fused with tissue joint);
- during internal displacement of composite joints, compression restoration and docking of bone formations in the joint joint bag are performed;
- when there is a fracture of the cartilage inside the cavity of the articular bag, fragments of the cartilaginous tissue hit, then they are eliminated and the sharpened parts are polished.
Features of the rehabilitation period
Final rehabilitation after arthroscopy of the shoulder joint continues for 6 months. At the preliminary stage, it is recommended to impose a bandage on the injured joint, which will fix it. In addition, a course of physiotherapy is conducted.
During the first week after surgery, cold compresses are applied to the damaged area. The finiteness is fixed by means of a detachable bandage, which is changed after a month..
In addition to the above, the patient is advised to perform non-difficult physical exercises, the main purpose of which is to stimulate blood flow and maintain the proper state of the muscles. Beginning warm-up is simple: you need to bend and unbend the brush and elbow..
Do these exercises should be before the appearance of painful sensations. Prohibited flies and jerks, external twisting of the limb.
During recovery, an important point is to competently and timely carry out LPC after arthroscopy joint, since this aspect directly determines the duration of rehabilitation period.
The process itself involves a physical load every day, carried out 4-5 times a day for 10-15 approaches.
When there is a noticeable strain on the joint, swelling or manifestation of the pain syndrome, the load should be reduced, this should be told to the doctor.
Warm-up should be carried out under the supervision of a physician and taking into account the personal characteristics of the patient. Active physical activity can begin after 2-3 months after surgery.
At this stage of rehabilitation, it is allowed to use the block simulator, apply rubber shock absorbers and gravity. A good effect can be achieved if you do exercises in the water. It is acceptable to use special platforms, rubber balls or other accessories.
Advantages of arthroscopy
The main advantages that distinguish arthroscopy from any other open surgery on the shoulder are the following criteria:
- preservation of the integrity of the joint, since only a small incision of the soft tissue is carried out;
- scars from the operation are barely visible;
- recovery at the end of the operation no more than 3 days;
- Pain after surgery is characterized by low intensity;
- the patient is able to leave the hospital on the day of the operation;
- risk of adverse consequences if all the requirements (disinfection, competent procedure with an arthroscope, etc.) are observed, approaches zero;
- the initial motor activity of the joint will return much sooner than during the open surgery.
Arthroscopy of the shoulder joint allows doctors of this specialization to increase the therapy of pathological processes of this joint to a qualitatively new level.
Its main advantage is considered the minimal probability of infection during the period of surgical intervention. Previously, to achieve the desired results, experts made an incision of not less than 15-20 cm.
In addition, this method is 100% reliable, because it makes it possible to detect all diseases of the joints during one operation.
A source: http://PosleVipiski.ru/revmatologiya/reabilitatsiya-posle-artroskopii-plechevogo-sustava.html
Arthroscopy of the shoulder joint: minimally invasive treatment of shoulder pain
Recommendations of orthopedist and rheumatologist ...
Arthroscopy of the shoulder joint
During the operation, an arthroscope is inserted under the skin, which allows the doctor to see the joint, enlarged 60 times, on the screen.
Thanks to this, surgeons are able to perform the operation associated with the smallest manipulations, while doing about three notches, the length of which is not more than one centimeter.
Advantages of arthroscopy of the shoulder joint
information for reading
Minimally invasive methods for the treatment of shoulder diarrhea diseases have long been a standard in therapy and recognized by specialists. Advantages of the technique:
- The procedure takes no more than one hour (in rare cases, a little longer).
- The tissues after the operation heal quickly, respectively, hospitalization will be short-lived: in the absence of complications, no more than four days.
- The technique is absolutely objective.
- Damage to tissues is reduced to a minimum, respectively, the scars after surgery will be virtually invisible.
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"Habitual dislocation" - indications for arthroscopy of the shoulder joint
Arthroscopy of the shoulder joint is mainly prescribed for "habitual dislocation" (recurring). The reasons for setting such a diagnosis are as follows:
- The most common cause of dislocation are injuries. Periodic injury to the joints occurs in people whose activities are associated with a rise in weight, including athletes.
- Increased flexibility of the shoulder joints can lead to rupture of ligaments.
- Improper development of the pustular fossa of the scapula increases the risk of injury; The humerus can easily pop out of the cavity.
- Bundles and capsules of the joints become brittle due to permanent stretching. Such symptoms are peculiar to swimmers.
The diagnosis is made if 2-3 dislocations were obtained during the year.
Shoulder bladder periarthritis can cause arthroscopy
The following diseases and conditions can also be an indication for the operation, but in less frequent cases:
- Shoulder bladder periarthritis is an inflammatory process of the capsule of brachial diarthrosis and tendons. The reason can be a lot of physical activity. It manifests itself in the form of numbness and pain in the hands.
- The muscle rupture in the "rotational cuff". The reason is a trauma associated with the destruction of muscle tissue. Symptoms are weakness and pain.
- When the load on the joint is too high, the ligament ruptures. Symptoms - stiffness in movement, redness, acute pain.
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- What is the plexitis of the shoulder joint, how to relieve shoulder inflammation
- Anatomy of the shoulder joint
Contraindications are divided into two types: absolute and relative. The absolute factors include: the presence of infected wounds, skin diseases that have a purulent-inflammatory process, fibrous and bone ankylosis.
If there are ligament ruptures, open wounds, traumas that disrupt the capsular tightness, then contraindications are relative.
Also contraindications are: individual intolerance of pain medications, weakened immune system, lung and cardiovascular system diseases.
Diseases of the lungs are a contraindication
Preparing for an operation
Arthroscopy is a mini-operation, to which the patient must be prepared. The following actions should be performed:
- Consultation with an orthopedist or traumatologist is underway.
- A conversation was conducted with an anesthesiologist, who will help to choose a method for anesthetizing, and also to identify contraindications.
- Made ultrasonic, magnetic resonance, X-ray studies (not appointed in all cases).
- Analyzes were made for the detection of such infections as HIV, syphilis, hepatitis, and others.
- Have on hand the result of ECG (electrocardiologic study).
- Blood was transferred to the coagulogram.
- Have the results of biochemical analysis, according to which the doctor will determine the state of metabolic and mineral metabolism, the health of the kidneys and liver.
Such preparation for the procedure will secure the patient: reduce the risk of complications, the indications for the operation will be extremely accurate.
Arthroscopy of the shoulder joint
For anesthesia during surgery, general anesthesia is used with a mask or endotracheal method.
Further, with the aid of an antiseptic solution, the place in which the operation will be performed, namely the humeral joint, will be processed..
Then the capsule of the joint is pierced and a saline solution is introduced, which promotes tissue dilution, and, accordingly, facilitates the passage of the instrument and improves visualization..
In 2-3 places with the help of the trocar, punctures are made, through which an arthroscope (camera) is introduced, allowing to see all the violations with the maximum accuracy. If necessary, additional tools are introduced into the punctures, in order to remove the affected tissue, to carry out the plastic surgery inside the joint.
Complications after surgery
Arthroscopy, like any surgical intervention, can lead to complications. Risks are reduced to a minimum level, but there are likely to be the following consequences:
- Puffiness and inflammation along the circumference of the punctures.
- Pain in the joint.
- There is bleeding from the damaged veins. This complication is very rare. The use of tools that cause minor trauma reduces the risks to almost zero.
- Violation of the neurological nature, expressed in the form of reduced sensitivity, numbness. In this case, you should immediately consult a doctor.
Rehabilitation period is a very important moment, because from a properly selected set of activities with full compliance depends on how quickly the working capacity will be restored and maintained functionality.
A bandage is applied to the puncture site, which protects against getting various infections, which should only be changed by a medical professional. During the dressing, the puncture site is treated with antiseptic agents.
Rehabilitation after arthroscopy of the shoulder joint also includes taking medications:
- In order to avoid infection, antibiotics are prescribed taking into account individual intolerance.
- Preparations that prevent inflammation.
LFK after arthroscopic brachial diarrhea
LFK (therapeutic and sports complex) is the basis of rehabilitation. Begin to perform exercises better the next day after surgery.
Therapeutic exercises with an immobilization bandage
In the first 5 days with a healthy hand, it is necessary to knead the diarthroses on the operated arm, which were not affected during the operation. Next, you can strain the shoulder joint in the least amount.
Exercises for the first three weeks of the postoperative period
One of the exercises is to squeeze fingers on the arm
- Strain the muscles for a few seconds.
- Compress fingers on the hand.
- Move the brush and flex the wrist joint.
- To set in motion the area of the shoulder girdle.
Such exercises stimulate blood circulation and do not allow the hand to become numb.
LFK after removing the bandage
Gymnastic exercises in the first days after removal of the bandage will be accompanied by pain and discomfort. But the exercise should not stop.
Exercises to perform from the fourth week of rehabilitation:
Put your hand on the wall, gently lift up, then lower
- It is necessary to bend at an angle of approximately 90 degrees, so that the hand is parallel to the legs, and to perform oscillatory movements in different directions.
- Put your hand on the wall, gently lift up, then lower it.
- Produce rotational movements of the shoulder, while the hands should lie on the shoulder joints.
In addition to these exercises, you can simulate washing or pulling up on a rope. Over time, the load on the shoulder joint increases.
Gymnastics is done at least twice a day (better - 3) for 10-15 times each reception.
Hospital sheet after surgery
After arthroscopy of the shoulder joint, a person will not be able to work for several days, regardless of the nature of the activity.
After one week, you can go to work, which is not associated with heavy physical exertion (teacher, accountant, etc.). Athletes can return to training after 4 months.
Accordingly, the time of the hospital is determined primarily by the condition of the puncture, and then - by professional activity.
Injuries to diarrtosis can worsen the person's well-being to a large extent, and their complete cure is possible surgically. Arthroscopy allows you to get rid of the disease with minimal discomfort during the operation and in a short time to return to the habitual way of life.
A source: http://SustavInfo.com/vidy/plechevoy/artroskopiya-plechevogo-sustava/
Arthroscopy of the shoulder joint
Arthroscopy of the shoulder joint is performed under the conditions of the surgical department under general or local anesthesia.
After laying the patient in a certain position, enter into the joint cavity, a percentage solution of sodium chloride in a volume of 30 to 40 ml in order to stretch the capsule and better visualize the structures.
Then a small incision is made, into which a special instrument is introduced-an arthroscope. It is a rigid tube equipped with an optical system.
The image obtained during the study is enlarged on the monitor screen. During the survey, you can not only identify pathological changes within the joint, but also carry out such operations as:
- fixation of ligaments during their separation;
- removal of nonviable tissues;
- Excision of osteophytes - marginal proliferation of bone tissue;
- extraction of chondromic bodies;
- resection of hypertrophic synovium;
- removal of adhesions.
After carrying out arthroscopy marked positive changes from the affected joint in the form of:
- reduction of pain syndrome;
- reducing the amount of effusion in the joint cavity;
- increasing the amplitude of movements in the joint.
Advantages of arthroscopy
Arthroscopy is currently an alternative to the standard operation with wide access due to the fact that it has the following qualities:
- Low traumatic and minimally invasive.
- High informativity.
- Slightly postoperative scars.
- A short period of rehabilitation.
- Ability to intervene in a short-stay hospital.
- A small percentage of postoperative complications.
Indications for arthroscopy
Arthroscopic surgery is indicated under the following conditions:
- Clarification of the diagnosis, if other methods of examination were not very informative.
- Preservation of pain syndrome after surgical interventions.
- Damage to the joint, accompanied by hemarthrosis - a hemorrhage into the cavity of the joint bag.
- Injury of the biceps tendon.
- Rheumatoid arthritis, accompanied by hypertrophy of the synovium.
- Instability of the shoulder joint (habitual dislocations or subluxations of the shoulder).
- The development of contracture - a persistent decrease in the volume of movements in the shoulder joint.
- Impigement syndrome (shoulder-scapular periarthritis) is a condition in which the muscles contract with the scapula, resulting in pain during the withdrawal and flexion of the shoulder.
Contraindications to arthroscopy are few. These include:
- inflammatory phenomena in the joint cavity of an infectious nature;
- presence of general contraindications for pain management (severe decompensated diseases of the system blood circulation and respiration, liver and kidney pathology with impaired function, allergic reactions to components of anesthesia).
The procedure of arthroscopy is characterized by a low percentage of complications. Nevertheless, it is possible that:
- bleeding from a damaged vessel during manipulation;
- Infectious inflammation;
- iatrogenic damage to joint structures.
Since the method of carrying out arthroscopy is characterized by low traumaticity, the postoperative recovery period takes no more than 6-7 days. The measures taken are aimed at achieving the following effects:
- reduction of soft tissue swelling;
- the fastest recovery of the motor function of the joint;
- maintenance of muscular strength.
The rehabilitation program after the operation begins in a hospital and then continues in an outpatient setting. The entire stage of recovery can be divided into periods:
Early postoperative- includes:
- application of an aseptic dressing;
- medicamental therapy (relief of pain and inflammatory phenomena);
- absence of any load on the joint in the first two days;
- holding classes of physical therapy - begin with the third day, is aimed at maintaining muscle tone, strengthening the musculoskeletal system, improving blood supply in the joint.
Immobilization period- is necessary for the healing of tissues and the formation of a stable scar.
The fixation of the shoulder joint in the abduction position is carried out for the next 3-4 weeks.
During this period, exercise exercises in the form of isometric gymnastics are also performed. Electromyostimulation is performed.
Period of restoration of functional statethe shoulder joint. The following rehabilitation measures are carried out:
- exercises exercise in the form of passive movements, the onset of active;
- massage courses;
- physiotherapeutic procedures;
- restriction of sports loads (up to six months).
Cost of arthroscopy
This method of diagnosis and treatment is an expensive procedure. The total cost consists of the following services:
- stay in the hospital;
- a kind of anesthesia;
- the procedure itself;
- subsequent rehabilitation;
- use of consumables during the operation.
Thus, the total cost of arthroscopy using consumables is about 45 thousand rubles and higher, depending on the volume of the operation.
A source: http://LechenieSpiny.ru/content/artroskopiya-plechevogo-sustava
Restoration after arthroscopy of the shoulder joint
Arthroscopy of the shoulder joint is a method of minimally invasive surgical intervention, in which all manipulations are performed through small incisions, and not through a large longitudinal incision. One of the advantages of such an operation is a short recovery period. With a responsible approach of the patient to rehabilitation, the number of complications is minimized.
Features of the recovery period
Rehabilitation after arthroscopy of the shoulder joint is quite a long one. Full recovery takes about 4-6 months.
In the early days, the patient needs cold compresses, and the limb is tightly fixed by applying a detachable bandage.
The period during which a bandage is to be worn is determined by the attending physician depending on the manipulations performed and the patient's condition.
When a pain syndrome occurs, the patient is allowed to use any suitable pain medication, and anti-inflammatory medications are prescribed to prevent complications.
One of the main dangers in the rehabilitation period is muscle atrophy and various stagnant phenomena.
To avoid this, you need special gymnastics, which helps strengthen the joint..
In the first 1-2 days, it is better not to bother the hand, and after that the minimum load is allowed, which should increase every day..
The first physical exertion must be under the control of the attending physician, who must explain to the patient all the rules for exercising physical therapy.
On the second day after the operation, the exercises are performed in three positions: lying on a healthy side, lying on the back and standing.
From the third day it is necessary to continue classes in the gym.
The general condition of the patient usually improves significantly at 5-6 days, and from this point on the main task is to activate the motor state of the injured limb. All exercises are aimed at improving local blood circulation and preventing the hypotrophy of shoulder muscles.
At the initial phase of physical activity, the patient performs successive active and passive movements with a healthy shoulder: this should form a specific program of actions. Gradually, the movements are transferred to the "sick" side. It is necessary to train daily.
When performing any exercises, the patient should listen carefully to his own feelings.
If the pain during or after exercise becomes too strong and does not abate, it is necessary to tell the attending physician about it.
If necessary, you have to reduce the load or pick up another set of exercises.
Rules for performing therapeutic exercises
For maximum strengthening effect in the performance of any exercise, you must adhere to certain rules. Otherwise, LFK will bring the body more harm than good.
- The patient needs systematic: to engage in exercise therapy every day, clearly adhering to all medical recommendations. Personal preferences when choosing exercises should not matter. If you feel unwell, you should try to do all possible actions, even in a sitting position.
- It is important to follow certain safety procedures. Any actions are carried out progressively. It is necessary to take into account the capabilities of the body, so as not to damage the problem joint. If it is possible, at least the first two weeks it is better to visit the exercise room of the LFK, so that the lessons are supervised by a specialist.
- Loads increase gradually, in accordance with the recommendations of specialists. Otherwise, there is a risk of irreversible damage to the joint, after which surgical intervention will be required again.
- Sharp movements and excessive loads are excluded, the shoulder should be protected. If the recommended actions exceed the capabilities of the patient, this should be told to the doctor and discard the problematic exercises.
To hurry and try to "jump above your head" is not a good idea
Of course, each patient wants to recover as soon as possible in order to quickly return to normal life. But you can not hurry. It is necessary that the muscles gain strength gradually.
Getting on with active physical activity is usually allowed 3-6 weeks after the operation, the terms are set for each patient individually.
By the time the power loads are allowed, the patient can already work with weights, rubber shock absorbers and block simulators.
Also used are rubber balls or special platforms.
Rehabilitation gymnastics can be conditionally divided into several groups:
- light actions for muscle tone;
- force active loads on the entire shoulder section;
- load with the use of additional devices.
You need to start with a warm-up for the hands, the shoulders remain motionless. Brushes perform circular movements forward and backward alternately, at least 3-5 approaches are necessary.
There are also exercises to strengthen the ligaments, known to many even from school lessons in physical education. Hands bend in the elbows and keep parallel to the floor, the blades are reduced at least 5-7 times. After the joint is kneaded by means of circular motions.
Force loads consist of exercises with an expander or dumbbells. During the first exercises you only need to take the lightest dumbbells or weights. Such actions will help not only to strengthen the damaged ligaments, but also to build muscle mass..
One of the most used simulators is a gymnastic stick. The following exercise is recommended: hands are pulled up, the stick is installed parallel to the floor. With slow movements, it moves to the right and left, which allows you to tap into virtually all muscle groups of the joint..
During the first days after surgery, any activities will bring some discomfort to the patient.
Painful sensations after activity are amplified, and aching pain is absolutely normal.
But if you can not tolerate it, it is better to stop the exercises immediately and provide the patient with peace and a cold compress.
A source: http://diametod.ru/endoskopiya/vosstanovlenie-posle-artroskopii-plechevogo-sustava
Arthroscopy of the shoulder joint (shoulder): surgery, rehabilitation after
Arthroscopy is performed in two cases: when a joint diagnosis is required, or when its operative treatment is required. The procedure is carried out in public medical institutions and private clinics.
The operation is performed using an endoscopic device - an arthroscope. With the help of it, you can treat not only joint diseases, but also a ligament apparatus. The procedure has the chances of postoperative complications: therefore, correct rehabilitation is extremely important. Half of the success of the entire treatment depends on it.
What do they do with arthroscopy of the shoulder?
As mentioned above, the procedure is used to diagnose various joint diseases, and to treat its pathologies. Including it can be used in the treatment of the shoulder joint (right and left, it does not matter).
Therapeutic arthroscopy is good because it is a minimally invasive technique. That is, during its carrying out minimal damage to tissues. This increases the success of treatment, reduces the likelihood of postoperative complications, and the operated tissues are restored much faster.
Most often arthroscopy of the shoulder is performed with various traumatic injuries, less often with congenital defects and abnormalities of the structure of the shoulder joint. But in the diagnosis of such defects, the procedure is often used, especially when MRI or CT does not give a complete picture of the pathology.
The procedure can be carried out for almost any joint in the human body. However, in most cases, the hip, knee, shoulder and elbow joints are operated. The effectiveness of the method directly depends on where the pathology is localized.
Thanks to arthroscopy, you can cure more than a dozen different shoulder diseases.
Including, it is possible to treat not only the joints, but also muscles with tendon tendons.
During the procedure, they can connect the muscles and tendons at the site of the rupture, stabilize the joint, and remove the bony tumors.
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Arthroscopy of shoulder joints is prescribed in a dozen diseases of cartilage and bone tissue, as well as diseases of the muscles and tendons. Often, it helps to treat the instability of the joint after sports injuries.
Arthroscopy of the shoulder joint
List of readings:
- Osteoarthritis of the clavicle-acromial joint, various degenerative-dystrophic pathologies.
- Subacromial impingment.
- Capsule (it is also a "frozen shoulder").
- Gaps and injuries of the rotator cuff.
- Prolonged flowing tendonitis.
- Various damages of the tendons (including their ruptures), rupture of the tendon cuff of the long bicep head.
- Instability in the shoulder joint.
- Habitual dislocation (chronic destabilization of the shoulder joint).
Also, arthroscopy can be used to diagnose the described diseases (although for the most part they can be detected using magnetic resonance imaging or computed tomography).
The procedure is often used in degenerative-dystrophic pathologies of shoulder joints. Such pathologies can be several dozen, and some of them arise for unknown reasons (that is, without previous injuries or obvious predispositions).
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Arthroscopy is considered a safe procedure, with a mildly ongoing rehabilitation period. However, even such safe methods have contraindications.
Absolute contraindications are:
- Infected wound at the site of the intervention.
- General (systemic) infectious processes.
- Purulent lesions and pronounced inflammatory processes in the tissues of the operated joint (due to the threat of infection into the joint).
- Bone or fibrotic ankylosis. These are pathologies in which the joint slit is closed with a bone or connective tissue. Due to ankylosis, complete immobilization of the affected joint develops.
- General exhaustion of the patient, severe fever, general weakness, malaise, cachexia.
Healthy and damaged shoulder
- excessive damage with rupture of ligamentous apparatus or joint capsule with or without loss of tightness damaged joint - due to the inability to normally stretch the joint cavity for its subsequent visualization.
- massive hemorrhages in the operated joint, prolonged moderate bleeding - due to the inability to drain blood that will interfere with intra-articular structures.
The contraindications described are relevant for both diagnostic and therapeutic arthroscopy in relation to any group of joints.
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Possible complications after arthroscopy
Despite the safety, in relatively rare cases, the operation can end in serious consequences for the health of the patient. Fortunately, most of the complications can be noticed and stopped within a couple of days, or immediately "in place."
Possible complications of shoulder arthroscopy:
- Damage to vascular branches (arteries or veins) or nerve nodes. Complication has a probability of development of less than 1%, it happens extremely rarely.
- Neurological complications, including paresthesia (numbness) of the skin areas. Usually they result from unsuccessful anesthesia with damage to the subcutaneous nerve nodes. The situation is frequent, but usually temporary, passes by itself, and does not always require treatment.
- Stretching or damage to tendon ligaments, muscles and other tissues surrounding the shoulder joint. A relatively rare complication, usually healed within a couple of weeks.
- Very rarely at the end of surgery, the surgeon forgets to remove from the wound cavity any instrument, gauze turunda or other medical accessories. Sometimes the wound is broken by fragments of a broken instrument during the operation.
- Possible thrombophlebitis of the arteries or veins that run around the shoulder joint.
- Possible postoperative infectious arthritis, occurring in,% of cases.
- It is rare (no more,%) to develop hemarthrosis with a massive and painful hemorrhage in the operated joint.
- Very rarely develops algodystrophic syndrome in the form of pain and immobilization of the operated joint. Usually successfully treated, but very long (recovery can last longer than a year).
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How is arthroscopy of the shoulder joint performed?
Step by step the process looks like this:
- The procedure begins with the patient being placed on the operating table so that it is easiest for the surgeon to gain access to the affected joint. Usually the patient is laid on a healthy side, the arm with the affected shoulder is pulled upwards and extends it by means of a suspended load system.
- Make a puncture: a needle is injected into the joint and a physiological saline solution is injected through the syringe. Do this so that the cavity stretches as far as possible: without this, the arthroscope will not work (except that with damage to the cartilage).
- On the skin, a small incision is made through which the articular cavity is pierced with a trocar.
- The doctor enters an arthroscope and performs a primary examination of the cavity of the damaged joint.
- To improve visibility, additional physiological saline is added.
- If necessary, the doctor makes additional punctures, both at the beginning of the operation, and throughout its entire length. Through them, not only physiological solution is added to flush the joint cavity, but also various surgical instruments. The patient at this stage may feel slight discomfort due to mechanical manipulations with the joint, but no more (the shoulder does not hurt).
Sewing tissues during arthroscopy of the shoulder
After the procedure, a disinfectant dressing is applied to the operated area, and the necessary (depending on the situation) medicines are prescribed.
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Does it hurt, and under what anesthesia do?
Usually arthroscopy of the shoulder joint is performed under general anesthesia. Used mask or endotracheal anesthesia. Such species are quite safe, completely deprive the patient of pain, and relatively rarely give side effects.
Less commonly, local anesthesia is used, but even with her, the patient does not feel pain. Pain and swelling may appear after surgery. Such side effects are stopped by medication.
What anesthetic is used for local anesthesia depends on the disease that needs to be treated. Sometimes combinations of anesthetic pair are used.
Local anesthesia involves carrying out multiple injections of anesthetics around the affected shoulder, possibly intra-articular injection of an analgesic.
However, local anesthesia is rarely used in this operation: although the patient does not experience pain under this influence, he can feel discomfort.
It is also very rare to perform spinal anesthesia with the administration of an anesthetic in the spinal canal. Anesthesia in this case is achieved at the level of the spinal cord: the patient does not feel even uncomfortable sensations during the operation.
The problem is only in the consequences of such anesthesia - spinal anesthesia, although rare, but can give quite serious complications.
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Joint arthroscopy (video)
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Where do and how much does it cost?
The operation is performed only in large state hospitals, or in large private clinics. How much does the procedure cost? It depends on the health facility and the region.
Sometimes arthroscopy is free of charge if the patient has a quota. The problem is that in this case you will have to wait for the operation in the order of the queue. And the queue can be delayed for many months.
The cost of paid shoulder arthroscopy in public medical institutions is on average 2, 00 rubles. In private clinics, the cost is higher: from 35-40 thousand.
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Rehabilitation after arthroscopy of the shoulder: how to recover?
Restoration after arthroscopy is a very important stage, from which the effectiveness of the procedure often depends.
If rehabilitation is not performed correctly, then various complications are possible.
Most often the operated shoulder simply heals very long, and the patient can experience pain or discomfort.
Wounds after shoulder arthroscopy
In order to avoid such problems, the postoperative period must be carried out with full and unconditional compliance with the doctor's recommendations.
The recovery phase may include such techniques:
- For the first time the patient completely limits the movements of the operated shoulder: it can not be loaded even minimally.
- Gradually begin to prescribe physical exercises within the LFK (therapeutic and sports complex).
- Various physiotherapeutic procedures are prescribed (except for thermal ones - they can provoke inflammation), massage (only not manual).
- At first, it is possible to wear various orthopedic products that immobilize an operated shoulder.
Rehabilitation can be quite long, and take up to six months.
After undergoing rehabilitation, the patient should gradually increase the load on the joint. In the first 2-3 years after the operation, you will need to visit a doctor to examine your shoulder (even if there are no complications: just for prevention). This is recommended every several months.
A source: http://osankino.ru/operacii/artroskopiya-plechevogo-sustava.html