Shoulder Arthroscopy: A Patient's Guide to Keyhole Surgery

Shoulder arthroscopy has transformed how we treat almost every condition inside the shoulder joint. Through two or three portals the size of a small buttonhole, a high-definition camera and precision instruments give us a clearer view and gentler treatment than was possible with open surgery thirty years ago. This article explains which conditions are treated arthroscopically, what each operation involves, and what the recovery looks like.

What can be done through a keyhole?

The list of modern arthroscopic shoulder operations is long. The common ones are:

• Rotator cuff repair — suture anchors reattach the torn tendon to the bone
• Subacromial decompression — removing a bony spur that pinches the cuff (now used more selectively than before)
• Bankart repair for shoulder instability
• SLAP repair for tears of the upper labrum, particularly in overhead athletes
• Biceps tenotomy or tenodesis for biceps tendon pain
• Capsular release for stubborn frozen shoulder
• AC joint resection for arthritis of the AC joint
• Loose body removal

What the operation looks like

Almost all shoulder arthroscopies are performed under general anaesthesia, often combined with an interscalene block — a nerve block that numbs the shoulder for 12–18 hours, dramatically reducing pain on emergence. The patient is positioned either beach-chair or lateral. Two or three small portals are made and the joint is filled with saline for a clear view. The pathology is then addressed under direct vision. Most operations are day-care procedures.

Recovery — depends on the operation

Recovery depends entirely on what was done inside the joint:

Subacromial decompression alone

Sling for comfort, full range of motion immediately, return to office work in 1–2 weeks, return to overhead activity at 6–8 weeks. The least demanding shoulder arthroscopy.

Rotator cuff repair

Sling for 4–6 weeks to protect the repair. Gentle passive movement from day 1. Active movement from week 6. Strengthening from week 12. Return to overhead sport at 4–6 months.

Bankart or SLAP repair

Sling for 4–6 weeks. Progressive rehabilitation. Return to contact or overhead sport at 4–6 months.

Capsular release for frozen shoulder

Sling for comfort only. Aggressive physiotherapy from day 1 to maintain the released range.

Risks

Shoulder arthroscopy is safe in experienced hands. Reported complication rates are low — infection well under 1%, nerve injury under 1% (and usually transient, related to nerve block or positioning), stiffness more common in the early weeks but usually resolving with rehab.

The role of physiotherapy

Most shoulder outcomes are determined as much by the physiotherapy as by the operation. A well-trained shoulder physiotherapist who understands surgical protocols is invaluable. We refer to therapists familiar with each specific operation and provide written protocols.

When arthroscopy is not the right answer

Some shoulder problems are not arthroscopic problems. End-stage arthritis needs shoulder replacement, not arthroscopy. Massive irreparable rotator cuff tears may need reverse shoulder replacement. Some instability with significant bone loss is better addressed with a Latarjet procedure than a Bankart repair. The right operation for the right problem is the foundation of good surgical care.