Shoulder arthroscopy is a minimally invasive surgical procedure used to diagnose and treat shoulder problems. Using small incisions and an arthroscope, the surgeon can examine the internal structures of the shoulder joint. Common reasons for arthroscopy include biceps tendinitis, calcific tendinitis, and fractures or dislocations of the collarbone or acromioclavicular joint. Arthroscopy allows for accurate diagnosis and treatment while minimizing pain, scarring, and recovery time compared to open surgery.

1. ARHTROSCOPY OF
SHOULDER
Shoulder is a very complex joint and therefore prone to develop
problems like pain, weakness, instability or restriction of
movements. Although your shoulder surgeon can get to
diagnosis based on your symptoms, history, examination , X-ray
and various scans, in some cases he has to use arthroscopy to
determine pin point the problem and if possible at the same time
perform corrective surgery to remedy the problem.
Arthroscopy also commonly called as keyhole surgery as this is
performed though 2-4 small key hole incisions of around 5 mm
length. The surgeon uses a small telescope with a camera to
look inside the joint and video is seen on the screen in theatre.
Through the other holes specialized instruments are passed to
do the required intervention. As compared to open surgery this
procedure has several advantages. There are no big skin
incisions and less scarring. There is also no muscle cutting
involved leading to minimal pain post-operative period with a
quicker recovery. All this also reduces the incidence of overall
complication rates. Most of the patients are able to go home
same day following arthroscopic surgery.

2. Biceps Problems
• The famous Biceps tendon in front of your arm takes its
origin in the shoulder. The pathologies affecting this
tendon are one of the common cause of pain in the front of
shoulder. The inflammation an degenerations of this tendon
are called as biceps tendinitis. Ina advanced cases the
tendon is torn from the shoulder with resultant bruising
and a bulge in the mid arm causing weakness of the muscle
and pain with cosmetic deformity.
The treatment consists of rest, avoiding activities bringing
on the pain and supervised physiotherapy. An injection in
the tendon sheath also is of immense help. If all these non-
operative measures fail to give relief then surgery provides
excellent pain relief where your surgeon reattach the
tendon on the top end of your arm bone, which can be
performed arthroscopically ( key hole) or open surgery.
PHOTO- anatomical, pappoyi and injection.
Occasionally, in younger age group specially, this tendon
gets pulled off from its far attachment in front of elbow
causing pain, bruising and marked weakness in this area.
This requires very early surgery to reattach this tendon to
prevent permanent loss of function of this important
muscle.

3. Calcific Tendonitis
• One of the common and most painful condition in 30-60 age
group affecting the shoulder. This is due to intense reaction
to the build up of calcium in the shoulder muscles/ tendons
(rotator cuff). The exact cause of this calcium deposit is
unknown but repetitive micro injury to the tendon or
degeneration can be one of reasons .This calcium deposits
triggers an extremely painful response resulting in swelling
and pain. This reduces the space available in the shoulder
joint to move. This can be diagnosed on clinical examination
after taking careful history and confirmed on X-rays. The small
amount of calcium not visible on xrays. can be seen on
ultrasound scans which are very sensitive to presence of
calcium and associated damage to shoulder tendon/muscle.
PHOTOS OF CALCIUM ON XRAY.

4. Fractured around the shoulder
CLAVICLE (COLLAR BONE)
FRACTURE & AC JOINT
DISRUPTION-
• A fractured collarbone and acromio-clavicular joint (ACJ) separation
are common injuries involving all age groups who fall on the side of
their shoulder or on the outstretched hand. Historically, these injuries
were treated non surgically with slings or splints, but the long follow
up in these cases have shown compromised functions at shoulder and
persistence of pain in cases of severe displacement of clavicle fracture,
resulting shortening of clavicle bone or in case of joint disruption.
Results specially in elderly females are poor with non-operative
measures. Therefore, severe displaced fractures of clavicle, bony spike
right under skin threatening to come through the skin, soft tissue
interposition, multi fragmented fracture ( comminuted) or acromio-
clavicular joint separation should be treated with surgical repair to get
the normal anatomy back and ensuring normal function of the shoulder
joint. Injuries in this region specially sustained in high velocity
accidents canalso involve associated injuries to chest, neurovascular
structures ( subclavian artery or brachial plexus) which can be fatal.