A detached arthroscopic lens within the shoulder joint: a case report

Shoulder arthroscopy has become a common procedure in today’s orthopedic practice. The safety of this procedure has been well established, but there are some complications associated with every surgical procedure both minor and major. In the present era, with advanced arthroscopic instruments, it is rare to encounter the problem of instrument breakage during arthroscopic surgery. Here, we report an unusual case in which we found a detached arthroscopic lens within the shoulder joint. A 58-year-old male patient who was previously operated for shoulder arthroscopy for the treatment of impingement syndrome combined with shoulder stiffness. We performed shoulder arthroscopy again and removed the detached lens arthroscopically. This case warrants the need for the surgeon and the operating room staff to be well acquainted with the arthroscopic instruments and to check the instruments properly before and after the completion of the procedure. If the operating room staff would have identified the damage to the scope, encountered during the primary operation, we could have avoided the second procedure to remove the lens.     

Editorial Commentary: Hip Arthroscopy—A Microcosm in the Evolution of Arthroscopy in Sports Medicine

Hip arthroscopy represents a microcosm in the evolution of arthroscopy within sports medicine. It has evolved right before our eyes over a condensed time frame with current-day techniques in arthroscopy and concepts in sports medicine. Early on, arthroscopy identified labral tears and other painful problems that had previously gone unrecognized and untreated because open procedures were rarely performed for these poorly defined conditions. The evolution of hip arthroscopy changed when femoroacetabular impingement was described and open surgical procedures were used for treatment. Open procedures for the hip, like the knee and shoulder before it, then evolved to less invasive arthroscopic methods. Techniques, technology, and understanding of hip disorders have all evolved simultaneously, resulting in a quickly changing landscape in the role of arthroscopy. And an improved focus has been gained on disorders other than femoroacetabular impingement that can lead to hip problems. This evolution is not novel because we have seen it in other joints, as well as among other general surgical procedures; most important, this evolution is not complete. Miles to go before we sleep.     

Outpatient shoulder surgery: a prospective analysis of a perioperative protocol

During a 10-month period, 106 consecutive outpatient shoulder procedures were done in 102 patients who were followed up prospectively for a minimum of 6 months. The procedures included arthroscopic surgery alone (60%) and open surgeries with or without associated arthroscopy (40%). The anesthetic protocol included propofol and nitrous oxide, without scalene block augmentation, and local 0.5% bupivacaine. Patients were discharged with oral analgesics. Ninety-five percent of the patients successfully underwent their procedure as an outpatient; only 5% required admission on the day of surgery, and none required readmission. There were no short- or long-term postoperative complications attributable to the protocol. Ninety-six percent of the patients were satisfied with their pain management, and all patients were satisfied with their overall experience.     

Arthroscopy of the shoulder joint.

Arthroscopy is without doubt the most comprehensive procedure for shoulder lesions, providing even better inspection of the interior of the joint than conventional open procedures. In 174 diagnostic arthroscopies, it proved more reliable than the computed tomography scan, ultrasound, or arthrography. The results of ultrasonography proved disappointing despite the enthusiastic reports on this technique, probably due to imperfections of equipment and lack of expertise rather than any inherent defect in the method. Arthrography seems to have a high incidence of false results. Though an invasive method requiring anesthesia, arthroscopy offers many diagnostic advantages such as an assessment of the role of the long biceps tendon and glenohumeral ligaments in recurrent or ordinary dislocation and the recognition of rotator cuff lesions not detectable at arthrography. It is also possible to assess the nature of shoulder instability and so to plan the appropriate operative procedure. A major advantage of arthroscopy is the possibility of carrying out treatment in the same session, though many of the suggested procedures are very demanding in terms of technical skill and time; the complication rate is often excessive. It is therefore best to restrict operative arthroscopy to simpler procedures such as irrigation in joint infections, the trimming of infolded flaps of labrum or stubs of biceps tendon, and the removal of loose bodies, where results are excellent. Arthroscopic repair of the rotator cuff or stapling of the labrum are more questionable regarding successes, complications, and recurrence. The equipment for arthroscopic operations needs improvement. Perhaps the major advantage of arthroscopic diagnosis is that it directs open procedures to the essential, thus minimizing operative trauma.     

Shoulder arthroscopy in degenerative and inflammatory diseases]

A new concept of shoulder arthroscopy is presented based on experience with 800 shoulder arthroscopies. All open surgical procedure on the shoulder are preceded by arthroscopy. The procedure is performed with the patient lying on his or her side. The medium is CO2, and the advantages are less bleeding, a natural picture, no fluid edema. After diagnostic arthroscopy (with CO2), operative arthroscopy (with fluid) or open joint surgery follows. The surgery can easily be performed in the same position for good access with any approach. Preliminary diagnostic arthroscopy helps to plan the procedure (approach, additional surgery). Minimal exposure is beneficial for faster rehabilitation.     

Pain‐related unscheduled contact with healthcare services after outpatient surgery

This prospective, observational study explored the need for pain‐related unscheduled contact with healthcare services after outpatient surgery. We hypothesised that 10% of outpatients would have pain‐related unscheduled contact with healthcare services, and that the incidence would differ depending on the type of surgical procedure. In total, 905 patients who had undergone one of five common outpatient surgical procedures (knee or shoulder arthroscopy, surgical correction of hallux valgus, laparoscopic cholecystectomy or laparoscopic gynaecological procedures) completed an electronic questionnaire one week and eight weeks after surgery. Data from 732 patients (81%) were available for analysis. Within the first eight weeks after surgery, 150 patients (20.5%) had made unscheduled contact with healthcare professionals, in 247 cases due to pain that was most frequent in the first postoperative week. Risk factors were female sex, unemployment and laparoscopic cholecystectomy. The most frequent healthcare contact was with the general practitioner (46.4%), and the most frequent outcome was further information and guidance (41.2%). We have demonstrated that a minority of patients still needed to make contact with health services after outpatient surgery, most often due to inadequate pain management. This finding should be considered when planning postoperative monitoring and care, and developing postoperative patient education.     

Interscalene plexus block for arthroscopy of the hurnero-scapular joint

Interscalene plexus block was performed in nine patients subjected to shoulder arthroscopy. The operating conditions, including muscle relaxation, were fully adequate in all patients (after additional local anaesthesia of the skin in four patients). With the exception of one patient who experienced temporary hoarseness (probably due to a concomitant block of the recurrent laryngeal nerve), no side effects were found and the patients tolerated the surgical procedure well. Interscalene block might be a suitable alternative to general anaesthesia for shoulder arthroscopy. However, additional local anaesthesia at the site where the arthroscope is to be inserted is frequently required.     

Ankle Arthroscopy: No-Distraction and Dorsiflexion Allows Advanced Techniques

Ankle dorsiflexion arthroscopic technique with distraction at a surgeon’s discretion is the current standard for ankle arthroscopy in most parts of the world. Reasons favoring the use of dorsiflexion during anterior ankle arthroscopy are based on the insertion of the anterior ankle joint capsule, which happens at a distance from the articular surfaces: this allows a large and safe anterior working area during dorsiflexion; ankle dorsiflexion also reduces the tension of anterior neurovascular structures and moves them away from the anterior aspect of the ankle, which protects them from damage during performance of the arthroscopic procedure; in addition, a lower rate of complications has been reported when dorsiflexion without distraction is being used for ankle arthroscopy. Nevertheless, intermittent ankle distraction can still be used during ankle arthroscopic procedures, but with just a few indications. In this infographic, authors explore and present the current indications for distraction in ankle arthroscopy as well as the broader indications for performing ankle dorsiflexion arthroscopic technique.     

Shoulder arthroscopy with the use of local anesthesia

In recent years shoulder arthroscopy has become increasingly used. To simplify the procedure and to minimize cost and operative risks, a study has been conducted to evaluate the use of local anesthesia for diagnostic shoulder arthroscopy. Two groups of patients were studied. The first group of 17 patients was examined while the patients were under general anesthesia, but a continuous infusion of lidocaine-chloride 0.2% was also performed. Serial blood samples were obtained. In all patients the peak serum level of local anesthetic was below the toxic levels. Seventeen other patients were operated on while they were under local anesthesia; 20 ml 1% prilocaine-epinephrine was injected into the soft tissues on the posterior aspect of the shoulder, and a continuous infusion of 0.2% lidocaine-chloride was infused intraarticularly during the procedure. In addition, adjunctive diazepam was used in eight patients. Three patients could not complete the procedure because of pain. We conclude that the absorption pattern of local anesthetic from the shoulder joint during arthroscopy is within the acceptable dose range. However, performing diagnostic shoulder arthroscopy with the patient under local anesthesia is a demanding procedure for the patient and may not always be possible.     

Arthroscopic proficiency: A survey of orthopaedic sports medicine fellowship directors and orthopaedic surgery department chairs

Purpose: The goal of this study was to evaluate the opinion of sports medicine fellowship directors and orthopaedic surgery department chairpersons on how many repetitions the average resident needs to become proficient in several common arthroscopic procedures. Type of Study: A cross-sectional study. Methods: A questionnaire was mailed to all fellowship directors on a list maintained by the American Academy of Orthopaedic Surgeons and to all department chairpersons on a list maintained by the American Medical Association. Respondents were asked to estimate the number of operations needed for a trainee to reach minimal proficiency (able to perform procedure skin-to-skin with supervision) and proficiency (capable of performing procedure without supervision) for 5 common arthroscopic procedures: diagnostic knee scope, partial medial meniscectomy, anterior cruciate ligament (ACL) reconstruction, diagnostic shoulder scope, and subacromial decompression. Results: A total of 164 of 230 (71%) people responded to the questionnaire. Department chairpersons who did not perform arthroscopy consistently estimated two thirds the number of operations that department chairpersons who did perform arthroscopy and nearly half the number of operations estimated by fellowship directors. Chairpersons who did perform arthroscopy had responses more similar to fellowship directors than to department heads who did not perform arthroscopy. Conclusions: These results indicate that, in the opinion of physicians involved in the education of residents and fellows, it may take a substantial number of repetitions to become proficient in arthroscopy. Physicians who perform little or no arthroscopy themselves may underestimate its difficulty. Interestingly, there was substantial variability in the number of repetitions estimated to achieve proficiency in all procedures. The results of this study may be helpful in designing arthroscopic training programs for orthopaedic residents or sports medicine fellows; however, the wide variability in opinions may indicate difficulty in reaching a consensus.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 7 (September), 2002: pp 795–800     

肩关节镜术中低体温情况的观察性研究

目的观察肩关节镜术中围手术期低体温的发生率以及影响因素。 方法回顾性分析2020年6月至2020年9月以及2020年12月至2021年2月于本院治疗的161例肩关节镜手术患者,排除1例年龄过小、2例合并颈椎病、3例数据不全的患者,实际入组参与研究患者155例,其中左侧肩66例、右侧肩89例;男50例、女105例（男：女=1:2）;平均年龄（58.87±11.50）岁（19~79岁）。126例肩袖损伤,9例肩关节不稳定,1例肱骨大结节骨折,16例冻结肩,3例钙化性肌腱炎。记录患者的基本资料、手术时长、麻醉分级、麻醉方式、术中体温保护措施、手术室的温度,对这些数据进行统计学的分析,评估围手术期低体温的发生率以及危险因素。 结果针对155例肩关节镜患者的资料分析结果可见手术开始时有43例患者的体温均处于低体温状态,112例患者处于正常范畴,低体温发生率为27.74%。而在手术结束时出现低体温状态的患者有62例,而93例患者处于正常范畴,术后的低体温发生率为40%。所有的低体温状态均处于轻度的围手术期低体温范畴。麻醉后出现低体温的患者中,性别和BMI的比值差异具有统计学意义,而术中及结束时出现低温的情况则与年龄、性别、手术时间、灌注量和保温措施相关。并且当手术时间超过90 min后,灌注液对核心体温的影响起到了主导作用。 结论肩关节镜手术中多种因素与围手术期低体温相关,常温灌注液体也对核心体温起到一定的影响作用,导致围手术期低体温的发生。     

Wrist arthroscopy: principles and clinical applications.

With the development of better and smaller equipment, arthroscopy of the wrist offers the same benefits achievable with arthroscopy of the knee, shoulder, or elbow - not only diagnostic information but also a therapeutic option. Standardized techniques of performing wrist arthroscopy have been developed to evaluate the treat various wrist disorders, such as lesions of the triangular fibrocartilage complex, intra-articular distal radius fractures, and scaphoid fractures. Arthroscopy is now performed in the treatment of dorsal-wrist ganglion cysts and interosseous ligament disruptions, as well as for bone incisions, such as radial styloidectomy, distal ulnar excision (wafer procedure), and proximal-row carpectomy. Compared with other techniques, arthroscopic procedures, such as repair of the triangular fibrocartilage complex, demonstrate better results and improved localization of the injury with a low complication rate. In addition, arthroscopic procedures involve lesssurgical dissection, less postoperative pain, a shorter recovery time, and an earlier return to work for the patient.     

Advances in wrist arthroscopic surgery in Indonesia

Since the 1990s, new insights in wrist arthroscopy have led to the introduction of numerous treatment methods. Consequently, therapeutic procedures are no longer limited to resection as more specialized repair and functional reconstruction methods, involving tissue replacement and essential structural augmentation, have been shown to be beneficial. This article discusses the most prevalent reasons and uses for wrist arthroscopy, with an emphasis on Indonesia’s most recent and major advances in reconstructive arthroscopic surgery. Joint debridement, synovectomy, ganglionectomy, capsular release, and osteotomies are frequent resection operations. Ligament repair and arthroscopy-aided reduction and fixation for fractures and nonunion are all examples of reconstructive surgery.     

Arthroskopie des oberen Sprunggelenks

At present, arthroscopy of the ankle joint is mostly an operative procedure; it is quite rare for it to be performed for the purpose of reaching a diagnosis. Arthroscopic operations are divided into reconstructive and resective procedures. Arthrodesis of the ankle joint under arthroscopic control and arthroscopy for the treatment of ankle fractures are not currently performed routinely.     

Anterior Interosseous Nerve Palsy After Shoulder Arthroscopy Treated With Surgical Decompression: A Case Series and Systematic Review of the Literature

Background: Anterior interosseous nerve (AIN) palsy is a very uncommon cause of upper extremity pain and weakness that comprises less than 1% of all upper extremity nerve palsies. Rarely reported but also mentioned in the literature is AIN palsy after shoulder arthroscopy. Methods: A systematic review of the literature to date using PubMed was conducted to identify patients who suffered AIN palsy after shoulder arthroscopy procedures. Articles included met the following criteria: (1) published in English; (2) primary presentation of the data; (3) patients had undergone shoulder arthroscopy before developing symptoms of AIN palsy; and (4) diagnosis was confirmed with clinical symptoms of AIN palsy. Measured outcomes included patient demographics, specific shoulder procedure, anesthesia procedure, intra-operative patient positioning, intra-operative compressive dressing, intra-operative traction, surgical versus conservative treatment, abnormal findings during decompression procedure, proposed mechanism of injury, and follow-up. Results: The search yielded 6 articles, of which 4 (13 cases) met inclusion criteria. An additional 2 cases were included in this report totaling 15 cases. The average patient age was 49 years (range: 31-64) with 73% males. At average follow-up of 24 months, 67% of patients experienced complete resolution of symptoms—more than half of which underwent surgical decompression. Patients who failed to progress experienced weakness of the flexor digitorum profundus and flexor pollicis longus muscles. Conclusions: Proposed injury mechanisms for AIN palsy after shoulder arthroscopy range from mechanical trauma, compressive hematoma, and direct anesthetic neurotoxicity. Management should be directed by clinical symptoms, imaging, and patient factors with majority of patients expected to have excellent clinical outcomes.     

Arthroscopic surgery--current status and perspectives

The morbidity after arthroscopic surgery is low; a hospitalization is not necessary in most patients. The possible operations of the knee joint include removal of loose bodies, resections on meniscus, plicae and synovium as well as more complicated procedures as suturing of a meniscus, total synovectomy and operations in patients with osteoarthritis. The advantage of the arthroscopic operation compared with arthrotomy is well documented in meniscal resection (shorter treatment, stay in the hospital and sick leave, reduced costs, and nevertheless excellent results) whereas the indication and clinical value of other arthroscopic procedures (i.e. suturing of a meniscal tear, lateral release, abrasion-arthroplasty) still are discussed. Diagnostic and operative arthroscopy of the shoulder joint has found its place and will certainly improve our knowledge on significance and treatment of disorders and injuries of this joint. In selected cases, an arthroscopy of the elbow, the hip, the ankle, the wrist or the temporomandibular joint offers important diagnostic information and may allow operative treatment. Arthroscopic surgery is technically difficult and not without problems. However, the rate of complications is extremely low (0.56%). Infections occur in significantly less than 1% of the cases. In veterinary medicine, therapeutic arthroscopy is used mainly in horses, but arthroscopies have been performed in the ox, the cow, the pig, the dog, the cat, and the rabbit. Modern joint surgery includes arthroscopic techniques; the training of trauma surgeons and orthopedic surgeons in arthroscopy is therefore mandatory.     

Arthroscopic shoulder surgery

Arthroscopy has proven to be a very important orthopaedic tool for treatment of the knee and other joints. Since 1972, we have used the arthroscope to examine the interior of shoulder joints. We prefer to perform arthroscopy while the patient is under general anaesthesia, as local anaesthetic may result in unnecessary patient discomfort and there can be difficulty in distracting and rotating the humerus. Arthroscopic operative procedures include the inspection of a torn glenoid labrum and certain lesions of the biceps tendon, viewing a torn rotator cuff, locating loose bodies in the shoulder, surgery for recurrent dislocations, and division of the coracoacromial ligament.     

Arthroscopic Retrieval of over 100 Loose Bodies in Shoulder Synovial Chondromatosis: A Case Report and Review of Literature

Synovial chondromatosis is a rare and benign condition of unknown cause. It is also known as synovial osteochondromatosis. It is characterized by involvement of the synovial tissue, which lines various joints of our body. Initial symptoms range from pain in the joint, locking of the joint at times, especially the knee, to arthritis of the joint that is a late feature of this condition. Although large joints such as the knee are commonly affected, involvement of the shoulder joint is a rare occurrence. Historically an open arthrotomy was preferred for removal of loose bodies coupled with a thorough synovectomy. However, arthroscopy for loose body retrieval has gained popularity over the past two decades. Arthroscopic surgery is an extremely skilled procedure and there is a learning curve for operating in certain anatomical areas such as the shoulder. However, not only does an arthroscopy provide the surgeon with an excellent view of the shoulder but the patient also has a faster recovery. We report a rare case of shoulder synovial chondromatosis in which more than 100 loose bodies were successfully retrieved by an arthroscopy in an individual who had an excellent outcome post‐surgery, reaffirming our faith in the procedure. A detailed literature review of arthroscopic procedures is also presented.     

Arthroscopic shoulder surgery

Summary Arthroscopy has proven to be a very important orthopaedic tool for treatment of the knee and other joints. Since 1972, we have used the arthroscope to examine the interior of shoulder joints. We prefer to perform arthroscopy while the patient is under general anaesthesia, as local anaesthetic may result in unnecessary patient discomfort and there can be difficulty in distracting and rotating the humerus. Arthroscopic operative procedures include the inspection of a torn glenoid labrum and certain lesions of the biceps tendon, viewing a torn rotator cuff, locating loose bodies in the shoulder, surgery for recurrent dislocations, and division of the coracoacromial ligament.     

Arthroscopically assisted mini-openrotator cuff repair

Although open anterior acromioplasty and rotator cuff repair has reliably provided satisfactory results for several decades, efforts are continually being made to improve on these results. Arthroscopically assisted mini-open rotator cuff repair provides the advantages of arthroscopic glenohumeral inspection and identification and treatment of any concomitant lesions, deltoid origin preservation (with the arthroscopic subacromial decompression), decreased surgical morbidity, and improved cosmesis. In addition, this procedure can reliably be performed as an outpatient procedure and may allow accelerated postoperative rehabilitation. This report outlines the rationale and technique for this surgical approach, which may be used for the repair of significant partial-thickness tears and small to medium-sized full-thickness tears. Also, it requires èxperience and expertise in shoulder arthroscopy and arthroscopic subacromial decompression.