Arthroscopy is the use of fiberoptic light, camera, and instruments to diagnose and treat joint conditions.

Shoulder conditions that benefit from arthroscopy include osteochondrosis dissecans, bicipital tenosynovitis, glenohumeral ligament tears, arthritis, trauma, and cancer.

Arthroscopy offers faster procedure times, more precise identification and treatment of conditions, faster and easier recovery times, earlier return to function, decreased pain associated with the procedure, and minimal scarring.

What is it?

• Arthroscopy is the use of a fiberoptic light and camera to explore and manage joint injuries.
• It is a minimally invasive technique – instead of a large incision through the skin and into the joint, several small punctures are made to admit the light, camera, and instruments into the joint.
• The patient has significantly reduced recovery time compared with conventional shoulder surgery, and can often go home the same day.
• It is used to investigate and manage shoulder conditions like osteochondrosis dissecans (OCD), bicipital tenosynovitis (BT), glenohumeral ligament tears, arthritis, trauma, and cancer.

Pertinent anatomy

• The shoulder joint is formed between the humerus (bone of the upper forelimb) and the glenoid of the scapula (the joint portion of the shoulder blade), surrounded by a joint capsule, and has tendons (biceps and medial collateral) running through it.
• Within the joint, the arthroscope may examine the cartilage lining the surfaces of the bones, the inner surface of the joint capsule, and the tendons within the joint.

Clinical Signs

• The shoulder arthroscopy candidate will often be presented with a complaint of forelimb lameness that ranges from non-weight-bearing through toe-touching to intermittent lameness or a lameness only apparent at a walk, trot, or run.
• This lameness may be due to any one of many shoulder conditions, including OCD, BT, ligament tears, arthritis, trauma, and cancer.
  The clinician will find that the lameness localizes to a forelimb.
• Pain may be noted on shoulder palpation, there may also be decreased range of motion, muscle atrophy, swelling in the joint (effusion), swelling of surrounding soft tissues, and crepitus (‘crunchy’ instead of smooth joint motion).

Diagnosis

• An orthopedic examination is first performed, looking at range of motion, muscle atrophy, swelling in the joint (effusion), swelling of surrounding soft tissues, feeling for crepitus (‘crunchy’ instead of smooth joint motion), and the source of discomfort.
• Radiographs are taken to look for bony and joint changes – these are not always seen, and the radiographs may appear normal, especially in cases of joint soft tissue injury.
• Contrast injected into the joint is a technique sometimes used to identify joint soft tissue injuries.
• MRI is another imaging modality that is particularly useful for identifying soft tissue injuries involving muscles, tendons, and ligaments.
  If cancer is suspected, this may be confirmed with a bone scan or biopsy.
• Ultrasonography of the shoulder joint may be used to try to identify the affected joint soft tissues.
• An arthrocentesis, or joint tap (using a needle and syringe to obtain a small sample of joint fluid), and cytology (to analyze the sample) are useful to rule in or out various diseases.
• Arthroscopy of the shoulder can be both diagnostic and therapeutic, allowing visualization of the problem and treatment (see below), and removing the need for some of the investigations listed above.
• Labwork on blood and urine is often required prior to anesthesia to ensure organ function, and to look for signs of infection or inflammation.

Treatment

• Arthroscopy is often both diagnostic and therapeutic, and can be performed on a same day, outpatient basis.
• For BT sufferers, the biceps tendon is visually examined and, if diseased, a tenotomy can be performed. This cutting of the tendon allows it to move towards the humerus and reattach there with scar tissue in time, relieving the inflammation and pain in the shoulder. With arthroscopy (compared to surgery), the procedure is less traumatic, requires less time under anesthesia, does not require implants, and provides a quick and easy recovery for both patient and owner.
  For those with ligament tears, the traumatic rupture of the medial or lateral glenohumeral ligaments can be suspected through orthopedic exam, but often requires extensive diagnostics to confirm. Again, rather than a surgical approach, shoulder arthroscopy allows the surgeon to identify the damaged ligament, and to tighten the joint by creating a fibrous scar on the remaining ligament and joint capsule.
• Arthroscopy helps OCD sufferers in a similar fashion, allowing exploration of the joint, removal of broken-off pieces of cartilage, and freshening of cartilage beds to promote healing. Click here to watch an arthroscopic video demonstrating the treatment of shoulder OCD.
• As general anesthesia is required for arthroscopy, your pet is carefully monitored during the anesthesia for changes in blood pressure, heart rate and rhythm, breathing rate, temperature, and depth of anesthesia; the appropriate treatments are instituted as necessary.

Complications

• Infection is a potential post-arthroscopy complication. Signs to watch for include increased swelling, lameness, and drainage from the wounds. Appropriate treatment consists of antibiotics.
  Very rarely, an arthroscopic procedure may need to be converted to a surgical procedure due to arthroscopic findings.
• There are very rarely reactions to anesthetic drugs and protocols that may result in cardiac or respiratory arrest.

Home Care

• Your pet will likely be discharged with a non-steroidal anti-inflammatory drug (NSAID) like Rimadyl, Meloxicam, or Deramaxx. This medication will aid in control of post-arthrsocopic pain and inflammation.
  Strict rest is required for two weeks after the procedure – this means no running, jumping, or rough housing, with short leash walks for bathroom duty only. After the recheck examination, the go ahead will be given to gradually increase activity back to normal levels.
• A recheck examination is usually required two weeks after the procedure.
  Wounds will need to be kept clean and dry, with daily inspection for increased swelling, redness, or discharge.
• Instructions may be given for physiotherapy – this involves helping your pet through range of motion exercises to keep the joint from getting stiff.
• Instructions may be given for hot and cold packing of the joint. Cold packing helps with initial post-arthroscopic inflammation, and hot packing promotes healing.
• Lameness may be expected to resolve within the two week rest period.
• Recommendations may be made to change your pet’s diet to one that promotes joint healing and delays arthritis, e.g. Hill’s J/D.
   

Prognosis

• Prognosis without treatment for many shoulder conditions is a lifetime of pain, and lameness, and the development of arthritis.
• Therapy is designed to reduce pain and lameness, and reduce the degree and speed with which arthritis develops.
• Arthroscopy provides a means to reduce the post-operative recovery time, helping your pet return to normal activity sooner.

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