29825 Arthroscopy, shoulder, surgical; with lysis and resection of adhesions, with or without manipulation

Name of the Procedure:

Arthroscopy, Shoulder, Surgical; with Lysis and Resection of Adhesions, with or without Manipulation.

Summary

This surgical procedure involves using a small camera (arthroscope) to view the inside of the shoulder joint. Surgeons then remove and cut away any scar tissue (adhesions) that may be causing pain and limiting movement. This can also include manipulating the joint to improve function.

Purpose

Medical Conditions Addressed:

• Adhesive capsulitis ("frozen shoulder")
• Shoulder stiffness due to scar tissue or previous surgeries

Goals:

• Relieve pain
• Restore shoulder mobility and function

Indications

Symptoms and Conditions:

• Chronic shoulder pain
• Limited range of motion
• Stiffness not responding to conservative treatments (e.g., physical therapy)
• Recurring shoulder immobility after previous interventions

Patient Criteria:

• Persistent symptoms despite non-surgical treatments
• No response to corticosteroid injections or physical therapy
• Confirmed diagnosis through imaging studies

Preparation

Instructions:

• Fasting for at least 6-8 hours prior to the procedure
• Adjustments or halting of certain medications as directed by the surgeon
• Pre-operative imaging such as MRI or X-ray
• Physical examination and medical history review

Diagnostic Tests:

• MRI or ultrasound to assess the extent of adhesions

Procedure Description

Steps:

1. Anesthesia: Generally performed under general anesthesia or a regional block.
2. Incisions: Small incisions are made around the shoulder to insert the arthroscope and other instruments.
3. Visualization: The arthroscope, equipped with a camera, projects images of the shoulder joint onto a screen.
4. Lysis and Resection: Specialized tools are used to cut and remove scar tissue and adhesions.
5. Manipulation: The surgeon may gently manipulate the shoulder to enhance mobility.
6. Closure: Small incisions are closed with sutures or sterile strips.

Tools and Equipment:

• Arthroscope
• Small surgical instruments (probes, scissors)
• Fluid pump to irrigate the joint

Anesthesia:

• General anesthesia or regional block (performed by an anesthesiologist)

Duration

Approximately 1-2 hours

Setting

Typically performed in a hospital or outpatient surgical center

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Surgical technologists

Risks and Complications

Common Risks:

• Infection
• Bleeding
• Swelling

Rare Risks:

• Nerve damage
• Blood clots
• Failure to relieve symptoms

Complications Management:

• Antibiotics for infection
• Pain medication and rest
• Follow-up care for persistent symptoms

Benefits

• Pain relief
• Improved shoulder mobility
• Enhanced quality of life
• Results typically seen within weeks after surgery and rehabilitation

Recovery

Post-Procedure Care:

• Arm in a sling for initial days
• Pain management with medication
• Physical therapy starts within a few days

Expected Recovery Time:

• Return to normal activities: 1-3 months
• Full recovery: up to 6 months

Restrictions:

• Avoid heavy lifting and overhead activities initially
• Adherence to physical therapy schedule

Alternatives

Treatment Options:

• Physical therapy alone
• Corticosteroid injections
• Open shoulder surgery for severe cases

Pros and Cons:

• Non-surgical options are less invasive but may be less effective
• Open surgery offers comprehensive intervention but comes with a longer recovery time

Patient Experience

During Procedure:

• No pain is felt due to anesthesia
• Minor discomfort at incision sites post-surgery

After Procedure:

• Pain managed with medication
• Sling usage for comfort
• Physical therapy to regain strength and mobility
• Follow-up visits to monitor progress