29821 Arthroscopy, shoulder, surgical; synovectomy, complete

Name of the Procedure:

Arthroscopy, shoulder, surgical; synovectomy, complete

Summary

Arthroscopic shoulder synovectomy is a minimally invasive surgical procedure where a surgeon uses an arthroscope (a type of endoscope) to view, diagnose, and treat joint problems in the shoulder. During this procedure, the surgeon removes the entire synovial membrane (synovectomy) within the shoulder joint.

Purpose

This procedure addresses chronic inflammation of the synovial membrane, often due to conditions like rheumatoid arthritis or other inflammatory joint diseases. The goal is to alleviate pain, improve mobility, and reduce inflammation and joint damage.

Indications

• Chronic shoulder pain and inflammation not responsive to conservative treatments
• Rheumatoid arthritis or other synovial membrane disorders
• Recurrent shoulder effusion (fluid buildup)
• Decreased shoulder mobility due to synovial thickening

Preparation

• The patient may be advised to fast for 6-12 hours before the surgery.
• Medications, particularly blood thinners, might need adjustment.
• Pre-operative assessment including blood tests, imaging studies (like MRI or X-rays), and a thorough medical evaluation.

Procedure Description

1. Anesthesia: General anesthesia or regional block anesthesia is administered.
2. Incisions: Small incisions (portals) are made around the shoulder.
3. Arthroscope Insertion: An arthroscope equipped with a camera is inserted through one of the incisions.
4. Examination: The surgeon examines the joint's inside on a video monitor.
5. Synovectomy: Special instruments are inserted through other incisions to remove the synovial membrane.
6. Closure: The incisions are closed with sutures or surgical tape.

Tools and Equipment

• Arthroscope
• Small surgical instruments (shaver, scissors, forceps)
• Video monitor system

Duration

The procedure typically takes about 1 to 2 hours.

Setting

• Hospital surgical suite or outpatient surgical center

Personnel

• Orthopedic surgeon
• Surgical nurses
• Anesthesiologist

Risks and Complications

• Infection
• Bleeding
• Blood clots
• Nerve or blood vessel damage
• Shoulder stiffness or decreased range of motion
• Anesthesia-related complications

Benefits

• Reduced pain and inflammation
• Improved shoulder function and mobility
• Minimized joint damage and further degeneration
• Enhanced quality of life

Recovery

• Pain management with medications
• Physical therapy for rehabilitation
• Avoiding strenuous activities for several weeks
• Follow-up appointment with the surgeon for progress evaluation
• Full recovery may take several weeks to a few months

Alternatives

• Conservative treatments (medication, physical therapy)
• Open synovectomy (more invasive)
• Joint injections (steroids, hyaluronic acid)
• Total shoulder replacement (for severe cases)

Patient Experience

• During the procedure: Patient is under anesthesia and won’t feel pain.
• After the procedure: Pain and discomfort managed with medications. Swelling and limited shoulder mobility initially, improving with physical therapy. Most patients can return to normal activities within a few weeks, though full recovery takes longer.

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