Home ArthroscopyShoulder Arthroscopy (Diagnostic & Therapeutic) in India

Shoulder Arthroscopy (Diagnostic & Therapeutic) in India

Minimally invasive keyhole surgery to diagnose and treat shoulder joint problems including rotator cuff tears, labral injuries, and impingement using a small camera and specialized instruments

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Overview

Dr. Gurudeo Kumar is Bihar's leading expert in shoulder arthroscopy, having successfully performed over 650 arthroscopic shoulder procedures at Arthoscenter Patna with a 96% patient satisfaction rate. This minimally invasive technique has revolutionized shoulder surgery by allowing comprehensive diagnosis and treatment through tiny incisions. Shoulder arthroscopy involves inserting a small camera (arthroscope) about the size of a pencil through small incisions to visualize the inside of the shoulder joint. This allows Dr. Kumar to diagnose problems with incredible precision and perform repairs through additional small incisions using specialized miniature instruments. The shoulder joint is one of the most complex joints in the body, allowing an extraordinary range of motion. However, this mobility comes at the cost of stability, making the shoulder vulnerable to various injuries and degenerative conditions. Arthroscopy provides a powerful diagnostic and therapeutic tool for addressing these issues. Common conditions treated arthroscopically include rotator cuff tears (partial or full thickness), shoulder impingement syndrome, labral tears (including SLAP lesions), shoulder instability and recurrent dislocations, frozen shoulder (adhesive capsulitis), biceps tendon disorders, removal of loose bodies, treatment of arthritis, and removal of bone spurs. Benefits of arthroscopic surgery over traditional open surgery include smaller incisions (typically 3-4 portals of 5-10mm vs 6-10cm open incision), less pain and faster recovery, reduced scarring, better visualization of joint structures, lower infection risk, shorter hospital stay (often same-day or overnight), quicker return to activities, and ability to treat multiple problems simultaneously. Dr. Kumar uses state-of-the-art high-definition arthroscopic equipment and performs procedures in a dedicated arthroscopy suite. His extensive experience in shoulder arthroscopy ensures optimal outcomes, with most patients experiencing significant improvement in pain and function. The procedure typically takes 45 minutes to 2 hours depending on complexity. Recovery varies based on the specific procedure performed - simple diagnostic arthroscopy may require only 2-3 weeks of recovery, while complex repairs like rotator cuff reconstruction may require 4-6 months for full recovery. Dr. Kumar's comprehensive rehabilitation protocols are tailored to each patient's specific surgery and goals.

Symptoms & Indications

This surgery may be recommended if you experience:

Persistent shoulder pain that doesn't improve with rest or medications

Pain that worsens with overhead activities or reaching behind back

Night pain that disturbs sleep, especially when lying on affected shoulder

Weakness in the shoulder limiting daily activities

Shoulder stiffness and reduced range of motion

Clicking, popping, or grinding sensations in the shoulder

Feeling of shoulder instability or sensation that shoulder might "slip out"

History of shoulder dislocation or subluxation

Difficulty with activities like combing hair, reaching overhead, or throwing

Swelling or visible deformity around the shoulder joint

Procedure Details

Duration

45 minutes to 2 hours depending on complexity - diagnostic arthroscopy is quicker (45-60 minutes), while complex repairs like rotator cuff reconstruction take longer (90-120 minutes)

Anesthesia

General anesthesia combined with interscalene nerve block. The nerve block numbs the entire arm for 12-18 hours post-operatively, providing excellent pain control. Some patients experience temporary arm weakness/heaviness which is normal and resolves as block wears off.

Preparation for Surgery

Pre-operative evaluation includes detailed physical examination to assess range of motion, strength, and stability; X-rays to evaluate bones and joint space; MRI or MRI arthrogram (with contrast injection) for detailed soft tissue visualization including rotator cuff, labrum, and cartilage; sometimes CT scan for complex bone problems; blood tests and medical clearance; discussion of specific findings and surgical plan; medication review - blood thinners typically stopped 5-7 days before surgery; fasting after midnight before surgery; arrange transportation home as you cannot drive after anesthesia; prepare home with one-handed living aids; arrange help for first few days post-surgery; shoulder-specific preparation includes hair washing before surgery (will be difficult immediately after); wearing loose button-front shirt to hospital; understanding you will be in a sling for several weeks.

Surgical Steps

Patient positioned in beach-chair (semi-sitting) or lateral decubitus (side-lying) position depending on surgeon preference and specific procedure

General anesthesia with interscalene nerve block for pain control - this numbs the shoulder and arm

Shoulder and upper chest area cleaned with antiseptic solution and draped with sterile covers

Examination under anesthesia performed to assess range of motion, stability, and confirm physical findings

Small incision (about 1cm) made posteriorly (back of shoulder) for arthroscope insertion - this is the viewing portal

Arthroscope (camera) inserted and joint filled with sterile saline solution to expand the joint space for better visualization

Systematic diagnostic arthroscopy performed: glenohumeral joint (ball and socket) examined first - visualization of rotator cuff from inside, glenoid labrum inspection, articular cartilage assessment, long head of biceps tendon evaluation, ligaments and capsule examination

Additional portals (1-2 more small incisions) created as needed for instrument access - typically anterior (front) and sometimes lateral

Subacromial space (area above rotator cuff) examined: visualization of rotator cuff from above, assessment of bursa, examination for impingement or bone spurs, AC joint evaluation

Therapeutic procedures performed based on findings: Rotator cuff repair if tears identified - torn tendon reattached to bone using suture anchors; Labral repair for SLAP or Bankart lesions - torn labrum reattached using anchors; Subacromial decompression - removal of inflamed bursa and bone spurs causing impingement; Biceps tenodesis or tenotomy for biceps pathology; Capsular release for frozen shoulder; Debridement of damaged cartilage; Removal of loose bodies; AC joint resection if arthritic

Throughout surgery, high-definition camera provides magnified view of all structures on video monitors

Frequent arthroscopic pump adjustment maintains clear visualization by circulating fluid through joint

Meticulous technique ensures thorough treatment while minimizing trauma to healthy tissue

After completing all planned procedures, instruments removed and joint thoroughly irrigated

Portal incisions closed with single stitch or steri-strips (typically only 2-4 small incisions totaling 2-3cm)

Sterile dressings applied and arm placed in supportive sling

Patient awakened from anesthesia in operating room

Transferred to recovery area where nerve block provides excellent pain relief for 12-18 hours

Ice therapy applied to reduce swelling

Post-operative X-rays obtained if anchors or hardware placed

Typically discharged same day once stable and comfortable, or overnight observation for complex repairs

Detailed written instructions provided for home care, medications, physiotherapy appointments, and warning signs

Recovery Timeline

What to expect during your recovery journey

Day 1-3 (Immediate Post-Op)

Rest and Ice

Arm in sling 24/7 except for elbow/wrist exercises. Nerve block wears off after 12-18 hours - pain medications important. Ice shoulder 20 minutes every 2-3 hours. Keep surgical dressings clean and dry. Gentle pendulum exercises only (passive shoulder motion). Sleep in semi-reclined position to reduce swelling. Normal activities: eating, walking, light reading. Avoid: removing sling, lifting anything, reaching with affected arm.

Week 1-2

Early Protected Motion

Continue wearing sling full-time except during exercises. First physiotherapy visit at 3-5 days to assess wound and start gentle passive range of motion. Pendulum exercises 3-4 times daily. Passive forward elevation and external rotation exercises with physiotherapist or helper. Table slides and pulley exercises may begin. Pain and swelling gradually improve. Stitches removed at 10-14 days. Sleeping remains challenging - continue semi-reclined with pillow support. Can perform light computer work, write with other hand. Avoid: active motion of affected shoulder, lifting, pushing, pulling.

Week 3-6

Active Assisted Motion

May discontinue sling for simple activities during day (eating, typing) but continue for sleep and outside home. Progressive passive and active-assisted range of motion exercises. Therapist-guided advancement based on specific surgery performed. Rotator cuff repairs progress slowly; labral repairs may advance quicker. Focus on regaining motion without forcing. Light activities of daily living encouraged with affected arm below shoulder level. May drive if not taking narcotic pain medications (typically 3-4 weeks). Pain significantly reduced but stiffness common. Continue ice after exercise sessions.

Week 7-12

Strengthening Phase Begins

Sling fully discontinued for most procedures (some rotator cuff repairs may continue 8-10 weeks). Active range of motion exercises progress as passive motion goals achieved. Light resistance exercises with bands or 1-2 lb weights. Scapular stabilization exercises emphasized. Rotator cuff strengthening for non-repair procedures. Repair procedures focus on motion - strengthening delayed. Return to desk work, light household chores. Swimming (gentle) may begin at 10-12 weeks for some. Pain minimal but activity-related discomfort common. Joint may feel stiff, especially in morning.

Month 4-6

Progressive Strengthening

Aggressive strengthening program for most procedures. Rotator cuff repairs transition to strengthening phase. Progressive resistance exercises with weights, machines. Sport-specific training may begin for athletes. Return to most daily activities without restrictions. Light recreational activities resumed (golf, swimming, cycling). Heavy lifting still limited based on specific surgery. Goal: achieve 80-90% of normal strength and motion. Continue home exercise program. Occasional stiffness after inactivity normal.

Month 7-12

Return to Full Activity

Return to unrestricted activities for most patients. Athletes return to sport typically 6-9 months post-op (varies by sport and repair). Rotator cuff repairs: full healing at 6-9 months, may continue improving up to 12-18 months. Labral repairs: return to contact sports at 6 months. Continue maintenance exercises 2-3 times weekly lifelong. Strength continues improving up to 12-18 months. Expect 90-95% return to pre-injury function for most. Some activities may always cause minor discomfort but shouldn't limit function.

Tips for Faster Recovery

Wear sling consistently as directed - premature discontinuation risks re-injury especially for repairs

Ice religiously first 2 weeks - reduces pain and swelling significantly

Take pain medications as prescribed, don't wait until pain severe - easier to prevent than treat

Sleep semi-reclined (recliner or propped with pillows) for first 2-3 weeks for comfort

Attend all physiotherapy appointments - professional guidance crucial for optimal recovery

Do home exercises exactly as prescribed - consistency more important than intensity

Progress slowly - shoulder repairs need time to heal, pushing too hard causes setbacks

Don't compare your recovery to others - timeline varies based on specific procedure and individual factors

Be patient with rotator cuff repairs - they take 4-6 months to heal, full recovery 12-18 months

Avoid overhead reaching and lifting until cleared by surgeon, usually 8-12 weeks minimum

Keep incisions clean and dry until fully healed, typically 2 weeks

Report increasing pain, redness, drainage, or fever immediately - may indicate infection

Maintain good posture during recovery - slouching increases shoulder stress

Consider ergonomic modifications at work station if desk job

Continue maintenance exercises lifelong to prevent future problems and maintain results

Frequently Asked Questions

Common questions about this procedure

Q1.What conditions can be diagnosed and treated with shoulder arthroscopy?

Shoulder arthroscopy is a versatile procedure used to diagnose and treat numerous shoulder conditions. Common conditions include: Rotator cuff tears - both partial and full-thickness tears can be repaired arthroscopically; Shoulder impingement syndrome - removal of inflamed bursa and bone spurs (subacromial decompression); Labral tears including SLAP tears (superior labrum anterior to posterior) and Bankart lesions (from dislocations); Shoulder instability - repair of torn structures causing recurrent dislocations; Frozen shoulder (adhesive capsulitis) - capsular release to restore motion; Biceps tendon problems - tenodesis or tenotomy; AC joint arthritis - distal clavicle excision; Cartilage damage - debridement or microfracture; Loose bodies - removal of bone or cartilage fragments; Synovitis - removal of inflamed synovial tissue. Dr. Kumar can often diagnose issues more accurately with arthroscopy than with MRI alone, as the camera provides direct visualization and ability to probe structures. Many conditions that once required large open incisions can now be treated arthroscopically with better outcomes and faster recovery. During your consultation, Dr. Kumar will review your imaging and symptoms to determine if arthroscopy is the best treatment option for your specific condition.

Q2.How long is the recovery after shoulder arthroscopy and when can I return to work and sports?

Recovery timeline varies significantly based on the specific procedure performed. Simple diagnostic arthroscopy: Return to light work 1-2 weeks, full activity 3-4 weeks. Subacromial decompression: Return to desk work 2-3 weeks, manual labor 6-8 weeks, sports 3-4 months. Labral repair (SLAP/Bankart): Sling 4-6 weeks, light work 3-4 weeks, overhead activities 4-6 months, contact sports 6 months. Small rotator cuff repair (<1cm): Sling 6 weeks, light work 2-3 weeks, strengthening 3 months, full recovery 6-9 months. Large/massive rotator cuff repair: Sling 6-8 weeks, light work 3-4 weeks, strengthening 4-6 months, full recovery 12-18 months. General timeline factors: Desk work/computer work - typically 2-4 weeks. Manual labor/overhead work - typically 2-3 months minimum. Golf/swimming - typically 3-4 months. Tennis/throwing sports - typically 4-6 months. Contact sports - typically 6 months. Heavy lifting - typically 3-4 months. Age, health status, and tissue quality affect healing - younger patients generally recover faster. Smokers heal slower - stopping smoking improves outcomes. Adherence to physiotherapy critical - those who do exercises consistently recover faster. Your specific timeline will be provided based on what was performed during surgery - Dr. Kumar provides detailed written restrictions and progression plan.

Q3.What are the risks and complications of shoulder arthroscopy?

While shoulder arthroscopy is generally very safe with lower complication rates than open surgery, all surgical procedures carry some risks. Understanding these helps you make an informed decision and recognize warning signs. Common minor issues (usually temporary): Stiffness (most common) - affects 10-15% of patients, usually resolves with physiotherapy; Pain - expected for 1-2 weeks, well-controlled with medications; Swelling - common for first 2-3 weeks, ice and elevation help; Nerve irritation from positioning - temporary numbness/tingling resolves in days to weeks. Less common complications (1-3% overall): Infection - very rare with arthroscopy (<1%), treated with antibiotics; Excessive bleeding - rare, may cause increased swelling; Nerve injury - very rare (<0.5%), usually temporary; Blood clots - rare compared to lower extremity surgery; Persistent stiffness - may require manipulation under anesthesia. Procedure-specific risks: Rotator cuff repair - Re-tear (5-15% depending on tear size), larger tears higher risk. Stiffness requiring manipulation (2-5%), especially in diabetics. Anchor pullout (rare with modern anchors). Labral repair - Recurrent instability (5-10% for Bankart repairs), Failure requiring revision (3-5%). Decompression - Residual pain if bone spur removal incomplete, Deltoid weakness (very rare). Factors reducing risks: Choosing experienced surgeon like Dr. Kumar - 650+ shoulder arthroscopies. Following pre-operative instructions - stopping blood thinners, no eating/drinking before surgery. Proper post-operative care - wearing sling, attending physiotherapy, keeping incisions clean. Early recognition of problems - report fever, increasing redness, drainage. Compared to open surgery, arthroscopy has significantly lower infection rates, less blood loss, lower complication rates, and faster healing. Dr. Kumar discusses specific risks for your procedure during consultation.

Q4.How does arthroscopic shoulder surgery compare to traditional open surgery?

Arthroscopic shoulder surgery offers numerous advantages over traditional open surgery for most conditions, though some complex cases still require open approaches. Arthroscopic advantages: Smaller incisions - typically 3-4 incisions of 5-10mm vs one 6-10cm open incision. Better visualization - arthroscopic camera provides magnified, high-definition view of joint structures that's superior to naked-eye visualization in open surgery. Can see into areas not visible with open approach. Less tissue trauma - muscle-splitting vs muscle-detaching in open surgery, means less damage to deltoid and rotator cuff. Reduced pain - less tissue damage results in less post-operative pain. Faster recovery - return to activities typically 30-50% faster than open surgery. Lower infection risk - smaller wounds, shorter surgery time reduces infection risk. Less scarring - multiple tiny scars vs one large scar, better cosmetic result. Shorter hospital stay - often same-day discharge vs 1-2 night stay for open surgery. Lower complication rates - overall complication rate 2-5% vs 10-15% for open surgery. Same-day bilateral procedures possible - both shoulders can be done same day arthroscopically (not possible with open). When open surgery may be preferred: Very large/retracted rotator cuff tears requiring muscle transfers. Revision surgery with previous failed repairs. Fractures requiring plate and screw fixation. Severe arthritis requiring shoulder replacement. Complex instability requiring bone block procedures. Combined procedures that would take too long arthroscopically. Modern hybrid approaches: Sometimes Dr. Kumar uses "mini-open" approach - starts arthroscopically for diagnosis and partial treatment, then small 3-4cm incision for complex repair. Gets benefits of arthroscopic visualization with direct access for difficult repairs. Approximately 80-85% of shoulder procedures can now be done fully arthroscopically. Dr. Kumar evaluates each case individually, recommending the approach most likely to provide optimal outcome for your specific condition. He has extensive experience with both techniques.

Q5.What is the cost of shoulder arthroscopy at Arthoscenter Patna and does insurance cover it?

The cost of shoulder arthroscopy at Arthoscenter Patna under Dr. Gurudeo Kumar varies based on the specific procedure performed. Approximate costs are: Diagnostic arthroscopy only: ₹40,000-55,000. Subacromial decompression: ₹55,000-75,000. Labral repair (SLAP or Bankart): ₹80,000-1,10,000. Small rotator cuff repair: ₹90,000-1,25,000. Large/complex rotator cuff repair: ₹1,10,000-1,50,000. Multiple procedures combined: ₹1,20,000-1,75,000. Package typically includes: Comprehensive pre-operative consultation and examination; Pre-operative MRI review (MRI cost separate if needed - ₹8,000-12,000); All surgical charges and operating room costs; Arthroscopic equipment and instruments; Anesthesia (general + nerve block); Implants (suture anchors if needed for repairs - 2-6 anchors typical); Disposable arthroscopy supplies; Hospital charges (OPD or overnight stay); Post-operative medications for pain and inflammation; Initial physiotherapy consultation and instructions; Follow-up visits for first 3 months. Additional costs that may apply: Pre-operative MRI or MRI arthrogram if not already done: ₹8,000-15,000; Blood tests: ₹1,500-3,000; Nerve block (sometimes separate): ₹5,000-8,000; Extended hospital stay if needed: ₹3,000-5,000 per additional night; Outpatient physiotherapy sessions: ₹800-1,200 per session (15-20 sessions typical over 2-3 months); Post-operative imaging if complications: ₹2,000-8,000; Medications beyond first week: ₹2,000-5,000 total. Cost factors affecting price: Number of anchors needed - each anchor adds ₹8,000-12,000; Complexity and surgery duration - longer cases cost more; Single vs multiple procedures combined; Whether nerve block performed; Day care vs overnight stay. Insurance coverage: Most health insurance policies cover shoulder arthroscopy; Pre-authorization required - submit doctor recommendation and MRI; Typical coverage 50-80% of costs depending on policy; Cashless facility available for network insurance companies; Submit claim with all bills and discharge summary. Arthroscenter works with major insurers: ICICI Lombard, HDFC Ergo, Star Health, Care Health, Bajaj Allianz, New India Assurance, and others. Despite costs, arthroscopy often more economical overall than open surgery due to faster recovery, less time off work, fewer complications. Dr. Kumar provides transparent cost estimate during consultation after reviewing your MRI and determining specific procedure needed. ₹999 initial consultation includes examination, imaging review, treatment recommendation, and detailed cost breakdown for your insurance planning.

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