Shoulder Arthroscopy (Diagnostic & Operative)

Why this approach — at MOS

At Maryland Orthopedic Specialists, shoulder arthroscopy is the operative standard for shoulder soft-tissue pathology. We maintain a systematic approach to joint inspection before beginning any operative steps — even in cases where the planned procedure is straightforward, a complete arthroscopic survey occasionally reveals additional pathology that changes management. The additional 3–5 minutes of systematic inspection is a worthwhile investment in every case.

Patient comfort is a high priority. The interscalene nerve block eliminates most early post-operative pain and allows patients to go home comfortable and clear-headed. Our perioperative team is experienced with the specific recovery requirements of shoulder arthroscopy — positioning, sling use, ice application — and educates every patient before discharge.

Cases are scheduled through our ambulatory surgery center, which is optimized for orthopedic arthroscopic procedures. Most patients arrive, complete their surgery, and return home within 3–4 hours of arrival.

Who is a candidate?

Indications — Diagnostic

• Shoulder pain that remains undiagnosed after clinical examination and advanced imaging
• Suspected labral pathology (Bankart, SLAP) with equivocal MRI findings
• Unexplained shoulder stiffness requiring biopsy or direct visualization

Indications — Operative

• Rotator cuff tears (partial and full-thickness)
• Bankart lesions (anterior labral tears after dislocation)
• SLAP tears (superior labral tears)
• Biceps tendon pathology requiring tenodesis or tenotomy
• Shoulder impingement with subacromial bursitis requiring decompression
• AC joint arthritis requiring distal clavicle excision
• Frozen shoulder (adhesive capsulitis) requiring capsular release
• Loose bodies inside the joint
• Glenohumeral arthritis debridement

Conservative Treatment First

The decision to proceed with shoulder arthroscopy for an operative indication follows failed conservative management of the underlying condition — whether that is rotator cuff disease, instability, or impingement. Conservative care varies by diagnosis but typically includes physical therapy, activity modification, and selective injections. For a purely diagnostic arthroscopy, non-operative management is always attempted first, and the bar for proceeding to surgical visualization is the inability to establish a diagnosis and treatment plan through non-invasive means.

The procedure

What Is Shoulder Arthroscopy?

Shoulder arthroscopy is a minimally invasive procedure in which a small camera (arthroscope) is inserted into the shoulder through tiny incisions to diagnose and treat internal problems. It allows surgeons to directly visualize and repair structures inside the shoulder joint — labrum, rotator cuff, cartilage, and biceps — without a large open incision.

The word "arthroscopy" comes from the Greek words for joint (arthro) and look (skopein). A modern arthroscope is a pencil-sized instrument (typically 4–5 mm in diameter) containing a camera, fiber optic light source, and a port for introducing fluid to distend and clear the joint during visualization. The image is displayed on a high-definition monitor in the operating room, giving the surgeon a magnified, real-time view of every structure inside the joint.

Shoulder arthroscopy is used in two contexts. In a diagnostic context, it provides definitive confirmation of pathology that imaging (even advanced MRI) can miss or mischaracterize. In an operative context, it serves as the platform for virtually all modern shoulder soft-tissue surgery — rotator cuff repair, Bankart repair, SLAP repair, biceps tenodesis, subacromial decompression, and distal clavicle excision are all performed through arthroscopic portals.

The advantages of arthroscopy over open surgery are well established: smaller incisions, less soft-tissue disruption, lower infection rates, less post-operative pain, faster early recovery, and outpatient same-day surgery. The shoulder's complex three-dimensional anatomy — glenohumeral joint, subacromial space, AC joint — is fully accessible through standard arthroscopic portals, providing a view that is in many ways superior to what open surgery can offer.

What Happens During Shoulder Arthroscopy?

You arrive at the ambulatory surgery center approximately 90 minutes before surgery. An interscalene nerve block is placed by the anesthesiologist, followed by general anesthesia. You are positioned in the beach chair or lateral decubitus position, depending on the surgeon's preference and the planned procedure.

The shoulder is cleaned and draped. The joint is distended with sterile saline solution introduced through a spinal needle to create working space. A posterior portal (approximately 2 cm below and medial to the posterior corner of the acromion) is the primary viewing portal. A small incision is made and a trocar is gently advanced into the glenohumeral joint. The arthroscope is inserted and the fluid is regulated to maintain clear visualization.

Systematic inspection of the glenohumeral joint proceeds: the labrum (all the way around), the articular cartilage of the humeral head and glenoid, the biceps anchor, the rotator cuff undersurface, the axillary pouch, and the subscapularis. Additional portals are established as needed for instruments and the subacromial space is entered separately for rotator cuff and subacromial assessment.

Surgical treatment proceeds through the portals as required by the identified pathology. At the completion of the procedure, fluid is evacuated, portals are closed with sutures or skin tape, and the arm is placed in a sling.

Recovery timeline

Frequently Asked Questions