Shoulder Arthroscopy Types and Complications

Arthroscopic surgery is performed through small incisions using a camera to see the inside of a joint. Through several small incisions (about 1 centimeter each), your surgeon will insert a camera into one incision, and small instruments through the other incisions. The exact number of incisions made depends on the specific surgery performed.

A group of surgeons performing surgery on a patient
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Arthroscopic vs. Open Surgery

There's often a debate among patients and surgeons about which is better—arthroscopic or 'open' surgery. Open surgery, a procedure using larger incisions and enabling the surgeon to look directly into the joint, may be better for certain procedures under certain circumstances. Arthroscopic surgery has some advantages—smaller incisions, less tissue damage—but these are usually not helpful if the overall procedure cannot be performed as well. Other surgeons feel that directly looking at the area of damage can allow for better and stronger repair of damaged structures. The truth is that it depends on exactly what needs to be done, the patient's specific condition, and the surgeon's experience. Depending on the combination of these factors, one surgery may be best for your particular situation. You need to discuss with your surgeon if a particular procedure can be done arthroscopically.

There are debates among orthopedic surgeons about how to best perform different types of surgery. For example, many shoulder surgeons disagree about whether rotator cuff repairs can be performed as well arthroscopically as they can in open surgery. There are pros and cons to both, and these may vary based on the specific details of the injury.

Arthroscopic Shoulder Surgeries

  • Rotator Cuff Tears

Treatment of rotator cuff tears with shoulder arthroscopy can vary. Some orthopedic surgeons treat all rotator cuff tears arthroscopically, some choose arthroscopy for particular tears, and others treat them all with open surgery. There is no current consensus regarding which one is better for this condition.

Labral tears, such as Bankart tears and SLAP tears, are commonly treated with arthroscopy. It is very important that patients who have arthroscopic surgery for these procedures follow their post-operative rehab protocol very closely. Patients are often tempted to do too much, too soon.

  • Shoulder Bursitis

Patients with shoulder bursitis, also called impingement syndrome, that is not cured with conservative treatments may consider a procedure called an arthroscopic subacromial decompression. This procedure removes the inflamed bursa and some bone from the irritated area around the rotator cuff tendons. By removing this tissue, more space is created for the tendons, and the inflammation often subsides. This is often performed in conjunction with other procedures to address other problems in the shoulder at the same time.

  • Biceps Tendonitis

The biceps tendon can become irritated and inflamed as an isolated problem or in association with problems such as impingement syndrome and rotator cuff tears. When the biceps tendon is damaged and causing pain, a procedure called a biceps tenodesis can be performed to remove the diseased portion and reattach the tendon. This procedure usually causes no functional deficit, but often relieves symptoms.

Frozen shoulder seldom requires operative treatment, and treatment for many months or years is often necessary before considering it. When frozen shoulder must be treated surgically, it is of utmost importance to begin aggressive physical therapy immediately following surgery. Without this, it is likely the problem will return.

The AC joint, or acromioclavicular joint, is occasionally affected by arthritis. When arthritis of the AC joint is severe, the damaged end of the clavicle (collarbone) can be removed. By removing the damaged part of the joint, the symptoms of AC arthritis are often relieved.

Shoulder Arthroscopy Rehab

Recovery depends on what type of surgery is performed. One of the potential concerns with shoulder arthroscopy is that when the procedure hurts less than open shoulder surgery, patients may try to do too much, too soon. It is very important that you only perform activities that your surgeon recommends following shoulder arthroscopy. Even though your shoulder may feel fine, you need to allow time for repaired tissues to adequately heal. This is especially important for patients who have rotator cuff repairs and labral repairs. For these surgical procedures to be successful, soft tissues must heal before stress is placed on the repaired structures. Too much activity, too quickly, can lead to a recurrence of the problem your surgeon was trying to address.

Surgical Complications

Complications of shoulder arthroscopy are uncommon, but do rarely occur. Infection rates tend to be very low. The most common complication of surgery on the shoulder is stiffness after surgery and prolonged rehabilitation. This can usually be managed with physical therapy. Occasionally, shoulder arthroscopy can lead to a frozen shoulder that can make rehab challenging. One rare complication of shoulder arthroscopy is called chondrolysis. This is a very unusual, but particularly serious complication seen after arthroscopic shoulder surgery.

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Article Sources
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