Introduction
This is a keyhole operation performed under a general anaesthetic, sometimes combined with nerve block, which allows the surgeon to investigate the shoulder joint from inside. I have now developed a wide-awake shoulder arthroscopy service with my anaesthetic colleagues to enable these procedures to be done under a shoulder block.  This has been extremely helpful for patients who cannot have a general anaesthetic or are not keen to have a general anaesthetic. 

The Operation

The operation is done by keyhole surgery; usually through two or three 5mm puncture wounds. It involves examination of the shoulder joint using a tiny telescope with television camera introduced through a keyhole. I have now started using nasoscope which has made it possible to operations under a local anaesthetic!

General Advice

You will usually be in hospital either for a day or overnight. A doctor/physiotherapist will see you prior to discharge and you will be taught exercises to do and given further advice to guide you through your recovery.
You will be given a sling to keep your arm comfortable. It may be taken off as much as you wish and discarded as soon as possible. You will be encouraged to use your arm.

Complications

As with all surgery there is a risk of some complications. These are rare, but you should be aware of them before your operation. They include:

• Infection
• Prolonged stiffness or pain
• A need to redo the surgery
• Complications relating to the anaesthetic

What to expect afterwards

Pain

Following the procedure the shoulder may be sore for a few days. You will be prescribed painkillers in hospital and should continue to take these at home if necessary.

Wearing a Sling

You will return from theatre with your arm in a sling. The arm should be rested in the sling only until the soreness has settled. This should be a day at the most. It is important that you begin to move the shoulder and arm immediately after the procedure. After certain procedures like rotator cuff repair or stabilisation of shoulder you will be in a sling for 4-5 weeks. 

The Wound

There will be two or three small 5-mm puncture wounds in your shoulder. There may be stitches or only small sticking plaster strips over the wounds. These should be kept dry until healed. This usually takes ten to fourteen days.

Driving

You may drive as soon as you feel able and can manage all the controls safely.

Returning to work

You may return to work as soon as you feel able, depending on your job.

Leisure activities

These can be resumed as soon as you feel able. There are no restrictions but use soreness as your guide and stop if the shoulder feels uncomfortable.

Exercises

After leaving hospital you should exercise your arm frequently throughout the day. The arm may feel sore whilst you are doing the exercises but there should be no intense or lasting pain. Aim for four exercise sessions per day.