 Good afternoon. I am Dr. Rajesh Kumar from Manipal Hospital, Gaziabad. I am an orthopedic surgeon who is also doing joint replacements and arthroscopies. We are here today to talk about arthroscopy related to shoulder joints. Now, the question arises, what is arthroscopy? Arthroscopy means seeing the joint, the inside with the help of a camera. A scope, arth, means joint. Now, what are the benefits of arthroscopy as we compare it with normal conventional open surgeries? In arthroscopy, number one, the tissue damage is very less. The incision given is very small. The incision given are known as portals. So, we make two or three or sometimes four portals for the scope and for the instruments to pass from. The whole surgery is done while we view the inside of the joint, the lesions, the disease on a television, on a screen, which nowadays are high resolution screens. Also, people sometimes ask me whether arthroscopy is a major surgery or a minor surgery. So, I won't classify it as a major or minor surgery, but yes, definitely the tissue trauma is far less as compared to the conventional open surgeries. So, it is and the recovery time is also very fast. The patient's mobilization out of bed is very quick as compared to the normal conventional open surgeries. When we talk about shoulder arthroscopies, we usually think about few very common diseases, very common conditions for which shoulder arthroscopy is performed. One of them is the patient suffering from shoulder dislocation. And because shoulder joint is a joint which is made for mobility and thereby compromising with the stability, it is more prone to getting dislocated and the common dislocation is getting dislocated in the front or anterior dislocation. Usually when the shoulder dislocates, there is an injury to a structure which is known as labrum. Labrum is a structure which is a cartilaginous structure that surrounds the periphery of the socket of the joint. Shoulder joint is a ball and socket joint. So, this labrum gets toned in the front and sometimes the tear extends till the lower part of the cup also. The arthroscopy is usually recommended and we attempt repair of the labrum by making three or four odils which are very small incisions as I have explained you just now. It is very, we can say very less traumatic surgery as compared to the surgeries we used to do 30-40 years back, which were open surgeries and there were bony procedures also, but we now attempt to repair the tear and restore the normal anatomy of the shoulder joint. Almost every time the procedure gives a very good result. The second commonest, one of the commonest conditions for which shoulder arthroscopy is done is the rotator cuff tear. Rotator cuff is a combination of four muscles which are carrying out the movements at the shoulder joint along with some other major muscles. They are supraspinitis, infraspinitis, tyrospin and subscapularis. So, these muscles I can show you, I will like to show you a model. I have a model here. So, this model is showing a shoulder joint. The joint is a complex joint. It is not a shoulder joint actually, it is a shoulder girdle which has three bones. Clavicle which is there on in the front and there is a scapula which is there in the back and the arm bone which is known as humerus. The rotator cuff is attached on the humerus at this point. It is a cuff. Any tear, a complete tear, the rotator cuff will definitely hamper the movement at the shoulder joint which is usually abduction. Abduction means lifting your arms sideways and once it goes beyond a certain angle the delitoid takes over. Shoulder arthroscopy is an excellent method to repair these tears. With fairly good results and early mobilization of the shoulder can be attempted very next day. Thirdly, you can also take biopsies for some suspected lesions. We can use shoulder arthroscopy for opening the joints which are stiff like adhesive capsulitis. In a layman town we can say frozen shoulder. We can do release of the frozen shoulder by arthroscopies. Also arthroscopy can be done for removal of bones which are abnormally formed as we age. Like acromion hooks, the arthritis of the acromion clavicular joint so we can also depride these joints. There are certain structures in the shoulder joint which are primarily made for decreasing the friction between the tendons and the bones. These are bilayered structures and are known as bursas. The inflammation of the bursa usually gives immense pain in the shoulder because the space through which the tendons pass and the bursa is there, it's very a compromised state and once the bursa swells the space reduces and because it is inflamed also any pressure at that point by the tendon or the bone gives immense pain. Shoulder arthroscopy is an excellent tool to get rid of this condition. You can perform bursa to me that means removal of bursa. Mobilization can be started next day. I have noticed there are issues with the patients relating to the cost factor of the shoulder arthroscopy. The cost of the arthroscopy as compared to the open surgeries, I don't find any substantial difference. The cost is almost the same. Equipments are almost the same except for arthroscopy equipments which are arranged on a separate trolley. These are some small instruments along with the scope, arthroscope. Second common concern with the patients is whether arthroscopies are covered by the insurance companies or not. All scopies, all surgeries that we do through an arthroscope are covered. The only thing is the disease may not be covered in your insurance policy. Suppose there is a locking period of say 2 years for the ACL knee ligament injury. Then whether you do it open or you do it by arthroscope it won't be covered in the initial 2 years. But when the locking period is over all surgeries are covered. When we in a nutshell if we want to explain the whole topic of arthroscopy then we will be quick to address the issue in Hindi for our patients, for our clients, Hindi nationals. Arthroscopy is a surgery method in which we put a camera in a joint and we operate while watching it on TV. If we talk about the shoulder dislocation in this case, the damage caused by the joint can be repaired. Some muscles can be repaired. The big bones can be smoothened and the biopsies can also be taken. This duration of surgery is 1 to 1.5 hours and sometimes 2 hours of complex surgeries. Blood loss is not equal. Tissue damage is also very less when we compare it with open surgeries. Another important thing about shoulder arthroscopy is that we cannot see that part of the joint with open eyes. For example, this is my model. We are looking at the clavicle and if I want to see the under surface of the clavicle then I cannot see it with my eyes down. But you can simply put your arthroscopy here and as soon as you turn it, the camera will be under surface. So that area of the joint where we do not have access to the naked eye, that arthroscopy can be accessed and you can easily see it on TV. So friends, these shoulder arthroscopy advanced surgeries are available in Manipal Hospital which we have been doing here for many years. Me and my team have been doing arthroscopy here for almost 12 years and many of our patients have taken advantage of it. There are basketball players, there are cricket players, there are accidental injuries, there are simple slip and falls. There are many ways in which this can hurt your shoulder. So for today, I will request my audience that they have any questions to ask. If they have got any queries, I will be very happy to answer them and satisfy them. If you have any questions, please do ask. I will try my best to answer them correctly. Rajiv Sharma has asked a question, when do we need shoulder replacement surgery? Rajiv Ji, shoulder replacement surgery is an open surgery. This arthroscopy is not through any camera. It is not our topic, but I would like to tell you that either the patient has advanced arthritis, that is, his joints are completely bent and deformed and there is so much friction between them that it always hurts, which is not very common. This is not a very common thing, it is seen in the knees and hips, but the arthritis of the shoulder is usually very little. The second problem may be that the old infection occurred in the joint and after that the surface of the joint got damaged. Secondary arthritis has happened and now the pain remains in every movement, then the surgeon says go for replacement. Third thing, if the bone fracture is broken, there is no chance for reconstruction, it is not possible to fix it again. Then also sometimes we have to go for replacement. Another thing that we call an avascular necrosis. A means not vascular, vascular means blood, necrosis means death. If there is no blood, there is bone death. A vascular necrosis is also in the hip, that is, the joint of the shoulder is more common. It is not as common as you can see, but still there are some cases in which the bone has such a war and we had to replace the shoulder. Your next question is, what are the possible risks involved with shoulder replacement surgery? See, well, surgery done by a well experienced and technically sound surgeon. So, it should not be difficult in alignment and function. But during the procedure, when you are dissecting, when we reach the shoulder joint, the tissue we dissect, there are blood vessels and nerves in it. So, the danger of those blood vessels and nerves getting damaged is always there. Even in the operations with very good hands, sometimes, unfortunately, nerves get damaged, which are usually recoverable. Because in most cases, the tissue we retract and put into the joint, it usually recovers. That is a very safe surgery, otherwise. Deepankar Sahaja is asking, can we talk about Tennis Elbow in the next session? Then I would like to tell Deepankar, yes, why not? Because we are not only doing arthroscopies of shoulder and knee, but we have started doing elbows also. And the commonest problem for which elbow arthroscopy is Tennis Elbow. Or there is a tear in the muscle, which is known as extensive papyridiaeus pridus. So, it is a point on the outside of the elbow. So, we will talk in detail in the next session about it. What is Tennis Elbow? How it is caused? What are the different methods by which you can suffer this injury? What are the treatment modalities? And what is the role of arthroscopy in Tennis Elbow? So, my dear friends, I think that was the session for the day. I think I had been fairly informative to you. In the next session, as suggested by Deepankar, we will talk about Tennis Elbow. Thank you very much. This is Dr. Rajesh Kumar, orthopedic consultant from Manipal Hospital, signing off for the day. Thank you. Bye-bye.