Three bones—the collarbone, shoulder blade, and upper-arm bone—meet together to create the shoulder joint. The bones are surrounded by a number of tissues, including ligaments, muscles, tendons, and cartilage. The synovium, a tissue that surrounds the joint, secretes a lubricating fluid known as "synovial fluid," which nourishes cartilage, reduces friction within the joint and ensures pain-free range of motion. However, in cases such as Rheumatoid Arthritis,
the synovium becomes infected and inflamed. It is necessary to remove an inflamed synovium to reduce pain and increase the patient's range of motion. This procedure is known as a synovectomy, and is most often performed arthroscopically. It is often accompanied by a bursectomy (removal of fluid-filled sac that lubricates the shoulder), subacromial decompression (removal of extra bone and tissue to allow rotator cuff to move without friction), and removal of loose bodies or bone spurs that clutter the joint.
Detailed Description
Specialist
Orthopedic surgeon
Procedure
Before the procedure:
The patient's medical history and any possible allergies to medication are determined. The surgeon may order X Rays, an MRI, CT Scan, or EMG to look into the joint before the procedure. The patient is dressed in a hospital gown and anesthetized either locally or generally.
During the procedure:
A number of half-inch incisions will be made to allow the arthroscope to enter the shoulder joint. A sterile saline solution will be pumped into the joint both to cleanse it and to expand it for better visualization. The surgical staff may also pump air into the joint to create more room to see inside the joint. While watching a monitor that shows a magnified image of the inside of the shoulder, the surgeon guides the arthroscope to perform the procedure.
The surgeon uses the arthroscope to investigate any problems associated with synovitis: damage to the cartilage, loose bodies, or other inflamed or damaged tissue. He or she then removes the synovium from inside the shoulder joint using cutting tools and arthroscopic suction equipment. The patient may be discharged following the procedure, or may remain in the hospital for one to two days.
Recovery:
Recovery from the procedure most likely involves wearing a sling, which is removed for longer periods of time as healing progresses. Range of motion and strengthening exercises will follow the synovectomy. The most common of these is an exercise in which the patient walks his or her fingers up a wall to increase the range of motion within the shoulder. As always, post-operative exercises should only be done under the advice of a doctor or physical therapist. Therapy will hurt at first, but continued adherence to the exercises will both reduce pain and increase range of motion.
Complications/Risks:
- Re-growth of synovium
- Blood clots (very rare)
- Surgical wound infection
- Reaction to anesthesia
- Risk of developing arthritis
- Weakening of muscles
- Stiffness
- Neurovascular injury
Medications:
Prescription and non-prescription painkillers, shoulder sling for support.
Tell your doctor if …
You experience increasing pain, prolonged swelling, decreased sensitivity or decreasing joint motion after the procedure. Also, if you experience any symptoms suggestive of infection such as general malaise (tiredness) or fever, notify your doctor.
Last updated: 01-Jan-00
