Science Buddies: "Ask an Expert"

what type of shoulder surgery heals better or faster, scoping or open surgery? what kind of surgery is there for shoulders?

In general, the less invasive a surgery is, the shorter the recovery time. Thus, it can be generalized that the recovery time from an arthroscopic surgery is shorter than the recovery time from an open surgery.

The type of surgery performed depends on the goal of the surgery.

if arthroscopic is the shorter recovery time, why are doctors still performing both surgeries? i've been told by a doctor that open surgery vs. arthroscopic is a hot debate right now.

I believe that the debate is more about failure rates or "patient satisfaction" than about recovery times. A google search for "open surgery vs. arthroscopic" will lead you to several studies. If you have access to medical journals, this article will provide a discussion of some practical issues involved:

Controversies in arthroscopic shoulder surgery: arthroscopic versus open bankart repair, thermal treatment of capsular tissue, acromioplasties—are they necessary?
Angelo RL
Arthroscopy: The Journal of Arthroscopic and Related Surgery
December 2003 (Vol. 19, Issue (Supplement), Pages 224-228)

i think that medicated treatment is usually based on the popular opinion of both the doctor and the patient. and yes there is debate about many treatments but it is all about preference. recovery times does play an important roll because some patients may want a light surgery but the treatment for the certain cause may not be as complete as compared to a heavy surgical treatment in which may fix 99.9% of the cause

think of it like cancer...chemotherapy does help and somethimes it may take out most of the cancer....but opening someone up to take out the tumor is more serious

i am good friends with an excelent orthopidic surgon who says that the debate of arthroscopic carpultunnel surger is better than open and he said that its almost proven that arthroscopic is always better. are there any other procedures that are more accepted when it comes to shoulders?

I am a little confused about your question. Have you decided based on the opinion of your friend that the comparison of arthroscopic versus open surgery is a settled debate, and now you are looking for some other comparison?

You may want to look at the response I just left to a similar question on the physics "Ask an Expert" Forum. Not really physics, but hey, I'm a doc so I gave it a shot.

You need to distance yourself from the personal axes to grind of various surgeons (boy, if that was easy in what I do for a living.) A surgeon is likely to initially give you the answer that what he does routinely/exclusively/enjoys doing the most is always preferable.

Like most things in life, there are more than one way to skin a cat. What you need is to find review articles in peer-reviewed medical journals (orthopedic in this case) that compare techniques. No technique is universally better for every criteria (I wish that medicine was that easy). Everything has its plusses and minuses.

Arthroscopic techniques often have the advantage of less postoperative discomfort and quicker recovery. But if the goal is complete recovery, some arthroscopic techniques have limited visibility and things can be difficult to repair/see if you can't visualize them well.

Also, it takes time for a consensus opinion to form. Lots of doctors like new toys to play with. Which stand the test of time is the $64,000 question.

You need to pick a narrow criteria as to what defines "best." Pain-free range of motion, time until full weight-bearing, number of doses of post-operative pain medication required, there are tons of them. Do some research and pick something narrowly defined that you can study.

my goal of this activity is to pic a project- shoulder surgery- and to spend until about february becoming the master of this topic. i have narrowed down my interest to discovering the pro's and con's of scopic shoulder surgery and open shoulder surgery dealing with the same operation. i need help figuring out what it is a exactly i would like to gain out of this activity and am open to suggestons i have acess to medical records and can sign a FIFA to look at them. i would like some imput on what my total outcome should be aimed at.

I would do a search on types of shoulder surgery and pick one type of repair. The shoulder is a complicated joint, and there are a variety of operations on it.

Rotator cuffs tears are a common injury. Repair of them has been of great interest to orthopods 1.) due to star athletes getting them (e.g. Tommy John), 2.) Due to many people getting them, 3.) Due to their debilitating nature, and 4.) Due to a variety of techniques available to repair them (not all of which are surgical). Bankart procedures are another procedure that comes to mind. Total shoulder replacements are uncommon, and to my knowledge solely open procedures, so a comparison wouldn't be possible for you.

Here's a nice summary of some types of shoulder surgeries:

http://orthopedics.about.com/od/shoulde ... scopic.htm


Shoulder joints and their muscular and tendon attachments are complex, as is their kinesiology. It would be a great accomplishment to truly understand their motion and mechanism of injuries.

A retrospective chart review will have many issues of bias associated with them. For example, if you go to one orthopedic group, they have one shoulder expert, and he does 95% of his procedures using one technique, you won't get an unbiased sample to analyze. Looking at hospital records with several orthopedic surgeons (preferably from different groups/trained at different residencies) would help.

There will also be many HIPAA issues involved in getting the records. If that will be your approach, make absolutely sure before you embark on this that you really will be able to review the charts. Very often it is not possible / many institutions do not allow it.

I hope I haven't overwhelmed you with details, and I hope this gets you going in the right direction. Good luck, and have fun with your project.

thank you very much you have been very helpful. i may have some questions later but this is enought to get me going. thank you for your time i really appriciate it