What is shoulder arthroscopy and how is it performed?

Shoulder arthroscopy is a minimally invasive surgical technique in which a small camera (arthroscope) and instruments are introduced into the shoulder joint through small portals, avoiding the need for a large open incision. It is used to treat a wide range of shoulder conditions including rotator cuff tears, shoulder instability, labral tears, impingement, frozen shoulder, and biceps tendon pathology. It is performed under general anaesthetic as a day or overnight procedure, with significantly faster recovery than open surgery.

How long is recovery after rotator cuff repair surgery?

Recovery after arthroscopic rotator cuff repair involves sling immobilisation for approximately 6 weeks to protect the repaired tendon while it heals. Physiotherapy begins early with gentle range-of-motion exercises, progressing to strengthening at 3 months. Most patients return to light work and daily activities at 6–8 weeks, and to full activities and sport at 9–12 months. The timeline varies depending on the size of the tear and the demands of the patient's work and sporting activities.

Can shoulder surgery be covered by ACC or health insurance?

Shoulder surgery for conditions caused by an acute injury — including rotator cuff tears, shoulder dislocations, and labral tears — is often eligible for ACC cover in New Zealand. Degenerative conditions not related to a specific injury are not ACC-eligible but may be covered by private health insurance. Southern Cross and other major insurers typically cover shoulder surgery subject to policy terms and pre-approval. Dr Boyle's rooms can assist with information required for ACC claims and insurance pre-approvals.

Shoulder Procedures

Dr. Boyle performs the following shoulder procedures:

Arthroscopic rotator cuff repair

Keyhole repair of partial or full-thickness rotator cuff tears, performed through small portals using suture anchors to reattach the torn tendon to the bone. Performed as a day or overnight procedure under general anaesthetic. Recovery involves sling immobilisation for 6 weeks followed by a structured physiotherapy programme, with return to sport typically at 9–12 months. ACC-eligible for tears caused by an acute injury.

Arthroscopic Stabilisation (Bankart Repair)

Surgical repair of the torn anterior labrum and joint capsule following shoulder dislocation or instability. Performed arthroscopically through small portals. Highly effective at reducing the risk of re-dislocation and allowing return to sport. Recommended for active patients with recurrent instability or following a first dislocation in a young sportsperson. ACC-eligible following acute dislocation.

Latarjet Procedure

The Latarjet procedure is a bone transfer operation performed for shoulder instability that cannot be adequately treated with soft tissue repair alone. It is recommended when the shoulder socket (glenoid) has lost bone as a result of repeated dislocations — a situation known as a bony Bankart lesion or glenoid bone loss — or when a previous arthroscopic stabilisation has failed. During the procedure, a small piece of bone (the coracoid process) is transferred to the front of the shoulder socket, deepening it and providing an additional sling effect to prevent re-dislocation. The Latarjet procedure has excellent long-term results in appropriately selected patients and allows return to contact sport.

Posterior Labral Repair

Posterior labral repair is an arthroscopic procedure to reattach the torn posterior (back) labrum to the rim of the shoulder socket. It is performed for patients with posterior shoulder instability — a feeling of the shoulder slipping backwards — or following a posterior dislocation. The torn labrum is identified arthroscopically and secured back to the glenoid rim using small suture anchors, restoring the natural depth and stability of the joint. Recovery involves a period of sling immobilisation followed by a structured physiotherapy programme, with return to sport typically at 4–6 months.

SLAP Repair

A SLAP repair is an arthroscopic procedure to reattach the superior (top) labrum to the rim of the shoulder socket following a SLAP tear. Small suture anchors are used to secure the torn tissue back to the bone. SLAP repair is most appropriate for younger active patients with a confirmed superior labral tear causing significant symptoms. In older patients or those with associated biceps tendon pathology, biceps tenodesis may be recommended as an alternative or additional procedure. ACC cover applies when the tear resulted from an acute injury. Return to overhead sport typically occurs at 4–6 months.

Biceps Tenodesis

Biceps tenodesis is a procedure in which the long head of the biceps tendon is detached from its attachment at the top of the shoulder socket (where it contributes to labral pathology) and reattached at a lower point on the upper arm bone. By relocating the tendon anchor, tenodesis relieves anterior shoulder pain caused by biceps tendon pathology, SLAP tears, or biceps tendinopathy, while preserving biceps muscle function and strength. It is commonly performed arthroscopically or through a small open incision, often in combination with rotator cuff repair. Recovery involves sling immobilisation for 4–6 weeks, with return to full activity at 4–6 months.

Subacromial Decompression

Subacromial decompression is an arthroscopic procedure to create more space for the rotator cuff tendons beneath the acromion (the bony arch at the top of the shoulder). A small burr is used to smooth away any bone spur or thickened tissue on the undersurface of the acromion that is causing impingement on the rotator cuff. The procedure relieves the pain and restricted movement associated with shoulder impingement and subacromial bursitis, and is often performed in combination with rotator cuff repair. It is performed as a day procedure under general anaesthetic, with most patients returning to light activities within 2–4 weeks.

Calcific Tendonitis Debridement

Calcific tendonitis debridement is an arthroscopic procedure to remove calcium deposits from within the rotator cuff tendons — most commonly the supraspinatus — in patients whose symptoms have not resolved with non-operative treatment. Using a small shaver and burr, the calcium deposit is identified and thoroughly removed from the tendon. The procedure relieves the pain caused by the deposit and eliminates the source of the inflammatory response within the tendon. It is performed as a day procedure and is highly effective in appropriately selected patients, with significant pain relief typically experienced within weeks of surgery.

Frozen Shoulder Release (Arthroscopic Capsular Release)

Arthroscopic division of the thickened shoulder capsule to restore range of movement in patients with adhesive capsulitis (frozen shoulder) that has not resolved with non-operative treatment. Performed under general anaesthetic as a day procedure. Most patients experience significant improvement in shoulder movement within weeks of surgery, followed by a structured physiotherapy programme to consolidate gains.

AC Joint Reconstruction / Stabilisation

Acromioclavicular (AC) joint reconstruction is a surgical procedure to restore stability to the acromioclavicular joint following a significant dislocation (grade IV–VI separation) or in patients with chronic instability causing ongoing pain and functional limitation. The procedure reconstructs the ligaments that normally hold the clavicle down to the shoulder blade, using a combination of synthetic fixation devices and, where appropriate, tendon graft tissue. It is most commonly performed through a combination of arthroscopic and small open incisions. ACC cover applies to acute dislocations sustained through an injury. Return to contact sport typically occurs at 4–6 months.

Distal Clavicle Excision (Mumford Procedure)

Distal clavicle excision involves the removal of a small amount of bone from the end of the collarbone (clavicle) where it meets the acromion at the AC joint. By creating a small gap at the joint, the procedure eliminates the bone-on-bone contact that causes pain in AC joint arthritis or following AC joint injury. It is performed arthroscopically as a day procedure and is highly effective in relieving the pain associated with end-stage AC joint degeneration. Recovery is relatively rapid, with most patients returning to light activity within 2–3 weeks and full activity at 6–8 weeks.

Suprascapular Nerve Decompression

Suprascapular nerve decompression is a procedure to relieve compression of the suprascapular nerve, which supplies the infraspinatus and supraspinatus muscles of the rotator cuff. Compression may occur at the suprascapular notch or spinoglenoid notch — sometimes caused by a ganglion (fluid-filled) cyst associated with a labral tear — and causes deep shoulder aching, weakness of external rotation, and in some cases wasting of the muscles at the back of the shoulder blade. Where a cyst is the cause, arthroscopic decompression of the cyst and repair of the associated labral tear is highly effective. Isolated nerve compression without a cyst may be treated with arthroscopic release of the transverse scapular ligament.

Shoulder Arthroscopy / Diagnostic Arthroscopy

Shoulder arthroscopy is a minimally invasive procedure in which a small camera (arthroscope) is inserted into the shoulder joint through a small portal to assess the internal structures of the joint. It allows direct visualisation of the rotator cuff, labrum, articular cartilage, biceps tendon, and joint capsule. Diagnostic arthroscopy is performed when a definitive diagnosis cannot be established through clinical examination and imaging alone. In most cases, any pathology identified at the time of arthroscopy can be treated during the same procedure — making diagnostic arthroscopy and operative treatment a single-stage process. It is performed as a day procedure under general anaesthetic.

To arrange a specialist assessment, ask your GP or physiotherapist to refer you to Dr. Matthew Boyle at Auckland Bone and Joint Surgery. Referrals can be sent via HealthLink EDI: drmboyle, or by calling 09 281 6733. Dr. Boyle consults at AUT Millennium, 17 Antares Place, Rosedale, North Shore Auckland.