Clinicians › Shoulder

Shoulder Arthroscopy

What shoulder arthroscopy is, what it's used for, and how to prepare and recover.

184 citationsUpdated Oct 2026

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Shoulder arthroscopy is a commonly performed procedure generally considered safe, with morbidity and mortality remaining rare events [3, 42]. The overall 30-day complication rate is 1.0%, with complication rates typically ranging between 1% and 2% [5, 82]. While complications are not necessarily less prevalent or devastating than those associated with open techniques, they differ in nature [2]. The most common complication is return to the operating room, accounting for 29% of all complications, while readmission rates remain less than 1% [5, 82]. Increasing age and higher ASA scores are identified risk factors for adverse events [82]. Patients aged 60 years or older exhibit a low overall 30-day postoperative complication rate of 1.6%, which is higher than previously reported for the overall shoulder arthroscopy population [40].

The patient population undergoing shoulder arthroscopy in the US is primarily older, white, male adults [12]. Postoperative pain is relatively low, and the efficacy of the procedure is long-lasting in terms of pain symptoms [13]. For active patients aged 40 years and older undergoing arthroscopic shoulder stabilization, functional outcomes are favorable at a mean follow-up of 7 years, with low rates of revision surgery and progression to clinically relevant osteoarthritis [6]. Considering new technical possibilities, most cases of anterior shoulder instability are suitable for arthroscopic reconstruction, though further studies are necessary to validate continued efficacy [32]. Proper evaluation of bone loss best determines surgical indications and outcomes for shoulder instability [72].

Current guidelines for thromboprophylaxis lack consensus and require patient-specific considerations [39]. Surgeons must carefully interpret literature comparing open and arthroscopic rotator cuff repair outcomes, as differences in complications may be influenced by selection bias and narrowing indications for open repair [43]. The shoulder arthroscopy literature remains controversial, with conclusions often unsupported due to bias and limitations, and no clinical guidelines are definitive pending higher levels of evidence [4]. Arthroscopic shoulder procedures are increasingly performed in ambulatory surgery centers, although reimbursements declined from 2013 to 2022 [220]. A criteria-based testing protocol for return to play following arthroscopic shoulder stabilization is strongly recommended [45].

Anatomy & Pathophysiology

Bony Anatomy

The proximal humerus comprises four main parts: the humeral head, greater tuberosity, lesser tuberosity, and humeral shaft [89]. The articular head is spherical with a diameter of 37 to 57 mm [89] and an arc of approximately 160 degrees covered by articular cartilage [98]. The radius of curvature of the humeral head is approximately 25 mm, slightly larger in men than in women [98]. The most superior portion of the articular surface averages 8 mm above the greater tuberosity [89], with the superior margin normally positioned 8 to 10 mm superior to the top of the greater tuberosity [98]. Humeral version averages 29.8 degrees, ranging from 10 to 55 degrees [89]. The humeral head is retroverted an average of 30 degrees relative to the transepicondylar axis [90, 100] and 19° of retroversion relative to other axes [91]. The neck-shaft angle measures an average of 135 degrees [90] or 45 degrees (±5 degrees), with a range of 30 to 50 degrees [98]. The humeral head is inclined approximately 130 degrees with respect to the humeral shaft [89] and 41° of inclination [91]. The anatomic neck is located at the junction of the articular surface and the tuberosities, while the surgical neck represents an indistinct region below the tuberosities but above the humeral shaft [89].

The greater tuberosity serves as the attachment site for the supraspinatus, infraspinatus, and teres minor tendons [89], while the lesser tuberosity serves as the attachment site for the subscapularis tendon [89]. The bicipital groove lies between the greater and lesser tuberosities and serves as a pathway for the long head of the biceps [89]. The distal aspect of the bicipital groove is internally rotated with respect to the proximal portion [89]. The distance from the lateral base of the coracoid process to the lateral margin of the greater tuberosity is called the lateral humeral offset [98].

The glenoid is a convex structure of shallow depth shaped like an inverted pear [89]. The glenoid cavity is a shallow socket, approximately one third the size of the humeral head [90]. The glenoid articular surface radius of curvature is 2 to 3 mm larger than that of the humeral head [98]. The subchondral bone of the glenoid is relatively flat, and the articular concavity is augmented by cartilage and a circumferential labrum [91]. The glenoid labrum increases the depth of the socket by 50% around the humeral head [99] and provides up to 50% of marginal glenoid socket depth [91]. The glenoid articular surface and the labrum combine to create a socket that is approximately 9 mm deep in the superoinferior direction and 5 mm deep in the anteroposterior direction [99]. Adding the glenoid labrum increases the glenoid surface to 75% of the humeral head vertically and 57% horizontally [99]. The glenoid averages 5° of retroversion in relation to the axis of the scapular body [91, 100].

The scapula is anteverted on the chest wall approximately 30 degrees relative to the body [100]. The acromion has three ossification centers: the metacromion (base), the mesoacromion (middle), and the preacromion (tip) [91]. Failure of fusion of the acromial ossification centers results in os acromiale [91]. The clavicle is the first bone to ossify (fifth week of gestation) and is the only long bone to ossify by intramembranous ossification [91]. The medial (sternal) epiphysis of the clavicle is the last ossification center to fuse, at age 20 to 25 years [91]. The primary blood supply to the clavicle is periosteal, and no nutrient artery is present [91]. The scapula has only one true diarthrodial articulation, the acromioclavicular (AC) joint [91].

The proximal humerus has three centers of ossification: the humeral head (4 to 6 months), the greater tuberosity (1 to 3 years), and the lesser tuberosity (3 to 5 years) [91]. The proximal humeral ossification centers fuse to the shaft at age 17 to 20 years [91]. The proximal humeral physis closes by 14 to 17 years of age in girls and by 16 to 18 years in boys [95]. Eighty percent of subsequent growth of the humerus comes from the proximal humeral physis, accounting for approximately 40% of the growth of the entire upper extremity [95]. Humeral retroversion averages 65 degrees in infants and young children and gradually decreases, approaching adult values by 11 years of age [95]. The posteromedial metaphysis, a portion of the physis, and the epiphysis are intracapsular in the proximal humerus [95]. A large part of the proximal humeral physis is extracapsular, making it susceptible to traumatic injury [95]. The periosteum is thicker and stronger in the posteromedial portion of the proximal humerus than in the anterolateral portion [95].

Vascular Supply

The proximal humerus receives its blood supply from the anterior and posterior humeral circumflex branches from the third division of the axillary artery [89]. The anterior humeral circumflex artery arises from the axillary artery at the inferior border of the subscapularis and provides vascular inflow to the humeral head by way of its terminal anterolateral branch known as the artery of Laing (arcuate artery) [89]. The anterolateral ascending branch of the anterior humeral circumflex artery provides the primary blood supply to the humeral head [91]. The terminal intraosseous portion of the anterior humeral circumflex artery enters at the proximal aspect of the intertubercular groove as the arcuate artery [91]. The ascending branch of the anterior humeral circumflex artery courses parallel to the lateral aspect of the long head biceps tendon and enters the humeral head at the interface of the bicipital groove and greater tuberosity [89]. The major blood supply to the humeral head is through the ascending branch of the anterior humeral circumflex artery, which penetrates the head at the bicipital groove and becomes the arcuate artery [90].

The posterior humeral circumflex artery travels with the axillary nerve, enters the quadrilateral space posteriorly, and anastomoses with a branch of the anterior circumflex to supply the posterior cuff [89]. Quantitative assessment has shown that 64% of the humeral head blood supply arises from the posterior humeral circumflex artery [95]. Additional extraosseous collateral branches can permit humeral head perfusion despite complete ligation of the arcuate artery [89]. Injury to the arcuate artery may result in osteonecrosis of the humeral head [89]. Fractures of the anatomic neck have a poor prognosis because of complete disruption of the blood supply to the head [90]. A fracture involving the anatomic neck is prognostically worse than fractures involving other regions of the proximal humerus with respect to the potential disruption of the vascular supply to the humeral head and the subsequent development of avascular necrosis [89]. Surgical neck fractures are common, and with these, the blood supply to the head is preserved [90].

Nerve Supply

The brachial plexus and axillary artery are anterior to the coracoid process of the scapula and humeral head [90]. Nerves innervating muscles around the shoulder include the axillary, suprascapular, subscapular, and musculocutaneous nerves [90]. The brachial plexus is prone to injury when the proximal humerus is injured in fractures or dislocations, or during traction [95].

The axillary nerve is a terminal branch coming off the posterior cord of the brachial plexus just proximal to the coracoid process [94]. It circles the humeral neck just inferior to the glenohumeral joint as it courses posteriorly [95]. The axillary nerve passes beneath the conjoined tendon anterior to the subscapularis 3 to 5 mm medial to the musculotendinous junction and then adjacent to the inferior capsule before entering the quadrilateral space posteriorly [94]. The axillary nerve splits into the anterior and posterior branches within the quadrangular space [94]. The anterior and middle deltoid muscle receives sole innervation from the anterior branch of the axillary nerve [94]. Posterior deltoid muscle innervation varies, with supply only from the anterior branch in 2.3% of cases, from the posterior branch in 8.5%, and from both branches in 89.1% [94]. The posterior branch of the axillary nerve branches to supply the teres minor muscle and then terminates as the superior lateral brachial cutaneous nerve [94]. No accessory motor branches to the anterior deltoid cross the tendinous raphe between the anterior and lateral deltoid [94].

In the anterior deltopectoral approach, the axillary nerve can be palpated by sweeping a finger inferiorly across the subscapularis muscle tendon interface [94]. In the anterolateral deltoid splitting approach, the axillary nerve crosses approximately 5 cm inferior to the anterolateral acromial corner [94]. Shoulder abduction brings the axillary nerve closer to the acromion landmark [94]. In the posterior deltoid splitting approach, the axillary nerve is approximately 7 cm from the posterior acromial corner [94].

The suprascapular artery runs superior to the superior transverse scapular ligament, and the suprascapular nerve runs deep to the ligament [91]. Entrapment of the suprascapular nerve at the superior transverse scapular ligament causes denervation of both the supraspinatus and the infraspinatus [91]. The spinoglenoid ligament overlies the suprascapular nerve at the spinoglenoid notch [91]. Entrapment, traction, or compression of the suprascapular nerve at the spinoglenoid notch causes denervation of the infraspinatus [91]. The acromial branch of the thoracoacromial artery runs on the medial aspect of the coracoacromial ligament [100].

Muscles and Rotator Cuff

The rotator cuff consists of four muscles: the subscapularis, supraspinatus, infraspinatus, and teres minor [90]. The teres major is not a rotator cuff muscle [90]. The cuff muscles serve as depressors of the humeral head to allow the deltoid to efficiently abduct the humerus [90]. The infraspinatus and teres minor are external rotators, while the subscapularis is an internal rotator of the humerus [90]. The deltoid and pectoralis major muscles, along with the rotator cuff, cause predictable displacement of fractures around the proximal humerus [90].

The subscapularis originates from the anterior scapula and inserts anteriorly onto the lesser tuberosity [95]. It is the largest and strongest of the rotator cuff tendons [128]. The subscapularis is responsible for active internal rotation of the humerus and contributes to the stability of the shoulder [128]. It forms the anterior portion of the transverse plane "force couple" of the rotator cuff and serves to balance the forces generated across the joint to maintain glenohumeral congruency throughout movement [128]. The subscapularis inserts on the lesser tuberosity and causes medial displacement of fracture fragments [89].

The greater tuberosity provides attachment superiorly and posteriorly for the supraspinatus, infraspinatus, and teres minor, all of which originate from the posterior scapula [95]. The supraspinatus and infraspinatus insert on the greater tuberosity and cause superior and posterior displacement of fracture fragments [89]. The tendons of the infraspinatus and supraspinatus muscles join approximately 15 mm proximal to their insertion and cannot be readily separated by blunt dissection [99]. The infraspinatus and teres minor fuse near their musculotendinous junctions [99]. The teres minor has often been viewed as a minor contributor to rotator cuff function, but there has been heightened attention to its contribution, particularly when the other cuff tendons fail [99].

The deltoid forward flexes and abducts the shoulder and courses from the clavicle and acromion superiorly, coalescing into a common tendinous insertion onto the lateral upper third of the humeral shaft [95]. The pectoralis major powers adduction and internal rotation due to its tendinous insertion anteriorly onto the lateral wall of the bicipital groove [95]. The pectoralis major inserts on the humeral shaft and displaces it medially [89]. In massive rotator cuff tear, the pectoralis major and latissimus dorsi muscles are effective in improving glenohumeral kinematics and reducing acromiohumeral pressures [130].

Ligaments and Capsule

The shoulder capsule is large and has twice the surface area of the humeral head [102]. The shoulder capsule typically accepts approximately 28 to 35 mL of fluid, with a greater amount in women than in men [102]. In patients with adhesive capsulitis, the shoulder capsule accepts only 5 mL or less of fluid [102]. In patients with considerable laxity or instability, the shoulder capsule can accept larger volumes of fluid [102]. The capsule is lined by synovium and extends from the glenoid neck (or occasionally the labrum) to the anatomic neck and the proximal shaft of the humerus to varying degrees [102].

The coracoacromial ligament contributes to anterosuperior stability in rotator cuff deficiency and should be preserved with irreparable cuff tears to prevent anterosuperior escape [100]. The coracoacromial ligament is the arthroscopic landmark for a complete release of the rotator interval for adhesive capsulitis [100]. The coracohumeral ligament is a thick band of fibrous tissue extending from the coracoid process along the surface of the capsule to the tuberosities between the supraspinatus and subscapularis tendons [99]. The coracohumeral ligament is deep to the tendinous insertion of the cuff and blends with the capsule and supraspinatus tendon to form part of the roof of the biceps sheath [99]. A 1-cm wide thickening of fibrous tissue extends posteriorly from the coracohumeral ligament origin on the coracoid to the posterior margin of the greater tuberosity [99].

The transverse humeral ligament is an important stabilizer of the biceps tendon [100]. The transverse humeral ligament consists of a few transverse fibers of capsule that extend between the greater and lesser tuberosities and help contain the long head of the biceps tendon in its groove [102]. The fibro-osseous bicipital tunnel consists of three distinct anatomic zones: Zone 1 (bony groove), Zone 2 ("no man's land" from distal margin of subscapularis to pectoralis major tendon), and Zone 3 (subpectoral region) [92]. The soft tissue sheath covering the long head of the biceps tendon contributes to the roof of the bicipital tunnel [92]. The supraspinatus and subscapularis tendons join as a sheath that surrounds the biceps tendon at the entrance of the bicipital groove [99]. The roof of the biceps sheath consists of a portion of the supraspinatus tendon, and a sheet of the subscapularis tendon forms the floor [99]. The pectoralis major forms the roof of the distal continuation of the bicipital tunnel, which is a closed space that extends proximally to the glenohumeral joint [95].

Normal shoulder motion is approximately two-thirds glenohumeral and one third scapulothoracic [91].

Classification

Wright and Cofield: This classification divides periprosthetic humeral fractures associated with shoulder arthroplasty into three categories based on fracture location relative to the stem. Type A fractures propagate proximally from the distal stem, type B fractures are centered over the distal stem, and type C fractures are located distal to the tip of the stem [227].

DeOrio and Cofield: This system categorizes rotator cuff tears by size. Tear size is defined as small (<1 cm), medium (1 cm to <3 cm), large (3 cm to <5 cm), or massive (>5 cm) [269].

Rockwood: This classification differentiates rotator cuff tears chronologically based on the time since symptom onset or trauma. Categories include acute (<6 weeks), subacute (≥6 weeks and <6 months), chronic (≥6 months and <1 year), and inveterate (≥1 year) [270].

Goutallier: This scale classifies muscle fatty degeneration of the rotator cuff into five stages. G-0 indicates no fatty degeneration, G-1 indicates muscle > fat, G-2 indicates muscle = fat, G-3 indicates muscle < fat, and G-4 indicates complete replacement of muscle tissue with fat tissue [270].

Snyder: This classification system categorizes rotator cuff lesions into four types. C1 is defined as a lesion size ≤1 cm, and C2 is defined as a lesion width between 2 cm and <3 cm [270].

Clinical Presentation

History and Patient Demographics

In the United States, patients undergoing shoulder arthroscopy are primarily older, white, male adults [12]. The history must define the mechanism of injury, including the position of the arm, the amount of force applied, and the point of force application [139]. Injury with the arm in extension, abduction, and external rotation favors anterior dislocation [139]. Electoshock, seizures, or a fall on the flexed and adducted arm are commonly associated with posterior dislocation [139]. For recurrent instability, the history defines the initial injury, the position or action that results in instability, how long the shoulder stays out, and what means have been necessary to reduce the shoulder [139]. The history solicits evidence of neurologic or rotator cuff problems after previous episodes of shoulder instability [139]. Previous treatment of recurrent instability and the effectiveness of that treatment should be documented [139].

A failed arthroscopic stabilization procedure often starts with the failure to identify red flags in the patient’s history and physical examination that might preclude a successful arthroscopic repair [114]. Risk factors associated with treatment failure include age, gender, presence of osseous Bankart, and/or large Hill-Sachs lesions [114]. Risk factors associated with treatment failure include participation in competitive collision or forced overhead sports, hypermobility, time lapse between dislocation and reduction, and the number of instability episodes prior to operation [114]. In throwers, a detailed history with the chronology of symptoms is essential [160]. Pitchers commonly complain of loss of pitch control and loss of velocity and also describe symptoms distant from the shoulder joint [160]. Pain during cocking in throwers is often a result of instability or internal impingement with a type II SLAP lesion [160]. Pain during follow-through in throwers arises from rotator cuff or posterior capsular problems [160].

Swimmers often complain of pain during the catch or the recovery, when the shoulder is more often in the provocative impingement position [160]. In swimmers, instability is often the principal culprit, exacerbating symptoms of impingement [160]. Determining the onset of symptoms is critical to differentiate between traumatic and atraumatic instability [160]. Symptoms elicited with the arm in adduction and internal rotation may suggest posterior instability [160]. Symptoms reproduced by holding objects with the arms at the sides often indicate inferior instability [160]. Patient age, speed of onset, and duration of symptoms as well as the possibility of a precipitating injury should be ascertained to determine the contribution of the biceps to shoulder pain [158]. A young athlete with pain only on throwing or heavy use raises the suspicion of a SLAP tear [158]. An elderly individual with a degenerative tendon related to concomitant cuff tears, such as chronic impingement and rotator cuff tears, presents differently than a young athlete [158]. A larger number of patients screened positive for depression amongst patients undergoing knee and shoulder arthroscopy than were formally diagnosed [111].

Physical Examination: General Principles

The clinical evaluation is the beginning of the doctor-patient relationship, with the goal of carrying out an evaluation that leads to a reasonable management plan [54]. The four P’s that determine the outcome of treatment are the patient, the shoulder problem experienced, the procedure to treat the patient and the problem, and the physician rendering the treatment [54]. The examiner should ask, “What does your shoulder problem keep you from doing? When does it bother you the most?” rather than dwelling on pain [54]. The physical exam should start with a “no touch” approach, asking the patient to show which actions are difficult for the shoulder and what they feel is happening [54].

Active motion is checked by asking patients to show how high they can reach overhead, how far they can externally rotate the shoulder with the arm at the side, how far they can reach across their body, how far they can internally rotate the abducted arm, and how high they can reach up their back [54]. If patients cannot raise their arm actively, the examiner asks them to show how high they can raise it with the help of the opposite arm [54]. The examination seeks tangible findings such as loss of passive or active ROM, a palpable defect in the rotator cuff, minimal resistance to anterior translation of the humeral head pressed into the glenoid, palpable subacromial crepitus, muscle atrophy, loss of the biceps reflex, or an obvious “clunk” on cross-body adduction [54]. If the problem is not apparent on history, physical examination, and plain radiographs, or if the patient does not appear to be an excellent surgical candidate, nonoperative management is likely recommended [54].

Most physical examination tests are sensitive for a wide range of shoulder conditions, but very few are specific to the presence of a single disorder [140]. The use of any single test to establish a pathognomonic diagnosis could not be recommended [140]. Combinations of shoulder tests provided better accuracy than single tests, but only marginally so [140]. Imaging studies must be interpreted in light of a thorough history and physical examination and must not be used as a stand-alone method to direct patient care [140]. The evaluation of the overhead athlete requires the close integration of history and physical examination findings while utilizing a systematic approach [160]. Many traditional examination tests of the shoulder have not been validated or critically evaluated to a significant extent and should be used only as an adjunct to a wider global assessment [160]. A sport-specific approach should be used when evaluating the shoulder in an athlete [160]. A preseason examination is critical to document baseline shoulder stability, strength, and ROM, which can be used as a reference when evaluating a mid-season injury [160].

Physical Examination: Instability

The apprehension-relocation test (Fowler test) is the most sensitive test for instability [153]. In the apprehension-relocation test, the arm is placed into abduction and external rotation, and the patient experiences a sense of instability [153]. In the apprehension-relocation test, the examiner places a posterior force on the arm, and the sense of instability is relieved [153]. The load-and-shift test can be used to classify degrees of instability on the basis of distance of humeral head translation [153]. A grade 1+ on the load-and-shift test corresponds to 0 to 1 cm of translation to before the glenoid rim [153]. A grade 2+ on the load-and-shift test corresponds to 1 to 2 cm of translation to the glenoid rim [153]. A grade 3+ on the load-and-shift test corresponds to greater than 2 cm translation or over the glenoid rim [153]. An evaluation of generalized laxity should be performed [153].

The specificity of the anterior apprehension test, the relocation test, and the surprise test exceeds 95% for anterior shoulder instability [140]. For anterior shoulder instability, glenohumeral translation (apprehension), and not pain, is used as the sine qua non for diagnosis [140]. An examination under anesthesia is critical to the success of arthroscopic stabilization and is more sensitive for determining both the degree and direction of instability [114]. The pattern of instability can be determined during examination under anesthesia without being affected by patient apprehension or guarding [114]. The axial load test or load-and-shift test is conducted during examination under anesthesia, and translation is noted in the anterior, inferior, and posterior directions [114]. Grade 1+ instability corresponds to the translation of the humeral head to the edge of the glenoid [114]. Grade 2+ instability corresponds to the humeral head being subluxated over the glenoid rim but reducing spontaneously [114]. Grade 3+ instability corresponds to a frank dislocation of the humeral head over the glenoid rim that does not reduce spontaneously [114]. Constitutional ligamentous laxity is assessed using tests such as the Marshall test or Beighton score [114]. The sulcus sign is part of the physical examination for shoulder instability [114]. The jerk test is part of the physical examination for shoulder instability [114].

Physical Examination: Dislocation

An acutely dislocated shoulder is usually very painful, and muscles are in spasm in an attempt to stabilize the joint [139]. The humeral head may be palpable anteriorly in an anterior dislocation [139]. The posterior and lateral aspect of the shoulder shows a hollow beneath the acromion in an anterior dislocation [139]. The arm is held in slight abduction in an anterior dislocation [139]. Passive and active motions are limited by pain in an anterior dislocation [139]. Assessment of the neurovascular status of the upper extremity and charting of the findings before reduction is an essential part of the physical examination of an anteriorly dislocated shoulder [139].

Recognition of a posterior dislocation may be impaired by the lack of a striking deformity and by the fact that the shoulder is held in the traditional sling position of adduction and internal rotation [139]. Limited external rotation of the shoulder, often to <0 degrees, is a classic feature of posterior dislocation [139]. Limited elevation of the arm, often to <90 degrees, is a classic feature of posterior dislocation [139]. Posterior prominence and rounding of the shoulder in comparison to the normal side is a classic feature of posterior dislocation [139]. Flattening of the anterior aspect of the shoulder is a classic feature of posterior dislocation [139]. Prominence of the coracoid process on the dislocated side is a classic feature of posterior dislocation [139]. Asymmetry of the shoulder contours can often best be visualized by viewing the shoulders from above while standing behind the patient [139].

Motion is limited in posterior dislocation because the head of the humerus is fixed on the posterior glenoid rim by muscle forces, or the head might actually be impaled on the glenoid rim [139]. With the passage of time, the posterior rim of the glenoid can further impact the fracture of the humeral head and produce a deep hatchet-like defect or a V-shaped compression fracture [139]. Patients with old, unreduced posterior dislocations of the shoulder can have 30 to 40 degrees of glenohumeral abduction and some humeral rotation as a result of enlargement of the groove [139]. Long-standing disuse of the muscles about the shoulder results in atrophy, which accentuates the flattening of the anterior portion of the shoulder, the prominence of the coracoid, and the fullness of the posterior portion of the shoulder [139]. Posterior dislocation may be misdiagnosed as a frozen shoulder for which vigorous therapy may be mistakenly instituted in an attempt to restore range of motion [139].

Physical Examination: Rotator Cuff and Biceps

The best physical examination signs for rotator cuff disorders include weakness in external rotation, a positive drop-arm sign, and a painful arc of motion [140]. When weakness in external rotation, a positive drop-arm sign, and a painful arc of motion are positive in a patient older than 60 years of age, there is a 91% chance of a full-thickness rotator cuff tear [140]. Inspection may reveal the loss of biceps muscle contour following long head biceps tendon rupture [158]. Loss of biceps muscle contour is particularly important in the young, physically active patient, where acute tenodesis may be indicated to restore the normal biceps length-tension relationship [158]. Palpation can help distinguish the location of pain, which is typically felt more anteriorly in the shoulder over the bicipital groove with the arm in internal 10-degree rotation [158]. Lesions more proximal to the bicipital groove may not reveal tenderness on palpation [158].

O’Brien’s active compression test and O’Driscoll’s dynamic labral shear test are useful for SLAP pathology [158]. Where there is coexisting pathology involving the subacromial space, acromioclavicular joint, and rotator cuff, other tests have poor specificity and are not conclusive for biceps pathology [158]. Cuff integrity, including of the subscapularis that is intimately related to the long head biceps tendon, must be formally assessed [158]. The lift-off and belly press tests are part of the physical examination for shoulder instability [114]. O’Brien’s active compression test is part of the physical examination for shoulder instability [114]. Hawkin’s and Neer’s impingement tests are part of the physical examination for shoulder instability [114]. Cross-body adduction is part of the physical examination for shoulder instability [114].

Physical Examination: Frozen Shoulder

The hallmark of a frozen shoulder is the corresponding loss of both passive and active range of motion [144]. Practitioners that are not experienced with shoulder pathology often miss the diagnosis of frozen shoulder because they do not test range of motion [144]. Examiners often move directly to more provocative maneuvers to assess the rotator cuff, which are often positive in frozen shoulder patients [144]. Testing range of motion in the initial evaluation is paramount to avoid subsequent testing and treating being misdirected instead of focusing on the stiffness [144]. A complete cervical examination should be performed, including neurologic testing of the extremities, when evaluating a frozen shoulder [144]. The shoulder should be inspected for signs of trauma or previous surgery, which may provide clues for the diagnosis of acquired stiffness [144]. Important landmarks, such as the acromioclavicular joint and bicipital groove, are palpated for tenderness [144].

Range of motion, both active and passive, should be tested in all planes and recorded as objectively as possible [144]. Range of motion measurements should be repeated in the contralateral shoulder [144]. It is essential to differentiate glenohumeral motion from humeroscapular motion as many patients with glenohumeral stiffness can compensate with scapulothoracic motion [144]. Glenohumeral motion is best examined by examining the patient in the supine position with the arm free so that the scapula is being compressed against the chest wall through gravity [144]. Alternatively, the examiner can stabilize the scapula with one hand while passively moving the arm with the other to differentiate glenohumeral motion [144]. Strength testing of the rotator cuff is performed using standard manual motor testing as well as special tests such as belly press, lift-off, lag signs, and hornblower’s sign [144]. Provocative tests for impingement, acromioclavicular joint pathology, labral tears, instability, and biceps pathology may also be indicated depending on the history and clinical suspicion [144].

During the frozen phase of frozen shoulder, pain tends to abate, but motion becomes severely limited in all planes [144]. During the frozen phase of frozen shoulder, even simple tasks, such as turning off the light and washing hair, become chores [144]. Sleeping is usually problematic during the frozen phase of frozen shoulder [144]. The frozen stage can last between 3 and 12 months, but it can become refractory and last longer [144]. During the thawing stage of frozen shoulder, range of motion slowly returns [144]. As motion improves during the thawing stage, residual discomfort generally resolves [144]. Return of flexibility during the thawing stage can take months to years [144]. Motion restrictions often persist after the thawing stage, but these restrictions are generally mild and do not cause significant impairment [144].

Diagnostic Arthroscopy and Imaging Context

Diagnostic shoulder arthroscopy is the gold standard for diagnosis of shoulder pathology [15]. A reliable systematic approach is key to consistent and complete evaluation of the glenohumeral joint during diagnostic arthroscopy [15]. Shoulder arthroscopy can enhance the ability to evaluate the glenohumeral joint and reveal significant information that would otherwise be undetectable, particularly regarding labral tears, rotator cuff status, and biceps tendon lesions [63]. Arthroscopy of the shoulder may be invaluable as a diagnostic tool to confirm clinical and radiographic abnormalities [18]. Arthroscopy of the shoulder may be invaluable as a diagnostic tool to identify associated intra-articular and extra-articular pathologic conditions [18]. Arthroscopy of the shoulder may be invaluable as a diagnostic tool to treat a variety of lesions without the attendant morbidity of open surgical repair and reconstruction [18].

MRI has proven to be useful in identifying capsulolabral avulsions (HAGL and reverse HAGL lesions) and rotator cuff pathology [114]. Capsulolabral avulsions and rotator cuff pathology are common in patients over 40 years old with glenohumeral dislocation and at times coexist with a Bankart lesion [114]. Plain radiography is able to capture any substantial bone loss on the glenoid and humerus [114]. Computed tomography allows for a more precise quantification of bone loss than plain radiography [114]. Using CT, the best views to evaluate the glenoid are sagittal cuts and three-dimensional reconstructed en face glenoid views with humerus subtract

Investigations

Diagnostic Arthroscopy

Diagnostic shoulder arthroscopy remains the gold standard for diagnosing shoulder pathology [15]. It serves as an invaluable tool to confirm clinical and radiographic abnormalities, identifying associated intra-articular and extra-articular pathologic conditions [18]. Arthroscopy enhances the evaluation of the glenohumeral joint, revealing significant information regarding labral tears, rotator cuff status, and biceps tendon lesions that may otherwise be undetectable [63]. The technique allows for efficient, consistent, and effective evaluation of the shoulder joint when performed in the beach-chair position [19]. Furthermore, arthroscopy may be used to treat a variety of lesions without the attendant morbidity of open surgical repair and reconstruction [18].

In the post-arthroplasty setting, shoulder arthroscopy is most frequently used as a diagnostic tool [9]. It is supported as an adjunctive diagnostic tool in select patients with unresolved pain following shoulder arthroplasty [7]. Diagnostic arthroscopy provides critical information on periprosthetic infection, cuff tears, implant wear, and loosening when evaluating painful anatomic total shoulder arthroplasty [49]. Given the high rate of articular pathologies in operated shoulders, arthroscopy is invaluable for diagnosing and treating these conditions simultaneously with hardware removal [33].

Imaging Modalities

Plain radiography: Standardized plain films are almost always sufficient to garner the information needed for shoulder evaluation [51]. The standard shoulder series should include orthogonal views: a true AP view in the scapular plane, an AP view, an axillary view, and a scapular Y view [108]. The true AP view in the scapular plane visualizes the anterior greater tuberosity in profile [108]. The AP view with the arm held in internal rotation visualizes the posterior aspect of the greater tuberosity and the lesser tuberosity in profile [108]. The axillary view is necessary for evaluating glenohumeral joint instability and determining humeral head position; it may detect occult, locked posterior shoulder dislocation in patients lacking passive external rotation [108]. The scapular Y view provides visualization of the coracoacromial arch and can reveal coracoacromial spurs, serving as a reliable alternative for evaluating glenohumeral subluxation and dislocation [108].

Specific views are indicated for targeted assessments: the Serendipity view for the sternoclavicular joint, the West Point view for anterior glenoid bone loss, the Zanca view for the AC joint, the Stryker notch view for Hill-Sachs lesions after dislocation, and the Apical oblique view for glenoid rim fracture in instability [108]. The axillary view taken with the arm in the functional position of elevation is referred to as the "truth view" because it demonstrates glenohumeral relationships in the functional position of elevation [51]. This standardized axillary view enables the measurement of posterior subluxation or "functional decentering" that is not evident in images taken with the arm at the side [51]. The point of contact of the humeral articular surface on the glenoid reflects the degree of centering of the net humeral joint reaction force on the glenoid [51]. Malcentering of this force leads to posterior instability, posterior glenoid wear, and "rocking horse" loosening of prosthetic glenoid components [51].

Normal radiographic measurements include an acromiohumeral distance of 7 to 14 mm, a symmetric superior and inferior glenohumeral joint space width, and a coracoclavicular distance of 1.1 to 1.3 cm [108]. Neer classified acromial morphology as type I (flat), type II (curved), and type III (hooked) [108]. Type III acromial morphology correlates with the presence of rotator cuff disease, though no direct causal relationship has been demonstrated [108]. Surgeons should resist the temptation to "overimage," obtaining only the scans or reconstructions necessary for patient care [51].

MRI: MRI is the modality of choice for evaluating the rotator cuff, biceps, and subacromial/subdeltoid bursa [107]. T1-weighted MRI can reveal Hill-Sachs lesions, while T2-weighted MRI provides better visualization of full-thickness rotator cuff tears [107]. MR arthrography is considered the benchmark for evaluating labral tears but is rarely indicated for rotator cuff pathology [107]. Interpretation of anterior labral morphology by MRI is often incorrect, with normal labral patterns frequently misread as torn or detached, which can result in the incorrect diagnosis of shoulder instability [271].

Regarding diagnostic accuracy for full-thickness rotator cuff tears, MRI demonstrates 100% sensitivity, 68% specificity, 85% positive predictive value, 100% negative predictive value, and 89% accuracy [108]. In a community practice, radiologists miss approximately 50% of subscapularis tears on MRI examination, while a shoulder surgeon misses 28.6% [255]. However, preoperative MRI scans interpreted by orthopaedic surgeons using a described systematic approach resulted in improved accuracy in diagnosing subscapularis tendon tears compared with previous studies [165].

CT: CT arthrography is indicated when MRI or MR arthrography is contraindicated, such as in patients with pacemakers or vascular clips [107]. CT with three-dimensional reconstructions is the advanced imaging study of choice for determining the extent of glenoid bone loss in the setting of shoulder instability [108]. CT scans may offer a few degrees of increased precision in measuring glenoid version, but this precision does not necessarily improve the quality of the surgery or the clinical outcome [51]. CT scans have the disadvantage of being taken with the arm in the adducted position [51]. Information gained from a CT scan did not alter treatment decision-making in three-quarters of vignettes among surgeons experienced in managing anterior shoulder instability [251]. Diagnostic imaging may not reliably correlate with diagnostic arthroscopic findings at the time of a Latarjet procedure from both a bony and soft-tissue perspective [259].

Ultrasonography: Ultrasonography is a low-cost alternative to MRI and arthrography for evaluating both skeletal and soft-tissue structures of the shoulder [107]. It provides immediate, real-time visualization of the rotator cuff, biceps tendon, and calcific deposits [107]. Ultrasonography can be used to measure the subacromial space and detect atrophy of rotator cuff muscles [107]. However, it is highly operator dependent [107]. It is not as useful for evaluating labral tears or rotator cuff tears that are very small or larger than 3 cm [107]. For the detection of full-thickness rotator cuff tears, ultrasonography has a sensitivity of 98%, specificity of 80%, positive predictive value of 90%, negative predictive value of 95%, and accuracy of 94% [108].

Clinical Evaluation

The history and physical examination are paramount in the diagnosis of a stiff shoulder [29]. Ancillary studies may be helpful in certain circumstances for the diagnosis of a stiff shoulder [29]. If the problem is not apparent on history, physical examination, and plain radiographs, nonoperative management is likely to be recommended [54]. Nonoperative management is recommended even if MRIs show "acromioclavicular arthrosis," "labral fraying," a "humeral avulsion of the glenohumeral ligament (HAGL)" lesion, or "supraspinatus tendinosis" if the problem is not apparent on history, physical examination, and plain radiographs [54]. Physical examination tests are rarely capable of discriminating between shoulder problems [54].

Tangible findings sought during physical examination include loss of passive or active ROM, a palpable defect in the rotator cuff, minimal resistance to anterior translation of the humeral head pressed into the glenoid, palpable subacromial crepitus, muscle atrophy, loss of the biceps reflex, or an obvious "clunk" on cross-body adduction [54]. Understanding the function and pathology surrounding the teres minor is paramount in comprehensive management of the patient with shoulder pathology [11].

Epidemiology and Demographics

Up to 43% of patients undergoing shoulder arthroscopy can be classified as obese [22]. Early perioperative complications are uncommon in patients undergoing shoulder arthroscopy [22].

Complications and Risks

Glenohumeral chondrolysis is a rare and devastating complication of shoulder arthroscopy that can occur rapidly after routine procedures [56]. Pseudoaneurysm is a complication of shoulder arthroscopy that should be considered in postoperative patients with pain and a new-onset mass [58]. Mixed neuropathy presenting clinically as an anterior interosseous nerve palsy is a complication following shoulder arthroscopy [1]. Recognizing mixed neuropathy presenting as anterior interosseous nerve palsy and providing appropriate intervention or referral are important for any surgeon performing shoulder arthroscopies [1].

Shoulder arthroscopy in the year prior to shoulder arthroplasty is associated with an increased risk of complications, including revision and aseptic loosening [48]. Early results of total shoulder arthroplasty for young patients with shoulder chondrolysis show an opportunity for improvements in pain and function [86]. Progressive glenoid radiolucencies may develop in young patients treated with total shoulder arthroplasty for shoulder chondrolysis [86].

Evidence Quality and Literature

Shoulder arthroscopy literature remains controversial, with conclusions often unsupported due to bias and limitations [4]. No clinical guidelines are definitive pending higher levels of evidence for shoulder arthroscopy [4]. The majority of the most-cited articles in shoulder arthroscopy are case series and descriptive studies originating from the United States [31].

The Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Group was formed to conduct large multicenter studies on conditions of the shoulder [16]. The MOON Shoulder Group is made up of 16 fellowship-trained orthopaedic surgeons and research personnel from nine academic and private practice sites in the United States [16]. The group developed and standardized imaging protocols for rotator cuff disease [16]. It assembled validated patient-oriented outcome forms for rotator cuff disease [16]. The MOON Shoulder Group conducted validation studies on the classification of rotator cuff tears based on MRI and arthroscopy videotapes as well as radiographic findings associated with rotator cuff disease [16]. A standard physical therapy protocol was developed based on evidence from a systematic review to determine the effectiveness of physical therapy for management of rotator cuff disease [16].

In a prospective study of nonsurgical management of atraumatic full-thickness rotator cuff tears, fewer than 25% of patients underwent surgery within the next 2 years [16]. Duration of symptoms, pain, and activity level were not correlated with the severity of rotator cuff disease in the population studied by the MOON Shoulder Group [16]. MOON Shoulder Instability is an offshoot of MOON Shoulder, focusing on patients undergoing surgical treatment for shoulder instability [16]. Early studies by MOON Shoulder Instability have described baseline demographics and modifying factors in patients undergoing surgical treatment for shoulder instability [16]. Early studies by MOON Shoulder Instability have described limited early outcomes in patients undergoing surgical treatment for shoulder instability [16].

Among patients requiring additional arthroscopic procedures who had a preoperative MRI, the MRI identified pathology in only 1 case (0.5%) [26].

Treatment

Non-Operative

Nonoperative management of anterior shoulder instability can result in high rates of recurrent instability and pain at long-term follow-up [71]. At long-term follow-up of 17 years, a high rate of poor outcomes was observed following nonoperative management of anterior shoulder instability [71]. Most patients younger than 40 years with shoulder instability who were initially treated nonoperatively for 6 months were definitively treated without surgery [195]. When nonsurgical treatment of atraumatic shoulder stability is not effective, inferior capsular shift is the treatment of choice [197].

Operative

Indications: Shoulder arthroscopy is currently one of the most common orthopedic procedures, with many conventional shoulder procedures previously performed with open techniques now accomplished arthroscopically [37]. Arthroscopy of the shoulder may be invaluable as a diagnostic tool to confirm clinical and radiographic abnormalities, identify associated intra-articular and extra-articular pathologic conditions, and treat a variety of these lesions without the attendant morbidity of open surgical repair and reconstruction [18]. Experience with arthroscopy has led to an explosion of interest and expertise in the technical skills that have made arthroscopic surgery the mainstay of surgical management for a wide range of shoulder conditions [17]. Shoulder arthroscopy is increasingly used to manage a wide range of pathologies in the pediatric population, but special considerations regarding anatomy, anesthetic technique, equipment, and patient positioning are required [34]. Failure of standard investigations to identify the cause of pain after shoulder arthroplasty is an indication for diagnostic arthroscopy [36].

Surgical Approach / Technique: A thorough understanding of anatomic principles in conjunction with proper patient positioning and portal selection and placement are essential for successful arthroscopic shoulder surgery [23]. The described technique for diagnostic arthroscopy in the beach-chair position allows for efficient, consistent, and effective evaluation of the shoulder joint for the novice and expert alike [19]. As shoulder arthroscopy continues to evolve, adopting refined techniques such as posterior-to-anterior cannula-guided subacromial access will be crucial for addressing complex shoulder pathologies effectively [20]. The article provides an evidence-based review of methods and techniques to optimize visualization during arthroscopic shoulder surgery, emphasizing that a thorough understanding of the supporting literature is essential to interpret the clinical utility of each technique [8]. The purpose of the review on improving visualization in shoulder arthroscopy is to examine the benefits and complications reported in the literature for improving visualization [21]. Supine-position shoulder arthroscopy using the anterior portal as the initial approach serves as a safer, more cost-effective, and more accessible complementary approach for shoulder arthroscopy positioning and is worthy of routine clinical application [123]. Shoulder arthroscopy continues to evolve, and the revolution represented by its development remains in skilled hands, with the expectation that it will continue to evolve [24]. The article describes the evolution of shoulder arthroscopy from a marginalized technique to the standard of care, emphasizing the 'burden of craft' and the necessity for surgeons to selectively embrace technological advancement while honoring the surgeon's craft [122]. Arthroscopic Instruments represented the most frequent category among the top 100 most-cited shoulder arthroscopy patents [68].

Implant Selection: Arthroscopic anterior labral repair and capsulorrhaphy (also known as arthroscopic Bankart repair) is the most commonly performed procedure for recurrent anterior instability of the shoulder [25]. The procedure for arthroscopic Bankart repair has been refined significantly over the past 30 years but continues to have a rate of failure from recurrent instability that is higher than open repairs [25]. Identification of the underlying cause(s) for failure of the index procedure is the key to planning revision surgery for recurrent instability after arthroscopic repair [25]. Considering new technical possibilities, most cases of anterior shoulder instability are suitable for arthroscopic reconstruction, but further studies are necessary to validate continued efficacy [32]. Operative procedures for anterior instability can be done open or arthroscopically with comparable results [76]. At present, preferred surgical procedures for anterior instability include arthroscopic Bankart or capsular plication procedures as indicated [76]. For glenoid bony defects that cannot be repaired, anterior defects are reconstructed with a Latarjet procedure and posterior defects with an autograft iliac crest extracapsular bone graft [76]. Moderately sized (20% to 30%) humeral head defects are treated with an arthroscopic remplissage procedure and Bankart repair, and larger defects (35% to 45%) are treated indirectly by increasing the glenoid arc using a Latarjet procedure or by allograft repair of the defect [76]. In a contact or collision athlete, any significant Hill-Sachs lesion is treated [76]. Successful shoulder stabilization can be achieved with fewer than 3 anchors, and a single anchor is usually sufficient [81]. Use of knotless anchors may be a significant risk factor for subsequent dislocation 2 years after arthroscopic shoulder stabilization surgery [240]. The use of a knotless all-suture anchor with suture tape provides an advancement in arthroscopic shoulder stabilization surgery [244]. Arthroscopic thermal capsulorrhaphy neither enhanced nor impaired the outcomes of arthroscopic labral repair with biodegradable tacks in patients with primary recurrent anterior instability [254].

Alignment / Balancing Strategy: Early arthroscopic stabilization by anterior capsule-labrum reinsertion after initial anterior shoulder dislocation is associated with a low 10-year recurrence rate of 35% compared to non-operative management [205]. At the 2-year follow-up, 3 (20%) of 15 patients in the arthroscopic lavage group had a redislocated shoulder compared with 9 (60%) of 15 patients in the nonoperative group for traumatic primary anterior shoulder dislocation [208]. Active patients aged 40 years and older undergoing arthroscopic shoulder stabilization experienced favorable functional outcomes at a mean follow-up of 7 years, with low rates of revision surgery or of progression to clinically relevant osteoarthritis [6]. Despite the absence of evidence-based guidelines, there exists minimal variability in recommendations between North American and European shoulder surgeons regarding return to play criteria following shoulder stabilization [41]. Based on findings from a study on recurrence rates, the utilization of a criteria based testing protocol for return to play following arthroscopic shoulder stabilization is strongly recommended [45]. The Delphi method was used to achieve an international consensus statement on shoulder instability covering diagnosis, nonoperative management, surgical options, rehabilitation, and clinical follow-up [44]. Overall, 77% of statements in the international consensus statement on anterior shoulder instability reached unanimous or strong consensus, covering patient history evaluation, prognostic factors for nonoperative management, and Bankart repair steps [238]. Recent randomized trials and systematic reviews have not shown the superiority of modern arthroscopic techniques compared with open repairs for shoulder instability [35]. Open repair resulted in a significantly lower risk of recurrence compared to arthroscopic repair, and secondary outcome data suggest that open surgical repair may be recommended to reduce the risk of recurrent instability in younger male patients with a Hill-Sachs lesion [35]. Arthroscopic and open repair techniques for the treatment of recurrent traumatic shoulder instability yield comparable results if the procedure is selected on the basis of the pathologic findings at the time of surgery [35]. The available evidence indicates that arthroscopic approaches are not as effective as open approaches in preventing recurrent instability or enabling patients to return to work [35]. It is not uncommon to see shoulders in which suture anchors were misplaced and have given rise to secondary degenerative joint disease or "anchor arthropathy" [35]. Use of intra-articular infusion of local antibiotics via a pain pump after arthroscopic instability repairs results in a risk of a most severe complication: glenohumeral chondrolysis [35]. Although arthroscopic stabilization spares the incision of the subscapularis, the healing time for a labral reattachment is likely to be the same as the time to heal a subscapularis tenotomy; healing of both proceeds concurrently so the time to return to activity should not be different with the two approaches [35]. The routine use of bone transfers such as Latarjet does not seem advisable because of the increased risk of arthritis, screw-related problems, damage to the subscapularis, and difficulty in revision [35].

Pain Management: Regional anesthesia should become the standard practice for all arthroscopic shoulder surgeries due to its physiological and clinical advantages, including reduced intraoperative bleeding, improved surgical visualization, and enhanced patient safety and recovery [151]. Interscalene block remains the most consistent technique for reducing postoperative opioid requirements after shoulder arthroscopy [159]. Performing an interscalene block in arthroscopic shoulder surgery provides effective analgesia in the postoperative period [141]. The concomitant use of suprascapular nerve block and general anesthesia was highly effective in patients undergoing ambulatory shoulder arthroscopy [189]. The technique of interscalene block using low-dose bupivacaine provides excellent analgesia following shoulder surgery when combined with general anesthesia, with advantages including reduced opioid consumption, minimal sensory and motor dysfunction, and shortened time of hospital recovery [192]. Combining suprascapular nerve block and axillary nerve block is an effective and safe technique for intraoperative anesthesia and postoperative analgesia for certain procedures of shoulder arthroscopic surgery [193]. Suprascapular nerve block and axillary nerve block were considered to provide safe and effective analgesia in terms of early postoperative pain in arthroscopic shoulder surgery [207]. Interscalene block can provide effective anesthesia for arthroscopic shoulder surgery [215]. The interscalene regional block provided more pain relief than infusion pumps immediately after arthroscopic shoulder surgery [218]. Nerve block adjuncts may prolong postoperative block time and improve pain control, while there is no evidence to support the use of subacromial infusions or patient-controlled analgesia [217]. Subacromial continuous infusion of local anesthetic does not provide a clinically significant benefit compared with placebo as part of a multimodal analgesia regime after arthroscopic subacromial surgical procedures [156]. Among patients who underwent arthroscopic knee or shoulder surgery, a multimodal opioid-sparing postoperative pain management protocol, compared to standard opioid prescribing, significantly reduced postoperative opioid consumption over 6 weeks [172]. The initial 24 h after surgery plays a key role in controlling pain after arthroscopic shoulder surgery [73]. Pain after shoulder arthroscopy is relatively low and the efficacy of the intervention is long-lasting in terms of pain symptom [13]. Performing diagnostic shoulder arthroscopy with the patient under local anesthesia is a demanding procedure for the patient and may not always be possible [59].

Adjuncts: Arthroscopic surgery is the preferred method of rotator cuff repair for many shoulder surgeons, offering advantages such as more thorough visualization, diagnosis, and treatment of lesions within the joint [210]. Arthroscopy allows a more comprehensive assessment of intra-articular pathology and rotator cuff tear configuration by viewing from multiple angles [210]. Tendon mobilization is facilitated by precise releases of adhesions that limit tendon excursion, leading to an improved ability to anatomically reduce the edge and create a tension-free repair [210]. Injury to the deltoid muscle is minimized in arthroscopic repair, and the acromial deltoid origin is preserved, eliminating the risk of deltoid dehiscence [210]. A key theoretical benefit of arthroscopic rotator cuff repair is decreased postoperative pain secondary to less soft tissue trauma, which aids in postoperative rehabilitation and leads to earlier resumption of range of motion [210]. Anatomic footprint restoration is now possible in arthroscopic rotator cuff repair, with fixation at both the suture-tendon interface and the anchor-bone interface that approximates traditional open transosseous repairs [210]. While in biomechanical studies, the double-row repair outperforms single-row repair in failure strength, superior clinical results with double-row fixation over single-row fixation is still controversial [210]. Following nonoperative treatment for at least 6 weeks, subacromial decompression (SAD) is a viable and good surgical option for the treatment of shoulder impingement with an intact rotator cuff [157]. With the advent of shoulder arthroscopy, the rates of arthroscopic acromioplasty soared, but with more clinical research calling into question the role of acromioplasty with concomitant cuff repair, its role as an isolated procedure for rotator cuff pathology has been questioned [66]. Arthroscopic rotator cuff repair has evolved from arthroscopic-assisted mini-open approaches to all-arthroscopic approaches [66]. The goal of arthroscopic rotator cuff repair remains secure fixation to the humerus, with a relatively tension-free repair that respects biology and biomechanics [66]. Improved instrumentation has probably been the greatest advancement that has facilitated approaches to repairing cuff tendons through cannulas [66].

Setting of Care: Shoulder arthroscopy has a 1.0% thirty-day complication rate, with the most common complication being return to the operating room (29% of all complications) [5]. Overall, complications of shoulder arthroscopy are low, though most of the literature describing complications is limited to single-institution case series with conflicting data in several areas [37]. Fluid extravasation has the potential to be a life-threatening complication of shoulder arthroscopic surgery; however, it is most commonly managed nonoperatively, and symptoms typically resolve with no evidence of long-term complications [60]. Thromboembolic complications are extremely rare after shoulder arthroscopy, with no current guidelines for prophylactic treatment [75]. Corticosteroid injections administered within 4 weeks before shoulder arthroscopy are associated with an increased risk of infection [170]. Shoulder arthroscopy should be avoided within 4 weeks of a pre-operative steroid injection unless there is strong justification, and a cautious, individualized approach should be used before offering corticosteroid injections to patients anticipated to undergo subsequent shoulder arthroscopy [170].

Revision: Stabilization of the dominant shoulder resulted in residual surgery-related functional impairments on both sides, whereas stabilization of the nondominant shoulder resulted in impairments primarily noted in the nondominant, operative shoulder [74]. The hypothesis that shoulders showed a higher proportion or degree of osteoarthritis following operative treatment compared to non-operative treatment is not supported by the data [236].

Other Considerations: Shoulder arthroscopy in patients after arthroplasty is most frequently used as a diagnostic tool; however, it has utility in treating a number of predetermined pathologies [9]. These findings support the use of arthroscopy as an adjunctive diagnostic tool in select patients with unresolved pain following shoulder arthroplasty [7]. Arthroscopy can serve as both a diagnostic and therapeutic tool for patients who have pain after shoulder arthroplasty [36]. Arthroscopy allows the surgeon to directly visualize and evaluate the intra-articular and extra-articular parts of the shoulder [36]. Indications for the use of arthroscopy as a therapeutic tool in the postarthroplasty shoulder are extensive and have been well documented in the literature, ranging from removal of a loose glenoid component to treatment of shoulder instability [36]. When performing arthroscopy after arthroplasty, care should be taken to avoid damage to the metal or polyethylene surfaces [36]. A 30-degree arthroscope should be used and turned away from the humeral head or glenosphere (for reverse shoulder arthroplasty) as a method to avoid the “mirror effect” that can distort anatomy and confuse the surgeon [36]. Arthroscopic examination for more than 2 mm of motion at the interface correctly diagnosed all five of the loose glenoid components in a series of nine cases [36]. Diagnostic arthroscopy is a helpful tool for evaluating painful anatomic total shoulder arthroplasty by providing information on periprosthetic infection, cuff tears, implant wear, and

Complications

Overall Safety and Risk Factors: Complication rates after shoulder arthroscopy are generally low, ranging from 1% to 2%, with readmission rates below 1% [82]. While arthroscopic procedures are considered safe with very low complication rates [293], self-reported surgical complication rates have reached 7.9% in some series, exceeding literature norms [184]. Most available data derive from single-institution case series with conflicting findings [37]. Risk factors include increasing age and higher ASA scores [82]. Patients aged 60 years or older exhibit a 30-day postoperative complication rate of 1.6%, which is higher than the overall population average [40]. Although up to 43% of patients are obese, early perioperative complications remain uncommon [22]; however, a BMI >40 confers a statistically significant, albeit slight, increase in 30-day complication risk [292]. Resident involvement does not increase the risk of medical or surgical 30-day complications [65]. Increased procedure time is associated with significantly higher rates of superficial surgical site infections and overnight hospital stays [289].

Infection: The risk of infection following shoulder arthroscopy is approximately 0.21% [69], with Cutibacterium acnes infections occurring at a rate of 0.22% [296]. In revision shoulder arthroscopy, the rate of P. acnes infection is higher than previously published and should be considered in cases of refractory postoperative pain and stiffness [299]. The incidence of unexpected positive cultures is significantly higher in revision arthroscopic shoulder stabilization procedures than in primary surgeries [285]. Arthroscopic rotator cuff repair reduces the risk of infection compared with open techniques [294]. There is no study comparing infection rates between patients who receive and those who do not receive perioperative antibiotics in routine shoulder arthroscopic procedures [278]. Generally, shoulder arthroscopic surgery has a low rate of reoperation in the acute period [277]. Corticosteroid injections within 1 month of surgery significantly increase infection risk (OR, 2.63; P = .014) [52]. The risk is greatest when injections are given within 2 weeks of surgery, with injections given within 2–4 weeks also portending increased risk, albeit to a lesser degree [288].

Thromboembolism: Postoperative deep venous thrombosis (DVT) and pulmonary embolism (PE) are unusual but potentially fatal consequences of arthroscopic shoulder surgery. Reported incidences vary, with DVT and PE occurring at rates of 0.31% [136] and 0.24% [150]. Venous thromboembolism (VTE) occurs at a rate of 0.15% [152], with symptomatic VTE incidence at 3 months being approximately 0.3% [163]. Other studies report VTE incidence at 0.24% [169] and note that while rare, VTE remains a recognized complication [183, 196]. One study reveals a substantially higher rate of VTE than previously recognized [191]. Symptomatic DVT and PE are rare complications [222]. Oral contraceptive pill use at the time of surgery is not associated with an increased risk of VTE [232]. Awareness and early detection are the best approaches to managing thromboembolic disease following shoulder arthroscopy [252].

Stiffness / Arthrofibrosis: The incidence of secondary frozen shoulder following simple arthroscopic shoulder surgery is just over 5% [281]. Stiffness can complicate shoulder stabilization surgery, particularly when associated with overtightening of soft tissues and prolonged immobilization [233]. To avoid overtightening and loss of external rotation, capsulolabral reconstructions must be tensioned in 30 to 45 degrees of external rotation and 30 degrees of abduction [233].

Nerve Palsy: Nerve injuries can be permanent, particularly in the context of regional anesthesia with an interscalene block combined with general anesthesia [35]. Recognizing complications such as mixed neuropathy presenting as anterior interosseous nerve palsy and providing appropriate intervention or referral is critical for surgeons performing shoulder arthroscopies [1]. Neurovascular complications and subscapularis rupture are rare but devastating complications of open stabilization surgery, best prevented by meticulous technique and deliberate exposure of surgical planes during revision surgery [233]. The incidence of neurovascular complications in open stabilization surgery is reported as 1% to 8% [233]. In contrast, subscapularis rupture and neurologic injury are exceedingly rare in arthroscopic stabilization [233].

Instability-Specific Complications: With a follow-up of 97%, about one-third of stabilized shoulders experienced at least one redislocation after 8 to 10 years [84]. Failure to recognize and address the capsular component is the most common cause of failure following arthroscopic shoulder stabilization [85]. Failure of primary shoulder stabilization procedures is often related to uncorrected anatomic pathology, and the instability severity index score permits precise identification of patients at risk [301]. A lower rate of recurrence can be expected if surgery is performed after the first episode of dislocation [300]. Successful results were obtained in patients younger than 40 years with both primary and recurrent anterior shoulder instability after arthroscopic treatment [79]. While recurrence rates increased over time, patient satisfaction remained high, and no revision surgeries were required, demonstrating the long-term reliability of arthroscopic biceps tenodesis for anterior shoulder instability [302]. Systematic studies including newer publications (after 2000) are associated with more favorable arthroscopic outcomes [284]. Authors have called for unified terms around postoperative complications after shoulder stabilization surgery, noting that some systematic review results may not fully represent clinical reality [287].

Other Considerations: Early osteoarthritis after arthroscopic stabilization is often associated with anchor complications or chondrolysis from thermal capsulorrhaphy [233]. Rhee et al. treated five cases of early glenohumeral osteoarthritis an average of 12 months after arthroscopic stabilization and found intra-articular metal anchors in all cases [233]. Absorbable suture anchors can displace, break, and cause chondral injury or synovitis [233]. The similar amounts of bone loss between groups indicate that bone loss is not the primary determinant of failure in revision arthroscopic stabilization [298].

Latarjet Procedure Complications: The incidence of complications following the primary Latarjet procedure for shoulder instability varies from 0% to 25.7% [112]. The early graft failure rate is 4.7% and the nerve injury rate is 3.2% after the Latarjet procedure [265]. Two-thirds of graft failures required reoperation, and half of nerve injuries required reoperation [265]. In a cohort undergoing Latarjet for anterior glenohumeral instability, the overall short-term complication rate within 90 days was 7.5% (10 total complications) [266]. Six of these 10 complications required subsequent surgery, including two for recurrent instability, two for infection, one for musculocutaneous nerve palsy, and one for postoperative pain [266]. No cases of hardware failure or graft osteolysis were reported in the 90-day follow-up of 133 patients [266]. Outcomes at 3 years' follow-up were satisfactory in 80% of patients, and 86% had stable shoulders following revision of failed Latarjet with the Eden-Hybinette surgical technique [47].

Post-Arthroplasty Complications: The overall complication rate after total shoulder arthroplasty (TSA) is estimated at approximately 15% [235]. Complications tend to occur late in the postoperative course: component loosening occurs approximately 8 years after surgery, infection at 12 years, and periprosthetic fractures at 6 years [235]. The most commonly reported complications after TSA, in order of frequency, are component (primarily glenoid) loosening, glenohumeral instability, rotator cuff tear, periprosthetic fracture, infection, implant failure including dissociation of modular prostheses, and deltoid weakness or dysfunction [235]. In a review of 33 series (2540 shoulders) of unconstrained TSAs, component loosening accounted for 39% of all complications [199], instability for 30% [199], periprosthetic fracture for 11% [199], rotator cuff tear for 7.7% [199], neural injury for 4.8% [199], and infection for 4.6% [199]. Most nerve injuries are neurapraxias that recover with time; a complete neurologic examination should be performed early postoperatively to document deficits [199]. If no recovery is noted after 6 weeks, an electromyographic examination should be obtained and repeated at 3 months [199]. If no recovery is evident by electromyography at 3 months, exploration of the nerve should be considered [199].

Reverse Total Shoulder Arthroplasty: Reverse total shoulder arthroplasty (RSA) initially resulted in relatively high complication rates (50%) and unique complications [235]. In the past decade, with improved techniques and better understanding of the device, the complication rate for RSA has fallen to 6% [235]. The most common complications after RSA are scapular notching, hematoma formation, glenoid dissociation such as baseplate failure or aseptic loosening, glenohumeral dislocation, acromial and scapular spine fractures, infection, loosening or dissociation of the humeral component, and nerve injury [235].

Arthroscopic Techniques and Adjacent Procedures: O'Driscoll noted visual damage to the humeral head after arthroscopic excision of loose glenoids [36]. A 30-degree arthroscope should be used and turned away from the humeral head or glenosphere (for RSA) to avoid the “mirror effect” that can distort anatomy and confuse the surgeon [36]. In a series of 203 cases of TSA, 5% had prophylactic acromioplasty, and 3% had impingement refractory to conservative management [36]. Arthroscopic subacromial decompression yielded excellent or good results in five of six patients with impingement syndrome after TSA [36].

Other Complications: Postoperative complications after arthroscopic remplissage procedures include persistent tenosynovitis of the long head of the biceps tendon and ipsilateral ulnar nerve palsy, with a rate of 0.9% (2 of 212) [243]. The rate of postoperative complications after Weber osteotomy procedures was 29% (53 of 184), including pain, hematoma, infection, nonunion, delayed union, reoperations related to hardware and other noneinstability-related causes, and internal rotation deficit [243]. The rate of postoperative complications after humeral allograft reconstructions was 74%, including spontaneous avascular necrosis and collapse, persistent pain, clicking, catching, stiffness, and flattening [243]. The rate of postoperative complications after humeral arthroplasty was 19%, comprising rerupture of the subscapularis tendon after redislocation, humeral diaphyseal fracture distal to the implant after a fall, scapular notching, loosening of the glenoid and humeral components, humeral fracture, infection, pain from glenoid wear, brachial plexus injury, axillary nerve injury, adhesive capsulitis, and subacromial impingement [243].

Return to Sports: There were no infections, cases of shoulder stiffness, or neuropathies in the early postoperative period for patients returning to sports after arthroscopic anterior stabilization [204]. Seven patients had recurrence after surgery in this cohort [204]. Five patients had a subsequent dislocation requiring manual reduction, and 2 had a subsequent subluxation episode [204]. Four of these patients had traumatic instability events after their return to sports participation (2 contact and 2 noncontact athletes) [204]. One patient had a dislocation during a seizure episode [204]. These 5 patients (4 male and 1 female) subsequently underwent open revision procedures [204].

Recovery

Light activity (weeks): The evidence base does not specify a defined week range for light activity, desk work, driving, or light activities of daily living following arthroscopic shoulder surgery.

Full activity (months): No specific month range for full manual work, sport, or full range-of-motion and strength return is established in the provided evidence.

Complete recovery / outcome plateau (months): The provided evidence does not define a specific month range for the stabilization of pain, strength, or final functional outcomes.

Rehabilitation protocol: There is no clear consensus regarding optimal post-operative rehabilitation following arthroscopic shoulder stabilisation [146]. A randomized controlled trial demonstrates that exergames can be used effectively in the rehabilitation of patients following arthroscopic shoulder surgery [175]. Arthroscopic capsular release with manipulation and a well programmed rehabilitation program can avoid any delay of surgery and limitation of motion after cuff repair in patients with concomitant moderate shoulder stiffness [194].

Functional milestones: Achieving 69.5% of maximal ASES score improvement or 75% of maximal SANE score improvement is indicative of achieving patient satisfaction after arthroscopic rotator cuff repair [297]. A criteria based testing protocol for return to play following arthroscopic shoulder stabilization is strongly recommended based on findings that recurrence rates are improved following such a protocol [45].

Other Considerations: The initial 24 hours after surgery plays a key role in controlling pain after arthroscopic shoulder surgery [73]. The rates of postoperative infection among patients who received an ipsilateral corticosteroid injection at 2 months (OR, 0.89; P = .264), 3 months (OR, 0.71; P = .534), and 4 months (OR, 0.87; P = .484) were similar and did not reach statistical significance when compared with controls [52]. Earlier return to light duty is associated with earlier return to full duty after shoulder arthroscopic surgery in patients with a Workers' Compensation claim [116]. Earlier Orthopaedic Surgeon evaluation of WC patients with shoulder injuries was associated with a higher return to full duty after shoulder arthroscopic surgery [174]. The duration of sick leave after arthroscopic shoulder surgery in Germany does not exceed sick leave duration in other countries [241]. Despite the absence of evidence-based guidelines, there exists minimal variability in recommendations between North American and European shoulder surgeons regarding return to play criteria [41]. A substantial number of athletes do not meet expected goals for operative shoulder function and strength compared with the contralateral shoulder at 6 months postoperatively [83]. Professional elite goalkeepers requiring shoulder surgery for different causes demonstrated a high rate of return to play despite the persistence of mild symptoms [237]. Patients can have a high expectation of return to wildlife sports following shoulder surgery [247]. Mid-term outcomes in active-duty patients undergoing double-pulley remplissage for shoulder instability without glenoid bone loss demonstrate an overall return to active-duty rate of 91.67% [248]. High school football players who returned to competitive play after arthroscopic shoulder stabilization surgery experienced a higher rate of recurrent instability that was dependent on their years of eligibility remaining [279]. Female patients had a lower postoperative return to sport and shoulder scores after the modified Latarjet procedure compared with literature reports [280]. Following arthroscopic shoulder labral surgery, most MLB pitchers and positional players were able to return to play successfully but experienced shorter careers thereafter [282]. A systematic review stated a high return to sport rate after anterior shoulder stabilization procedures among studies that reported both rate of RTS and time to RTS [283]. The outcomes at 3 years' follow-up for revision of failed Latarjet with the Eden-Hybinette surgical technique were satisfactory in 80% of patients and 86% had stable shoulders [47]. The improvements in clinical outcome as well as the radiographic results for reverse arthroplasty after previous surgery for recurrent anterior shoulder instability seem to be comparable with those of other studies reporting on the outcome of reverse shoulder arthroplasty for other conditions [50]. With a follow-up of 97%, about one third of the stabilized shoulders experienced at least one redislocation after 8 to 10 years following arthroscopic shoulder stabilization using suture anchors [84]. Early results of total shoulder arthroplasty for young patients with shoulder chondrolysis following arthroscopic shoulder surgery show an opportunity for improvements in pain and function; however, progressive glenoid radiolucencies may develop in these patients [86]. Twenty years postoperatively, arthroscopic Bankart repair was associated with good to excellent shoulder function, low pain levels and high patient satisfaction [295]. Arthroscopic partial repair may produce initial improvement in selected outcomes at 2-year follow-up, but about half of the patients were not satisfied with their outcomes, which had deteriorated over time [290]. Resident involvement in shoulder arthroscopy was not associated with increased risk of adverse events, increased operative time, or readmission within 30 days [245]. Patient compliance with PROMs decreased over time with the lowest percentage of patients completing electronic surveys at the traditional 2-year follow-up for shoulder arthroscopy [242].

Key Evidence

• [L4] Recognizing this complication and providing appropriate intervention or referral are important for any surgeon performing shoulder arthroscopies. [1] (10.1016/j.jse.2016.04.037)
• [L4] Complications of arthroscopic shoulder surgery are not necessarily less prevalent or devastating than those associated with open techniques, though they differ in nature. [2] (10.5435/jaaos-22-07-410)
• [L5] Shoulder arthroscopy is a commonly performed procedure with low risks. [3] (10.1016/j.jhsa.2015.01.002)
• [L5] The editorial states that shoulder arthroscopy literature remains controversial, conclusions are often unsupported due to bias and limitations, and no clinical guidelines are definitive pending higher levels of evidence. [4] (10.1016/j.arthro.2012.07.001)
• [L4] Shoulder arthroscopy has a 1.0% thirty-day complication rate, with the most common complication being return to the operating room (29% of all complications). [5] (10.1016/j.arthro.2014.12.011)
• [L4] Active patients aged 40 years and older undergoing arthroscopic shoulder stabilization experienced favorable functional outcomes at a mean follow-up of 7 years, with low rates of revision surgery or of progression to clinically relevant osteoarthritis. [6] (10.1016/j.jseint.2024.05.015)
• [L4] These findings support the use of arthroscopy as an adjunctive diagnostic tool in select patients with unresolved pain following shoulder arthroplasty. [7] (10.1016/j.jse.2026.07.016)
• [L4] The article provides an evidence-based review of methods and techniques to optimize visualization during arthroscopic shoulder surgery, emphasizing that a thorough understanding of the supporting literature is essential to interpret the clinical utility of each technique. [8] (10.5435/jaaos-d-23-01025)
• [L4] Shoulder arthroscopy in patients after arthroplasty is most frequently used as a diagnostic tool; however, it has utility in treating a number of predetermined pathologies. [9] (10.1016/j.jse.2015.09.013)
• [L5] Shoulder Arthroscopy, Third Edition is highly recommended as a must-read for every shoulder surgeon. [10] (10.1016/j.arthro.2014.07.021)
• [L5] Understanding the function and pathology surrounding the teres minor is paramount in comprehensive management of the patient with shoulder pathology. [11] (10.5435/jaaos-d-15-00258)
• [L4] Patients undergoing shoulder arthroscopy in the US are primarily older, white, male adults. [12] (10.1177/17585732261420111)
• [L4] Pain after shoulder arthroscopy is relatively low and the efficacy of the intervention is long-lasting in terms of pain symptom. [13] (10.1016/j.otsr.2011.02.003)
• [L4] Arthroscopic revision of failed open anterior shoulder stabilization provides satisfactory results in a selected patient population. [14] (10.1016/j.arthro.2009.04.073)
• [Paper] Diagnostic shoulder arthroscopy is the gold standard for diagnosis of shoulder pathology, and a reliable systematic approach is key to consistent and complete evaluation of the glenohumeral joint. [15] (10.1016/j.eats.2018.12.003)
• [L5] Experience with arthroscopy has led to an explosion of interest and expertise in the technical skills that have made arthroscopic surgery the mainstay of surgical management for a wide range of shoulder conditions. [17] (10.1016/j.mporth.2009.08.008)
• [L5] Arthroscopy of the shoulder may be invaluable as a diagnostic tool to confirm clinical and radiographic abnormalities, to identify associated intra-articular and extra-articular pathologic conditions, and to treat a variety of these lesions without the attendant morbidity of open surgical repair and reconstruction. [18] (10.1016/s0278-5919(20)30081-8)
• [L5] The described technique allows for efficient, consistent, and effective evaluation of the shoulder joint for the novice and expert alike. [19] (10.1016/j.eats.2024.103083)
• [L5] As shoulder arthroscopy continues to evolve, adopting such refined techniques will be crucial for addressing complex shoulder pathologies effectively. [20] (10.1016/j.eats.2025.103901)
• [L5] The purpose of this review is to examine the benefits and complications reported in the literature for improving visualization in shoulder arthroscopy. [21] (10.5397/cise.2022.01291)
• [L3] Up to 43% of patients undergoing shoulder arthroscopy can be classified as obese, but early perioperative complications are uncommon. [22] (10.1016/j.arthro.2016.03.022)
• [L5] A thorough understanding of anatomic principles in conjunction with proper patient positioning and portal selection and placement are essential for successful arthroscopic shoulder surgery. [23] (10.5435/00124635-201306000-00003)
• [L5] Shoulder arthroscopy continues to evolve, and the revolution represented by its development remains in skilled hands, with the expectation that it will continue to evolve. [24] (10.1016/j.arthro.2009.06.015)
• [L4] [26] (10.1177/23259671261415839)
• [L4] Revision arthroscopic anterior stabilization of the shoulder can result in satisfactory outcomes in appropriately selected patients who have failed previous capsulolabral repair. [27] (10.1016/j.jse.2014.11.034)
• [L5] The majority of the most-cited articles in shoulder arthroscopy are case series and descriptive studies originating from the United States. [31] (10.1016/j.asmr.2020.09.011)
• [L5] Considering new technical possibilities, most cases of anterior shoulder instability are suitable for arthroscopic reconstruction, but further studies are necessary to validate continued efficacy. [32] (10.1007/s00402-002-0423-6)
• [L4] The high rate of articular pathologies in operated shoulders makes arthroscopy an invaluable tool to diagnose and treat them at the same time of hardware removal. [33] (10.1007/s00590-017-1938-4)
• [L5] Shoulder arthroscopy is increasingly used to manage a wide range of pathologies in the pediatric population, but special considerations regarding anatomy, anesthetic technique, equipment, and patient positioning are required. [34] (10.5435/00124635-201307000-00004)
• [L4] Current guidelines for thromboprophylaxis in shoulder arthroscopy lack consensus and need patient-specific considerations. [39] (10.2106/jbjs.rvw.23.00228)
• [L3] Patients 60 years or older who underwent shoulder arthroscopy have a low overall 30-day postoperative complication rate of 1.6%, which is higher than previously reported for the overall shoulder arthroscopy population. [40] (10.1016/j.arthro.2016.05.035)
• [L4] Despite the absence of evidence-based guidelines, there exists minimal variability in recommendations between North American and European shoulder surgeons regarding return to play criteria. [41] (10.1016/j.jse.2021.01.026)
• [L2] Morbidity and mortality are rare events after elective shoulder arthroscopy, and the procedure should generally be considered safe. [42] (10.1016/j.jse.2013.06.022)
• [L5] Shoulder surgeons must carefully interpret literature comparing open and arthroscopic rotator cuff repair outcomes, as differences in complications may be influenced by selection bias and narrowing indications for open repair. [43] (10.1016/j.arthro.2017.11.026)
• [L5] The Delphi method is a structured communication technique used to allow a panel of experts to achieve a consensus in a systematic manner, resulting in an international consensus statement on shoulder instability covering diagnosis, nonoperative management, surgical options, rehabilitation, and clinical follow-up. [44] (10.1016/j.arthro.2021.11.052)
• [L3] Based on our findings, we strongly recommend the utilization of a criteria based testing protocol for return to play following arthroscopic shoulder stabilization. [45] (10.1177/2325967120s00381)
• [L4] The outcomes at 3 years' follow-up were satisfactory in 80% of patients and 86% had stable shoulders. [47] (10.1016/j.otsr.2019.12.009)
• [L3] Shoulder arthroscopy in the year prior to shoulder arthroplasty is associated with an increased risk of complications, including revision and aseptic loosening. [48] (10.1177/17585732231176269)
• [L5] Diagnostic arthroscopy is a helpful tool for evaluating painful anatomic total shoulder arthroplasty by providing information on periprosthetic infection, cuff tears, implant wear, and loosening. [49] (10.1016/j.xrrt.2025.06.011)
• [L4] The improvements in clinical outcome as well as the radiographic results seem to be comparable with those of other studies reporting on the outcome of reverse shoulder arthroplasty for other conditions. [50] (10.1007/s00264-014-2325-y)
• [L3] [52] (10.1177/0363546518825348)
• [L4] Glenohumeral chondrolysis is a rare and devastating complication of shoulder arthroscopy that can occur rapidly after routine procedures. [56] (10.1177/0363546503262176)
• [L5] Review of this complication should alert surgeons to consider this diagnosis as a possibility in postoperative patients with pain and a new-onset mass, after shoulder arthroscopy. [58] (10.1016/j.jse.2013.05.018)
• [L4] However, performing diagnostic shoulder arthroscopy with the patient under local anesthesia is a demanding procedure for the patient and may not always be possible. [59] (10.1016/1058-2746(93)90008-5)
• [L4] Fluid extravasation has the potential to be a life-threatening complication of shoulder arthroscopic surgery; however, it is most commonly managed nonoperatively, and symptoms typically resolve with no evidence of long-term complications. [60] (10.1177/2325967118771616)
• [L4] Shoulder arthroscopy can enhance the ability to evaluate the glenohumeral joint and reveal significant information that would otherwise be undetectable, particularly regarding labral tears, rotator cuff status, and biceps tendon lesions. [63] (10.1177/036354659001800506)
• [L3] Resident involvement in shoulder arthroscopy procedures is not associated with increased risk for medical or surgical 30-day postoperative complications. [65] (10.5435/jaaosglobal-d-20-00138)
• [Paper] Arthroscopic Instruments represented the most frequent category among the top 100 most-cited shoulder arthroscopy patents. [68] (10.1016/j.xrrt.2026.100828)
• [L3] The risk of infection following shoulder arthroscopy was 0.21%, similar to reported numbers from other large series. [69] (10.1177/2325967117s00362)
• [L4] At long-term follow-up of 17 years, a high rate of poor outcomes was observed following nonoperative management of anterior shoulder instability. [71] (10.1016/j.jse.2021.07.016)
• [L5] Proper evaluation of bone loss best determines shoulder instability surgical indications and outcomes. [72] (10.1016/j.arthro.2021.01.004)
• [L2] The initial 24 h after surgery plays a key role in controlling pain after arthroscopic shoulder surgery. [73] (10.1007/s00167-012-1950-5)
• [L3] Stabilization of the dominant shoulder resulted in residual surgery-related functional impairments on both sides, whereas stabilization of the nondominant shoulder resulted in impairments primarily noted in the nondominant, operative shoulder. [74] (10.1177/03635465231156181)
• [Case_report] Thromboembolic complications are extremely rare after shoulder arthroscopy, with no current guidelines for prophylactic treatment. [75] (10.1016/j.otsr.2009.03.016)
• [L3] Successful results were obtained in patients younger than 40 years with both primary and recurrent anterior shoulder instability after arthroscopic treatment. [79] (10.1016/j.jse.2023.05.029)
• [L3] Successful shoulder stabilization can be achieved with fewer than 3 anchors, and a single anchor is usually sufficient. [81] (10.1016/j.jse.2013.08.010)
• [L3] Complication rates after shoulder arthroscopy are low (between 1% and 2%) and readmission rates are less than 1%, with increasing age and higher ASA scores identified as risk factors for adverse events. [82] (10.1016/j.arthro.2016.11.010)
• [L4] A substantial number of athletes do not meet expected goals for operative shoulder function and strength compared with the contralateral shoulder at 6 months postoperatively. [83] (10.1016/j.jse.2020.04.035)
• [L4] With a follow-up of 97%, about one third of the stabilized shoulders experienced at least one redislocation after 8 to 10 years. [84] (10.1177/0363546511415657)
• [L5] [85] (10.1016/s0278-5919(05)70183-6)
• [L4] Early results of total shoulder arthroplasty show an opportunity for improvements in pain and function; however, progressive glenoid radiolucencies may develop in these patients. [86] (10.1016/j.jse.2007.11.004)
• [L3] Overall, a larger number of patients screened positive for depression amongst patients undergoing knee and shoulder arthroscopy than were formally diagnosed. [111] (10.1177/2325967124s00350)
• [L3] The incidence of complications following the primary Latarjet procedure for shoulder instability was variable, ranging from 0% to 25.7%. [112] (10.1016/j.arthro.2023.05.024)
• [L3] Earlier return to light duty is associated with earlier return to full duty after shoulder arthroscopic surgery in patients with a Workers' Compensation claim. [116] (10.1016/j.asmr.2022.01.004)
• [L5] The article describes the evolution of shoulder arthroscopy from a marginalized technique to the standard of care, emphasizing the 'burden of craft' and the necessity for surgeons to selectively embrace technological advancement while honoring the surgeon's craft. [122] (10.1016/j.jse.2020.04.011)
• [Paper] It serves as a safer, more cost-effective, and more accessible complementary approach for shoulder arthroscopy positioning and is worthy of routine clinical application. [123] (10.1002/atn2.70109)
• [L5] In massive rotator cuff tear, the pectoralis major and latissimus dorsi muscles are effective in improving glenohumeral kinematics and reducing acromiohumeral pressures. [130] (10.1016/j.jse.2013.11.030)
• [L4] Postoperative DVT and PE are unusual and potentially fatal consequences of arthroscopic shoulder surgery with a low prevalence of 0.31%, but all patients in this series required hospitalization and subsequent anticoagulation. [136] (10.1016/j.arthro.2011.06.026)
• [L2] Performing of an ISB in arthroscopic shoulder surgery provides effective analgesia in the postoperative period. [141] (10.1080/08941939.2019.1576809)
• [L4] There is no clear consensus regarding optimal post-operative rehabilitation following arthroscopic shoulder stabilisation. [146] (10.1177/17585732231154889)
• [L4] Postoperative deep venous thrombosis and pulmonary embolism are unusual but serious and potentially fatal consequences of arthroscopic shoulder surgery with a low incidence of 0.24%. [150] (10.1016/j.arthro.2007.03.048)
• [L5] Regional anesthesia should become the standard practice for all arthroscopic shoulder surgeries due to its physiological and clinical advantages, including reduced intraoperative bleeding, improved surgical visualization, and enhanced patient safety and recovery. [151] (10.1016/j.arthro.2024.07.031)
• [L3] The results of this study show that although rare, VTE occurs following shoulder arthroscopy at a rate of 0.15%. [152] (10.1177/2325967114559506)
• [L1] Subacromial continuous infusion of local anesthetic does not provide a clinically significant benefit compared with placebo as part of a multimodal analgesia regime after arthroscopic subacromial surgical procedures. [156] (10.1016/j.jse.2019.11.010)
• [L5] Following nonoperative treatment for at least 6 weeks, SAD is a viable and good surgical option for the treatment of shoulder impingement with an intact rotator cuff. [157] (10.1016/j.arthro.2019.06.012)
• [L1] Interscalene block remains the most consistent technique for reducing postoperative opioid requirements after shoulder arthroscopy. [159] (10.1177/03635465261462708)
• [L2] The rate of symptomatic VTE in patients undergoing shoulder arthroscopy is low, being about 0.3% at 3 months. [163] (10.1177/1076029614567311)
• [L3] Preoperative MRI scans of the shoulder interpreted by orthopaedic surgeons with the described systematic approach resulted in improved accuracy in diagnosing subscapularis tendon tears compared with previous studies. [165] (10.1016/j.arthro.2012.04.142)
• [L1] The VTE incidence following shoulder arthroscopy is low at 0.24%. [169] (10.1016/j.asmr.2023.100815)
• [L5] The editorial concludes that shoulder arthroscopy should be avoided within 4 weeks of a pre-operative steroid injection unless there is strong justification, and that a cautious, individualized approach should be used before offering corticosteroid injections to patients anticipated to undergo subsequent shoulder arthroscopy. [170] (10.1016/j.arthro.2023.10.006)
• [L1] Among patients who underwent arthroscopic knee or shoulder surgery, a multimodal opioid-sparing postoperative pain management protocol, compared to standard opioid prescribing, significantly reduced postoperative opioid consumption over 6 weeks. [172] (10.1016/j.jisako.2023.03.424)
• [L4] Earlier Orthopaedic Surgeon evaluation of WC patients with shoulder injuries was associated with a higher return to full duty after shoulder arthroscopic surgery. [174] (10.5435/jaaosglobal-d-24-00269)
• [L2] This randomized controlled trial demonstrates that exergames can be used effectively in the rehabilitation of patients following arthroscopic shoulder surgery. [175] (10.1016/j.jse.2021.08.019)
• [L2] The incidence rate of VTE after arthroscopic shoulder surgeries is relatively low. [183] (10.1186/s13018-023-03592-0)
• [L4] The overall self-reported surgical complication rate for arthroscopic shoulder procedures was 7.9%, which is higher than the rates reported in the literature. [184] (10.5435/jaaosglobal-d-18-00093)
• [L1] The concomitant use of suprascapular nerve block and general anesthesia was highly effective in patients undergoing ambulatory shoulder arthroscopy. [189] (10.1097/00000539-199706000-00024)
• [L2] This study reveals a substantially higher rate of VTE following shoulder arthroscopy than previously recognized. [191] (10.1177/23259671261451735)
• [L1] The technique provides excellent analgesia following shoulder surgery when combined with general anesthesia, with advantages including reduced opioid consumption, minimal sensory and motor dysfunction, and shortened time of hospital recovery. [192] (10.1097/00115550-199823050-00007)
• [L4] Combining SSNB and ANB is an effective and safe technique for intraoperative anesthesia and postoperative analgesia for certain procedures of shoulder arthroscopic surgery. [193] (10.1016/j.arthro.2008.01.019)
• [L3] Arthroscopic capsular release with manipulation and a well programmed rehabilitation program can avoid any delay of surgery and limitation of motion after cuff repair in patients with concomitant moderate shoulder stiffness. [194] (10.1016/j.arthro.2008.06.007)
• [L3] Most patients younger than 40 years with shoulder instability who were initially treated nonoperatively for 6 months were definitively treated without surgery. [195] (10.1016/j.arthro.2021.03.047)
• [L4] While symptomatic VTEs are rare following shoulder arthroscopic procedures, surgeons must be aware that they still account for a certain number of postoperative complications. [196] (10.1016/j.xrrt.2022.05.003)
• [L5] When nonsurgical treatment of atraumatic shoulder stability is not effective, inferior capsular shift is the treatment of choice. [197] (10.5435/00124635-200903000-00002)
• [L4] [204] (10.1016/j.arthro.2013.09.008)
• [L2] Early arthroscopic stabilization by anterior capsule-labrum reinsertion after initial anterior shoulder dislocation is associated with a low 10-year recurrence rate of 35% compared to non-operative management. [205] (10.1016/j.otsr.2015.09.029)
• [L2] The SSNB and ANB were considered to provide safe and effective analgesia in terms of early postoperative pain in arthroscopic shoulder surgery. [207] (10.1016/j.jse.2011.04.022)
• [L1] At the 2-year follow-up, 3 (20%) of 15 patients in the lavage group had a redislocated shoulder compared with 9 (60%) of 15 patients in the nonoperative group (P = .03). [208] (10.1016/s1058-2746(99)90066-6)
• [L3] Interscalene block can provide effective anesthesia for arthroscopic shoulder surgery. [215] (10.1016/j.jse.2006.01.009)
• [L1] Nerve block adjuncts may prolong postoperative block time and improve pain control, while there is no evidence to support the use of subacromial infusions or patient-controlled analgesia. [217] (10.1177/0363546520971757)
• [L2] The interscalene regional block provided more pain relief than infusion pumps immediately after arthroscopic shoulder surgery. [218] (10.1016/j.arthro.2007.07.021)
• [L5] Arthroscopic shoulder procedures are increasingly performed in ASCs, but reimbursements for these procedures declined during the study period (2013-2022). [220] (10.1016/j.xrrt.2025.09.001)
• [L4] Symptomatic deep venous thrombosis and pulmonary embolism are rare complications of arthroscopic shoulder surgery. [222] (10.1016/j.jse.2006.05.009)
• [L3] OCP use at the time of arthroscopic shoulder surgery is not associated with an increased risk of VTE. [232] (10.1177/2325967118822970)
• [L1] The hypothesis that shoulders showed a higher proportion or degree of OA following operative treatment compared to non-operative treatment is not supported by the data. [236] (10.1007/s00167-020-06263-3)
• [L4] Professional elite goalkeepers requiring shoulder surgery for different causes demonstrated a high rate of return to play despite the persistence of mild symptoms. [237] (10.1007/s00167-021-06637-1)
• [L5] Overall, 77% of statements reached unanimous or strong consensus, covering patient history evaluation, prognostic factors for nonoperative management, and Bankart repair steps. [238] (10.1016/j.arthro.2021.07.022)
• [L3] However, use of knotless anchors may be a significant risk factor for subsequent dislocation 2 years after arthroscopic shoulder stabilization surgery. [240] (10.1177/2325967119s00273)
• [L3] The duration of sick leave after arthroscopic shoulder surgery in Germany does not exceed sick leave duration in other countries. [241] (10.1007/s00402-016-2460-6)
• [L4] Patient compliance with PROMs decreased over time with the lowest percentage of patients completing electronic surveys at the traditional 2-year follow-up for shoulder arthroscopy. [242] (10.1016/j.asmr.2022.11.004)
• [L4] [243] (10.1016/j.arthro.2014.06.010)
• [L5] The use of a knotless all-suture anchor with suture tape provides an advancement in arthroscopic shoulder stabilization surgery. [244] (10.1016/j.eats.2025.103598)
• [L3] Resident involvement in shoulder arthroscopy was not associated with increased risk of adverse events, increased operative time, or readmission within 30 days. [245] (10.1177/2325967118816293)
• [L5] Patients can have a high expectation of return to wildlife sports following shoulder surgery. [247] (10.1016/j.jseint.2025.101432)
• [L4] Mid-term outcomes in this population of active-duty patients undergoing DPR for shoulder instability without glenoid bone loss demonstrate a statistically and clinically significant improvement in patient-reported outcomes, a significant decrease of pain and an overall return to active-duty rate of 91.67%. [248] (10.1016/j.arthro.2021.09.003)
• [L4] Information gained from a CT scan did not alter treatment decision-making in three-quarters of vignettes among surgeons experienced in the management of anterior shoulder instability. [251] (10.1177/03635465231163148)
• [Case_report] Awareness and early detection are the best approach to thromboembolic disease following shoulder arthroscopy. [252] (10.5397/cise.2021.00500)
• [L3] Arthroscopic thermal capsulorrhaphy neither enhanced nor impaired the outcomes of arthroscopic labral repair with biodegradable tacks in patients with primary recurrent anterior shoulder instability. [254] (10.1177/0363546504270563)
• [L3] In a community practice, radiologists miss approximately 50% of subscapularis tears on MRI examination, while a shoulder surgeon misses 28.6%. [255] (10.1016/j.asmr.2023.100825)
• [L4] Diagnostic imaging may not reliably correlate with diagnostic arthroscopic findings at the time of a Latarjet procedure from both a bony perspective and a soft-tissue perspective. [259] (10.1016/j.asmr.2021.09.014)
• [L4] [265] (10.1016/j.arthro.2021.01.061)
• [L4] [266] (10.1016/j.arthro.2018.10.065)
• [L3] [269] (10.1177/0363546517702863)
• [L2] [270] (10.1007/s00167-011-1521-1)
• [L3] Interpretation of anterior labral morphology by MRI is often incorrect, with normal labral patterns often misread as torn or detached, resulting in the incorrect diagnosis of shoulder instability. [271] (10.1016/s1058-2746(96)80357-0)
• [L4] In general, shoulder arthroscopic surgery in this study population had a low rate of reoperation in the acute period. [277] (10.1177/0363546513510686)
• [L4] There is no study in the literature comparing infection rates between patients who receive and those who do not receive perioperative antibiotics in routine shoulder arthroscopic procedures. [278] (10.1055/s-0038-1636950)
• [L4] High school football players who returned to competitive play after arthroscopic shoulder stabilization surgery experienced a higher rate of recurrent instability that was dependent on their years of eligibility remaining. [279] (10.1177/23259671241239334)
• [L4] Female patients had a lower postoperative return to sport and shoulder scores after the modified Latarjet procedure compared with literature reports. [280] (10.1016/j.jse.2017.07.030)
• [L3] This large retrospective study found that the incidence of secondary frozen shoulder following simple arthroscopic shoulder surgery was just over 5%. [281] (10.1302/0301-620x.97b7.35387)
• [L3] Following arthroscopic shoulder labral surgery, most MLB pitchers and positional players were able to return to play successfully but experienced shorter careers thereafter. [282] (10.1016/j.asmr.2023.02.004)
• [L1] The authors maintain that their systematic review clearly stated a high return to sport (RTS) rate after anterior shoulder stabilization procedures among studies that reported both rate of RTS and time to RTS. [283] (10.1177/0363546519825642)
• [L4] Systematic studies that included newer studies (published after 2000) were associated with more favorable arthroscopic outcomes. [284] (10.1016/j.arthro.2019.10.022)
• [L2] The incidence of unexpected positive cultures (UPCs) is significantly higher in revision arthroscopic shoulder stabilization procedures than in primary surgeries. [285] (10.1002/arj.70130)
• [L5] Arthroscopic and related surgery has a low complication rate, but surgeons must learn from complications that do occur through careful review and study of etiology and prevention. [286] (10.1016/j.arthro.2014.08.002)
• [L5] The authors believe the reported results of the referenced systematic review are not fully representative of the available literature or clinical reality and call to unify terms around postoperative complications after shoulder stabilization surgery. [287] (10.1177/03635465231177872)
• [L3] The postoperative infection risk is greatest when corticosteroid injections are given within 2 weeks of shoulder arthroscopy, whereas injections given within 2-4 weeks also portend increased risk, albeit to a lesser degree. [288] (10.1016/j.arthro.2023.08.073)
• [L3] Increased shoulder arthroscopy procedure time is associated with significantly increased rates of superficial surgical site infections and overnight hospital stays. [289] (10.1016/j.arthro.2017.08.243)
• [L4] Arthroscopic partial repair may produce initial improvement in selected outcomes at 2-year follow-up, but about half of the patients were not satisfied with their outcomes, which had deteriorated over time. [290] (10.1177/0363546515585122)
• [L3] Patients with a BMI >40 have a statistically significant but only slightly increased risk of 30-day complications after shoulder arthroscopy. [292] (10.1016/j.arthro.2018.10.136)
• [L3] Arthroscopic procedures are safe with very low complication rates. [293] (10.1016/j.arthro.2018.10.108)
• [L4] Arthroscopic rotator cuff repair reduced the risk of infection compared with open techniques. [294] (10.1016/j.arthro.2015.08.021)
• [L3] Twenty years postoperatively, arthroscopic Bankart repair was associated with good to excellent shoulder function, low pain levels and high patient satisfaction. [295] (10.1177/2325967124s00022)
• [L1] C acnes infections occur at a very low rate (0.22%) following shoulder arthroscopy. [296] (10.1016/j.jse.2019.12.032)
• [L4] Achieving 69.5% of maximal ASES score improvement or 75% of maximal SANE score improvement is indicative of achieving patient satisfaction after arthroscopic rotator cuff repair. [297] (10.1016/j.arthro.2020.02.047)
• [L4] The similar amounts of bone loss between groups indicates that bone loss is not the primary determinant of failure in revision arthroscopic stabilization. [298] (10.1016/j.arthro.2022.08.044)
• [L2] The rate of P acnes infection in patients undergoing revision shoulder arthroscopy is higher than previously published and should be considered in cases characterized by refractory postoperative pain and stiffness. [299] (10.1016/j.jse.2015.03.008)
• [L2] A lower rate of recurrence can be expected if the patient undergoes surgery after the first episode of dislocation. [300] (10.1007/s00167-015-3785-3)
• [L5] Failure of primary shoulder stabilization procedures is often related to uncorrected anatomic pathology, and the instability severity index score permits precise identification of patients at risk. [301] (10.1016/j.arthro.2010.11.057)
• [L4] While recurrence rates increased over time, patient satisfaction remained high, and no revision surgeries were required, demonstrating the long-term reliability of ABR for anterior shoulder instability. [302] (10.1016/j.jseint.2025.07.004)

See Also

• Shoulder Instability
• Rotator Cuff Repair
• Os Acromiale
• Fractures
• Rotator Cuff
• Shoulder Arthroplasty
• Frozen Shoulder
• Rotator Cuff Disorders
• Total shoulder arthroplasty
• Latarjet Procedure
• Subacromial Decompression
• Reverse Shoulder Arthroplasty
• Biceps Tenodesis
• Brachial Plexus Injury
• Capsular Release for Frozen Shoulder

References

[1] Mixed neuropathy presenting clinically as an anterior interosseous nerve palsy following shoulder arthroscopy: a report of four cases. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2016.04.037

[2] Complications of Shoulder Arthroscopy. Journal of the American Academy of Orthopaedic Surgeons. 2014. DOI: 10.5435/jaaos-22-07-410

[3] Shoulder Arthroscopy: The Basics. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.01.002

[4] Shoulder Arthroscopy Literature Remains Controversial. Arthroscopy. 2012. DOI: 10.1016/j.arthro.2012.07.001

[5] An Analysis of Adult Patient Risk Factors and Complications Within 30 Days After Arthroscopic Shoulder Surgery. Arthroscopy. 2015. DOI: 10.1016/j.arthro.2014.12.011

[6] Outcomes of primary arthroscopic shoulder stabilization in active patients over 40—results at a mean follow-up of 7 years. JSES International. 2024. DOI: 10.1016/j.jseint.2024.05.015

[7] Assessing the Usefulness of Diagnostic Shoulder Arthroscopy in Evaluating Painful Shoulder Replacement: A Retrospective Case Series. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.07.016

[8] Optimizing Visualization in Shoulder Arthroscopy: An Evidence-Based Guide. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-23-01025

[9] Indications and outcomes of shoulder arthroscopy after shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.09.013

[10] Shoulder Arthroscopy, Third Edition. StephenJ. Snyder, RonaldP. Karzel, MarkH. Getelman, JosephP. Burns, MichaelS. Bahk, David M.Auerbach. Philadelphia: Lippincott Williams & Wilkins, 2014, 405 pp.. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.07.021

[11] Understanding the Importance of the Teres Minor for Shoulder Function: Functional Anatomy and Pathology. Journal of the American Academy of Orthopaedic Surgeons. 2018. DOI: 10.5435/jaaos-d-15-00258

[12] Epidemiological trends and indications of shoulder arthroscopy among 191,549 patients in the United States. Shoulder & Elbow. 2026. DOI: 10.1177/17585732261420111

[13] Pain after shoulder arthroscopy: A prospective study on 231 cases. Orthopaedics & Traumatology: Surgery & Research. 2011. DOI: 10.1016/j.otsr.2011.02.003

[14] The Role of Arthroscopy in Revision of Failed Open Anterior Stabilization of the Shoulder. Arthroscopy. 2009. DOI: 10.1016/j.arthro.2009.04.073

[15] Diagnostic Shoulder Arthroscopy: Surgical Technique. Arthroscopy Techniques. 2019. DOI: 10.1016/j.eats.2018.12.003

[16] Orthopaedic Knowledge Update Sports Medicine 6. Research Studies and Registries in Sports Medicine > Multicenter and Registry-­Based Research in Sports Medicine > Shoulder Research.

[17] Shoulder arthroscopy, anatomy and variants - part 1. Orthopaedics and Trauma. 2009. DOI: 10.1016/j.mporth.2009.08.008

[18] Shoulder Arthroscopy in the Throwing Athlete. Clinics in Sports Medicine. 1996. DOI: 10.1016/s0278-5919(20)30081-8

[19] Basics of Shoulder Arthroscopy Part II: Diagnostic Arthroscopy in the Beach‐Chair Position. Arthroscopy Techniques. 2024. DOI: 10.1016/j.eats.2024.103083

[20] Subacromial Access in Shoulder Arthroscopy Using a Posterior‐to‐Anterior Cannula‐Guided Technique. Arthroscopy Techniques. 2025. DOI: 10.1016/j.eats.2025.103901

[21] Improving visualization in shoulder arthroscopy. Clinics in Shoulder and Elbow. 2023. DOI: 10.5397/cise.2022.01291

[22] The Effects of Patient Obesity on Early Postoperative Complications After Shoulder Arthroscopy. Arthroscopy. 2016. DOI: 10.1016/j.arthro.2016.03.022

[23] Shoulder Arthroscopy: Basic Principles of Positioning, Anesthesia, and Portal Anatomy. Journal of the American Academy of Orthopaedic Surgeons. 2013. DOI: 10.5435/00124635-201306000-00003

[24] Shoulder Arthroscopy: Evolution of the Revolution. Arthroscopy. 2009. DOI: 10.1016/j.arthro.2009.06.015

[25] Arthroscopic Shoulder Surgery. 2022.

[26] The Utility of Shoulder Arthroscopy at the Time of Open Latarjet. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671261415839

[27] Clinical Outcomes Following Revision Shoulder Arthroscopic Capsulolabral Stabilization. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2014.11.034

[29] Rockwood And Matsen S The Shoulder. Arthroscopic Management of Prearthritic and Arthritic Conditions of the Shoulder and the Postarthroplasty Shoulder > SUMMARY.

[31] The Top 50 Most‐Cited Shoulder Arthroscopy Studies. Arthroscopy, Sports Medicine, and Rehabilitation. 2021. DOI: 10.1016/j.asmr.2020.09.011

[32] Rationales of arthroscopic shoulder stabilization. Archives of Orthopaedic and Trauma Surgery. 2002. DOI: 10.1007/s00402-002-0423-6

[33] Shoulder arthroscopy combined to hardware removal in proximal humeral fractures: a series of 58 cases with a mean follow-up of 2 years. European Journal of Orthopaedic Surgery & Traumatology. 2017. DOI: 10.1007/s00590-017-1938-4

[34] Shoulder Arthroscopy in Children and Adolescents. Journal of the American Academy of Orthopaedic Surgeons. 2013. DOI: 10.5435/00124635-201307000-00004

[35] Rockwood And Matsen S The Shoulder. Arthroscopic Management of Prearthritic and Arthritic Conditions of the Shoulder and the Postarthroplasty Shoulder > Instability.

[36] Rockwood And Matsen S The Shoulder. Arthroscopic Management of Prearthritic and Arthritic Conditions of the Shoulder and the Postarthroplasty Shoulder > OSTEONECROSIS > Arthroscopy After Shoulder Arthroplasty.

[37] Rockwood And Matsen S The Shoulder. Arthroscopic Management of Prearthritic and Arthritic Conditions of the Shoulder and the Postarthroplasty Shoulder > INTRODUCTION.

[39] Venous Thromboembolism Chemical Prophylaxis in Patients Undergoing Shoulder Arthroscopy. JBJS Reviews. 2024. DOI: 10.2106/jbjs.rvw.23.00228

[40] Shoulder Arthroscopy in Adults 60 or Older: Risk Factors That Correlate With Postoperative Complications in the First 30 Days. Arthroscopy. 2016. DOI: 10.1016/j.arthro.2016.05.035

[41] Return to play criteria among shoulder surgeons following shoulder stabilization. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2021.01.026

[42] 30-day morbidity and mortality after elective shoulder arthroscopy: a review of 9410 cases. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2013.06.022

[43] Editorial Commentary: Don't Throw Away the Retractors: Complications of Open Versus Arthroscopic Rotator Cuff Repair Could Be Influenced by Indications. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2017.11.026

[44] Comprehensive Review of Shoulder Instability Includes Diagnosis, Nonoperative Management, Bankart, Latarjet, Remplissage, Glenoid Bone‐Grafting, Revision Surgery, Rehabilitation and Return to Play, and Clinical Follow‐Up. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2021.11.052

[45] Recurrence Rates Following Arthroscopic Shoulder Stabilization are Improved Following a Criteria Based Return to Sport Testing Protocol. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120s00381

[47] Revision of failed Latarjet with the Eden-Hybinette surgical technique. Orthopaedics & Traumatology: Surgery & Research. 2020. DOI: 10.1016/j.otsr.2019.12.009

[48] Increased revision rates in shoulder arthroplasty following shoulder arthroscopy. Shoulder & Elbow. 2023. DOI: 10.1177/17585732231176269

[49] Benefits and limitations of diagnostic shoulder arthroscopy for painful anatomical shoulder arthroplasty investigation. JSES Reviews, Reports, and Techniques. 2025. DOI: 10.1016/j.xrrt.2025.06.011

[50] Reverse arthroplasty for osteoarthritis and rotator cuff deficiency after previous surgery for recurrent anterior shoulder instability. International Orthopaedics. 2014. DOI: 10.1007/s00264-014-2325-y

[51] Rockwood And Matsen S The Shoulder. Arthroscopic Management of Prearthritic and Arthritic Conditions of the Shoulder and the Postarthroplasty Shoulder > Radiographic Evaluation.

[52] The Timing of Corticosteroid Injections After Arthroscopic Shoulder Procedures Affects Postoperative Infection Risk. The American Journal of Sports Medicine. 2019. DOI: 10.1177/0363546518825348

[54] Rockwood And Matsen S The Shoulder. Developmental Anatomy of the Shoulder and Anatomy of the Glenohumeral Joint > SENIOR EDITOR COMMENTARY.

[56] Glenohumeral Chondrolysis after Shoulder Arthroscopy. The American Journal of Sports Medicine. 2004. DOI: 10.1177/0363546503262176

[58] Pseudoaneurysm after shoulder arthroscopy. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2013.05.018

[59] Shoulder arthroscopy with the use of local anesthesia. Journal of Shoulder and Elbow Surgery. 1993. DOI: 10.1016/1058-2746(93)90008-5

[60] Fluid Extravasation in Shoulder Arthroscopic Surgery: A Systematic Review. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118771616

[63] Shoulder arthroscopy: its role in evaluating shoulder disorders in the athlete. The American Journal of Sports Medicine. 1990. DOI: 10.1177/036354659001800506

[65] The Impact of Resident Involvement on Postoperative Complications After Shoulder Arthroscopy: A Propensity-Matched Analysis. JAAOS: Global Research and Reviews. 2020. DOI: 10.5435/jaaosglobal-d-20-00138

[66] Rockwood And Matsen S The Shoulder. Fractures, Dislocations, and Acquired Problems of the Shoulder in Children > EDITOR COMMENTARY.

[68] A bibliometric analysis of the top 100 most-cited shoulder arthroscopy patents. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2026.100828

[69] Patient-Related Risk Factors for Postoperative Infection Following Shoulder Arthroscopy: An Analysis of Over 420,000 Patients. Orthopaedic Journal of Sports Medicine. 2017. DOI: 10.1177/2325967117s00362

[71] Nonoperative management of anterior shoulder instability can result in high rates of recurrent instability and pain at long-term follow-up. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2021.07.016

[72] Proper Evaluation of Bone Loss Determines Shoulder Instability Indications and Outcomes. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2021. DOI: 10.1016/j.arthro.2021.01.004

[73] Analgesic effectiveness of nerve block in shoulder arthroscopy: comparison between interscalene, suprascapular and axillary nerve blocks. Knee Surgery, Sports Traumatology, Arthroscopy. 2012. DOI: 10.1007/s00167-012-1950-5

[74] Functional Deficits After Open Latarjet Procedure and Dominance of the Operated Shoulder: An Analysis of 133 Patients. The American Journal of Sports Medicine. 2023. DOI: 10.1177/03635465231156181

[75] Pulmonary embolism following thrombosis of the brachial vein after shoulder arthroscopy. A case report. Orthopaedics & Traumatology: Surgery & Research. 2009. DOI: 10.1016/j.otsr.2009.03.016

[76] Campbell S Operative Orthopaedics 4 Volume Set. POSTERIOR SURGICAL APPROACH FOR QUADRILATERAL SPACE SYNDROME > ANTERIOR INSTABILITY OF THE SHOULDER.

[79] Lesion prevalence and patient outcome comparison between primary and recurrent anterior shoulder instability. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2023.05.029

[81] Fewer anchors achieves successful arthroscopic shoulder stabilization surgery: 114 patients with 4 years of follow-up. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2013.08.010

[82] Shoulder Arthroscopy Complication and Readmission Rates: Impact on Value. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2016.11.010

[83] Return to sport testing at 6 months after arthroscopic shoulder stabilization reveals residual strength and functional deficits. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.04.035

[84] Long-term Results After Arthroscopic Shoulder Stabilization Using Suture Anchors. The American Journal of Sports Medicine. 2011. DOI: 10.1177/0363546511415657

[85] ARTHROSCOPIC SHOULDER INSTABILITY SURGERY. Clinics in Sports Medicine. 1999. DOI: 10.1016/s0278-5919(05)70183-6

[86] Young patients with shoulder chondrolysis following arthroscopic shoulder surgery treated with total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2008. DOI: 10.1016/j.jse.2007.11.004

[89] Rockwood And Matsen S The Shoulder. Shoulder and Elbow Specialty Clinic Workers’ Survey > ANATOMY.

[90] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 2Musculoskeletal Trauma Surgery > SHOULDER AND ARM INJURIES.

[91] Aaos Comprehensive Orthopaedic Review 3. Anatomy of the Shoulder, Arm, and Elbow > I. Shoulder.

[92] Rockwood And Matsen S The Shoulder. Developmental Anatomy of the Shoulder and Anatomy of the Glenohumeral Joint > Bursae.

[94] Rockwood And Matsen S The Shoulder. Developmental Anatomy of the Shoulder and Anatomy of the Glenohumeral Joint > EDITOR COMMENTARY.

[95] Rockwood And Matsen S The Shoulder. Fractures, Dislocations, and Acquired Problems of the Shoulder in Children > FRACTURES OF THE PROXIMAL HUMERUS.

[98] Campbell S Operative Orthopaedics 4 Volume Set. RECONSTRUCTIVE PROCEDURES OF THE SHOULDER AND ELBOW IN ADULTS > ANATOMY AND BIOMECHANICS.

[99] Campbell S Operative Orthopaedics 4 Volume Set. ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH BONE-PATELLAR TENDON-BONE GRAFT > SHOULDER INJURIES > ANATOMY AND BIOMECHANICS.

[100] Miller S Review Of Orthopaedics. Genetics of musculoskeletal conditions and abnormalities are summarized in Table 1.27 > UPPER EXTREMITY > SHOULDER.

[102] Rockwood And Matsen S The Shoulder. Developmental Anatomy of the Shoulder and Anatomy of the Glenohumeral Joint > Shoulder Capsule.

[107] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Shoulder Anatomy and Biomechanics, Clinical Evaluation, Imaging > Clinical Evaluation > Imaging.

[108] Aaos Comprehensive Orthopaedic Review 3. Imaging of the Shoulder and Elbow > I. Shoulder.

[111] Poster 385: Incidence of Preoperative Depression in Knee and Shoulder Arthroscopy Using Patient Health Questionnaire-2 (PHQ-2). Orthopaedic Journal of Sports Medicine. 2024. DOI: 10.1177/2325967124s00350

[112] Isolated Primary Latarjet Procedures for Anterior Shoulder Instability Results in High Rates of Graft Resorption and Glenohumeral Degenerative Changes With Low Rates of Failure at a Minimum 2‐Year Follow‐Up: A Systematic Review. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2023.05.024

[114] Rockwood And Matsen S The Shoulder. Fractures, Dislocations, and Acquired Problems of the Shoulder in Children > DIAGNOSIS AND DIAGNOSTIC ARTHROSCOPY IN SHOULDER INSTABILITY.

[116] Earlier Return to Light Duty Is Associated With Successful Return to Full Duty of Workers’ Compensation Patients Treated With Shoulder Arthroscopic Surgery. Arthroscopy, Sports Medicine, and Rehabilitation. 2022. DOI: 10.1016/j.asmr.2022.01.004

[122] Shoulder arthroscopy: a bridge from the past to the future. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.04.011

[123] Supine‐Position Shoulder Arthroscopy Using the Anterior Portal as the Initial Approach. Arthroscopy Techniques. 2026. DOI: 10.1002/atn2.70109

[128] Rockwood And Matsen S The Shoulder. Fractures, Dislocations, and Acquired Problems of the Shoulder in Children > Subscapularis Tears.

[130] The role of pectoralis major and latissimus dorsi muscles in a biomechanical model of massive rotator cuff tear. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2013.11.030

[136] Thromboembolic Phenomena After Arthroscopic Shoulder Surgery. Arthroscopy. 2011. DOI: 10.1016/j.arthro.2011.06.026

[139] Rockwood And Matsen S The Shoulder. Fractures, Dislocations, and Acquired Problems of the Shoulder in Children > Clinical Findings.

[140] Rockwood And Matsen S The Shoulder. Developmental Anatomy of the Shoulder and Anatomy of the Glenohumeral Joint > Costoclavicular Maneuver.

[141] The Effect of Pre-emptive Dexketoprofen Administration on Postoperative Pain Management in Patients with Ultrasound Guided Interscalene Block in Arthroscopic Shoulder Surgery. Journal of Investigative Surgery. 2019. DOI: 10.1080/08941939.2019.1576809

[144] Rockwood And Matsen S The Shoulder. Arthroscopic Management of Prearthritic and Arthritic Conditions of the Shoulder and the Postarthroplasty Shoulder > Physical Examination.

[146] Rehabilitation following shoulder arthroscopic stabilisation surgery: A survey of UK practice. Shoulder & Elbow. 2023. DOI: 10.1177/17585732231154889

[150] Thromboembolic Events After Arthroscopic Shoulder Surgery: A Case Series of Unusual Complications (SS‐36). Arthroscopy. 2007. DOI: 10.1016/j.arthro.2007.03.048

[151] Regional Anesthesia Should Be the Standard for All Arthroscopic Shoulder Surgeries. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.07.031

[152] Thromboembolism Following Shoulder Arthroscopy. Orthopaedic Journal of Sports Medicine. 2014. DOI: 10.1177/2325967114559506

[153] Miller S Review Of Orthopaedics. SHOULDER INSTABILITY > History and physical examination.

[156] Subacromial analgesia via continuous infusion catheter vs. placebo following arthroscopic shoulder surgery: a systematic review and meta-analysis of randomized trials. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.11.010

[157] Indications for Arthroscopic Subacromial Decompression. A Level V Evidence Clinical Guideline. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.06.012

[158] Rockwood And Matsen S The Shoulder. Arthroscopic Management of Prearthritic and Arthritic Conditions of the Shoulder and the Postarthroplasty Shoulder > Acknowledgements > Patient Evaluation.

[159] Nerve Blocks for Shoulder Arthroscopy: A Systematic Review of Randomized Controlled Trials With a Network Meta-analysis. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465261462708

[160] Rockwood And Matsen S The Shoulder. Arthroscopic Management of Prearthritic and Arthritic Conditions of the Shoulder and the Postarthroplasty Shoulder > EVALUATION OF THE OVERHEAD ATHLETE.

[163] Venous Thromboembolism in Patients Undergoing Shoulder Arthroscopy. Clinical and Applied Thrombosis/Hemostasis. 2015. DOI: 10.1177/1076029614567311

[165] A Systematic Approach for Diagnosing Subscapularis Tendon Tears With Preoperative Magnetic Resonance Imaging Scans. Arthroscopy. 2012. DOI: 10.1016/j.arthro.2012.04.142

[169] While the Incidence of Venous Thromboembolism After Shoulder Arthroscopy Is Low, the Risk Factors Are a Body Mass Index Greater than 30 and Hypertension. Arthroscopy, Sports Medicine, and Rehabilitation. 2023. DOI: 10.1016/j.asmr.2023.100815

[170] Editorial Commentary: Corticosteroid Injections Administered Within 4 Weeks Before Shoulder Arthroscopy Are Associated With an Increased Risk of Infection. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2023.10.006

[172] Multimodal Opioid-Sparing Postoperative Pain Protocol Versus Standard of Care for Patients Undergoing Knee and Shoulder Arthroscopy: A Randomized Controlled Trial. Journal of ISAKOS. 2023. DOI: 10.1016/j.jisako.2023.03.424

[174] Earlier Orthopaedic Surgeon Evaluation of Workers' Compensation Associated With Higher Return to Full Duty After Shoulder Arthroscopy. JAAOS: Global Research and Reviews. 2025. DOI: 10.5435/jaaosglobal-d-24-00269

[175] A multicenter randomized controlled trial comparing gamification with remote monitoring against standard rehabilitation for patients after arthroscopic shoulder surgery. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2021.08.019

[183] Venous thromboembolism after arthroscopic shoulder surgery: a systematic review. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-03592-0

[184] Complications After Arthroscopic Shoulder Surgery: A Review of the American Board of Orthopaedic Surgery Database. JAAOS: Global Research and Reviews. 2018. DOI: 10.5435/jaaosglobal-d-18-00093

[189] Suprascapular Nerve Block for Postoperative Pain Relief in Arthroscopic Shoulder Surgery. Anesthesia & Analgesia. 1997. DOI: 10.1097/00000539-199706000-00024

[191] Operative Duration as an Independent Risk Factor for Lower-Extremity Deep Vein Thrombosis Following Shoulder Arthroscopy: A Prospective Cohort Study With Systematic Ultrasonographic Screening. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671261451735

[192] Analgesic Effect of Interscalene Block Using Low-Dose Bupivacaine for Outpatient Arthroscopic Shoulder Surgery. Regional Anesthesia and Pain Medicine. 1998. DOI: 10.1097/00115550-199823050-00007

[193] A New Technique for Regional Anesthesia for Arthroscopic Shoulder Surgery Based on a Suprascapular Nerve Block and an Axillary Nerve Block: An Evaluation of the First Results. Arthroscopy. 2008. DOI: 10.1016/j.arthro.2008.01.019

[194] Moderate Preoperative Shoulder Stiffness Does Not Alter the Clinical Outcome of Rotator Cuff Repair With Arthroscopic Release and Manipulation. Arthroscopy. 2008. DOI: 10.1016/j.arthro.2008.06.007

[195] Multiple Instability Events at Initial Presentation Are the Major Predictor of Failure of Nonoperative Treatment for Anterior Shoulder Instability. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2021. DOI: 10.1016/j.arthro.2021.03.047

[196] Venothromboembolism following shoulder arthroscopy: a systematic review. JSES Reviews, Reports, and Techniques. 2022. DOI: 10.1016/j.xrrt.2022.05.003

[197] Complex Shoulder Disorders: Evaluation and Treatment. Journal of the American Academy of Orthopaedic Surgeons. 2009. DOI: 10.5435/00124635-200903000-00002

[199] Campbell S Operative Orthopaedics 4 Volume Set. RECONSTRUCTIVE PROCEDURES OF THE SHOULDER AND ELBOW IN ADULTS > INTRAOPERATIVE COMPLICATIONS > Table 12.4.

[204] Return to Sports After Arthroscopic Anterior Stabilization in Patients Aged Younger Than 25 Years. Arthroscopy. 2013. DOI: 10.1016/j.arthro.2013.09.008

[205] Ten-year follow-up of acute arthroscopic Bankart repair for initial anterior shoulder dislocation in young patients. Orthopaedics & Traumatology: Surgery & Research. 2015. DOI: 10.1016/j.otsr.2015.09.029

[207] An anatomic and clinical study of the suprascapular and axillary nerve blocks for shoulder arthroscopy. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2011.04.022

[208] Arthroscopic lavage compared with nonoperative treatment for traumatic primary anterior shoulder dislocation: A 2-year follow-up of a prospective randomized study. Journal of Shoulder and Elbow Surgery. 1999. DOI: 10.1016/s1058-2746(99)90066-6

[210] Rockwood And Matsen S The Shoulder. Fractures, Dislocations, and Acquired Problems of the Shoulder in Children > ARTHROSCOPIC ROTATOR CUFF REPAIR.

[215] Interscalene regional anesthesia for arthroscopic shoulder surgery: A safe and effective technique. Journal of Shoulder and Elbow Surgery. 2006. DOI: 10.1016/j.jse.2006.01.009

[217] Pain Control After Shoulder Arthroscopy: A Systematic Review of Randomized Controlled Trials With a Network Meta-analysis. The American Journal of Sports Medicine. 2020. DOI: 10.1177/0363546520971757

[218] Assessment of Pain Relief Provided by Interscalene Regional Block and Infusion Pump After Arthroscopic Shoulder Surgery. Arthroscopy. 2007. DOI: 10.1016/j.arthro.2007.07.021

[220] National trends in medicare utilization and reimbursement fees for common shoulder arthroscopy procedures performed in ambulatory surgery centers from 2013 to 2022. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2025.09.001

[222] Pulmonary embolism after shoulder arthroscopy: Could patient positioning and traction make a difference?. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.05.009

[227] Orthopaedic Knowledge Update Trauma. Periprosthetic Fractures > Upper Extremity Periprosthetic Fractures > Periprosthetic Fractures Associated With Shoulder Arthroplasty.

[232] Oral Contraceptive Pills Are Not a Risk Factor for Deep Vein Thrombosis or Pulmonary Embolism After Arthroscopic Shoulder Surgery. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967118822970

[233] Rockwood And Matsen S The Shoulder. Fractures, Dislocations, and Acquired Problems of the Shoulder in Children > COMPLICATIONS OF STABILIZATION SURGERY.

[235] Campbell S Operative Orthopaedics 4 Volume Set. RECONSTRUCTIVE PROCEDURES OF THE SHOULDER AND ELBOW IN ADULTS > COMPLICATIONS OF SHOULDER ARTHROPLASTY.

[236] Treatment type may influence degree of post‐dislocation shoulder osteoarthritis: a systematic review and meta‐analysis. Knee Surgery, Sports Traumatology, Arthroscopy. 2020. DOI: 10.1007/s00167-020-06263-3

[237] Elite professional goalkeepers report high rate of sport resumption after shoulder surgery. Knee Surgery, Sports Traumatology, Arthroscopy. 2021. DOI: 10.1007/s00167-021-06637-1

[238] Anterior Shoulder Instability Part I—Diagnosis, Nonoperative Management, and Bankart Repair—An International Consensus Statement. Arthroscopy. 2021. DOI: 10.1016/j.arthro.2021.07.022

[240] Comparison of Knotless Versus Traditional Glenoid Anchors in Early Outcomes Following Arthroscopic Shoulder Stabilization. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119s00273

[241] Duration of sick leave after shoulder arthroscopy in Germany: analysis of health care data. Archives of Orthopaedic and Trauma Surgery. 2016. DOI: 10.1007/s00402-016-2460-6

[242] Compliance with Electronic Patient Reported Outcome Measure System Data Collection Is 51% Two‐years After Shoulder Arthroscopy. Arthroscopy, Sports Medicine, and Rehabilitation. 2022. DOI: 10.1016/j.asmr.2022.11.004

[243] Remplissage, Humeral Osteochondral Grafts, Weber Osteotomy, and Shoulder Arthroplasty for the Management of Humeral Bone Defects in Shoulder Instability: Systematic Review and Quantitative Synthesis of the Literature. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.06.010

[244] Arthroscopic Shoulder Labral Repair Using Knotless All‐Suture Anchor With Suture Tape. Arthroscopy Techniques. 2025. DOI: 10.1016/j.eats.2025.103598

[245] Resident Involvement in Shoulder Arthroscopy Is Not Associated With Short-term Risk to Patients. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118816293

[247] Return to fishing and hunting recreation after shoulder arthroscopy and arthroplasty, a PacWest Shoulder Study Group survey. JSES International. 2026. DOI: 10.1016/j.jseint.2025.101432

[248] Double‐Pulley Remplissage in Active‐Duty Military Population With Off‐Track Anterior Shoulder Instability Results in Improved Outcomes and Low Recurrence at Minimum 4‐Year Follow‐Up. Arthroscopy. 2021. DOI: 10.1016/j.arthro.2021.09.003

[251] Use of Computed Tomography in the Evaluation of Anterior Shoulder Instability: Possible Effect on Surgical Management. The American Journal of Sports Medicine. 2023. DOI: 10.1177/03635465231163148

[252] Intraoperative pulmonary embolism in shoulder arthroscopy in a patient with previous SARS-CoV-2 infection: a case report. Clinics in Shoulder and Elbow. 2022. DOI: 10.5397/cise.2021.00500

[254] The Effects of Thermal Capsular Shrinkage on the Outcomes of Arthroscopic Stabilization for Primary Anterior Shoulder Instability. The American Journal of Sports Medicine. 2005. DOI: 10.1177/0363546504270563

[255] Both Radiologists and Surgeons Miss a Substantial Number of Subscapularis Tears on Magnetic Resonance Imaging Examination Prior to Shoulder Arthroscopy. Arthroscopy, Sports Medicine, and Rehabilitation. 2023. DOI: 10.1016/j.asmr.2023.100825

[259] Shoulder Arthroscopy in Conjunction With an Open Latarjet Procedure Can Identify Pathology That May Not Be Accounted for With Magnetic Resonance Imaging. Arthroscopy, Sports Medicine, and Rehabilitation. 2021. DOI: 10.1016/j.asmr.2021.09.014

[265] Arthroscopic Autologous Scapular Spine Bone Graft Combined With Bankart Repair for Anterior Shoulder Instability With Subcritical (10%‐15%) Glenoid Bone Loss. Arthroscopy. 2021. DOI: 10.1016/j.arthro.2021.01.061

[266] Shoulder Arthroscopy Can Restore Joint Function Following Proximal Humeral Fracture Malunion in Middle Age Individuals. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2018.10.065

[269] Does an Injection of Adipose-Derived Mesenchymal Stem Cells Loaded in Fibrin Glue Influence Rotator Cuff Repair Outcomes? A Clinical and Magnetic Resonance Imaging Study. The American Journal of Sports Medicine. 2017. DOI: 10.1177/0363546517702863

[270] Rotator cuff re‐tear or non‐healing: histopathological aspects and predictive factors. Knee Surgery, Sports Traumatology, Arthroscopy. 2011. DOI: 10.1007/s00167-011-1521-1

[271] Mri of the glenghumeral joint: Pitfalls in the diagnosis of labral pathology. Journal of Shoulder and Elbow Surgery. 1996. DOI: 10.1016/s1058-2746(96)80357-0

[277] Incidence of Acute Postoperative Infections Requiring Reoperation After Arthroscopic Shoulder Surgery. The American Journal of Sports Medicine. 2013. DOI: 10.1177/0363546513510686

[278] Are Prophylactic Intravenous Antibiotics Required in Routine Shoulder Arthroscopic Surgery? A Systematic Review of the Literature. Joints. 2018. DOI: 10.1055/s-0038-1636950

[279] Arthroscopic Shoulder Stabilization in High School Football Players. Orthopaedic Journal of Sports Medicine. 2024. DOI: 10.1177/23259671241239334

[280] The modified Latarjet procedure in female patients: clinical outcomes and complications. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2017.07.030

[281] Frozen shoulder after simple arthroscopic shoulder procedures. The Bone & Joint Journal. 2015. DOI: 10.1302/0301-620x.97b7.35387

[282] High Return to Play Rate and Diminished Career Longevity are Seen Following Arthroscopic Shoulder Labral Repair in Major League Baseball Players. Arthroscopy, Sports Medicine, and Rehabilitation. 2023. DOI: 10.1016/j.asmr.2023.02.004

[283] Return to Sport After Surgical Treatment for Anterior Shoulder Instability: A Systematic Review: Response. The American Journal of Sports Medicine. 2019. DOI: 10.1177/0363546519825642

[284] Arthroscopic Versus Open Bankart Repairs in Recurrent Anterior Shoulder Instability: A Systematic Review of the Association Between Publication Date and Postoperative Recurrent Instability in Systematic Reviews. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.10.022

[285] Significantly Higher Rate of Unexpected Positive Cultures in Revision Surgery Than in Primary Arthroscopic Shoulder Stabilization Surgery. Arthroscopy. 2026. DOI: 10.1002/arj.70130

[286] Hip Arthroscopy Dislocation and Shoulder Arthroscopy Positioning. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.08.002

[287] Complications Related to Latarjet Shoulder Stabilization: Letter to the Editor. The American Journal of Sports Medicine. 2023. DOI: 10.1177/03635465231177872

[288] Preoperative Corticosteroid Injections Within 4 Weeks of Arthroscopic Shoulder Procedures Are Associated With Increased Postoperative Infection Rates. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2023.08.073

[289] Increased Shoulder Arthroscopy Time Is Associated With Overnight Hospital Stay and Surgical Site Infection. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.08.243

[290] Arthroscopic Partial Repair of Irreparable Rotator Cuff Tears. The American Journal of Sports Medicine. 2015. DOI: 10.1177/0363546515585122

[292] The Impact of Body Mass Index on Complications After Shoulder Arthroscopy: Should Surgery Eligibility Be Determined by Body Mass Index Cutoffs?. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2018.10.136

[293] Body Mass Index as a Risk Factor for 30‐Day Postoperative Complications in Knee, Hip, and Shoulder Arthroscopy. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2018.10.108

[294] Risk Factors for Infection After Rotator Cuff Repair. Arthroscopy. 2015. DOI: 10.1016/j.arthro.2015.08.021

[295] Paper 09: Minimum 20-Year Outcomes Following Arthroscopic Bankart Repair for the Treatment of Anterior Shoulder Instability. Orthopaedic Journal of Sports Medicine. 2024. DOI: 10.1177/2325967124s00022

[296] Prevention of Cutibacterium acnes infection in arthroscopic shoulder surgery: a systematic review. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.12.032

[297] How Is Maximum Outcome Improvement Defined in Patients Undergoing Shoulder Arthroscopy for Rotator Cuff Repair? A 1‐Year Follow‐Up Study. Arthroscopy. 2020. DOI: 10.1016/j.arthro.2020.02.047

[298] Revision Arthroscopic Bankart Repair Results in High Failure Rates and a Low Return to Duty Rate Without Recurrent Instability. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2022.08.044

[299] Propionibacterium acnes infection in shoulder arthroscopy patients with postoperative pain. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.03.008

[300] Predictors of functional outcomes and recurrent shoulder instability after arthroscopic anterior stabilization. Knee Surgery, Sports Traumatology, Arthroscopy. 2015. DOI: 10.1007/s00167-015-3785-3

[301] Failure of Operative Treatment for Glenohumeral Instability: Etiology and Management. Arthroscopy. 2011. DOI: 10.1016/j.arthro.2010.11.057

[302] Long-term outcomes of arthroscopic Bankart repair: a 10-year follow-up study. JSES International. 2025. DOI: 10.1016/j.jseint.2025.07.004