It is the best and most modern solution in dealing with surgical problems of the shoulder, which allows us to see inside the joint, to diagnose and treat its problems in time.

“It began to be applied, initially, to professional athletes and then to more and more patients who were suffering from problems in this area and could not respond to their daily activities, such as work, obligations, or even enjoy their favorite pastimes, like sports and specifically swimming. Because of this, many patients undergo this surgery to return to their favorite activity as soon as possible, asking the common question: ‘When can I safely return to swimming?'” says o Dr. Ioannis X. Ferousis MD, PhD, Director of the Special Orthopedic Shoulder Surgery Clinic Metropolitan Hospital. He discusses the condition and its recovery below, taking into account the nature of shoulder arthroscopy, the recovery process, and the implications of swimming after surgery.

Understanding the shoulder

The shoulder morphology is a complex joint that moves at multiple levels, more than any other joint in the body and is therefore particularly prone to injury.
It consists of three bones, the scapula, the humerus and the clavicle. On the side of the scapula, the shoulder joint has a concave articular surface called the scapula, while on the side of the humerus, a spherical surface called the head. Articular cartilage covers both the head of the humerus and the scapula, while the muscles are attached to the bones by strong thickenings of connective tissue called tendons. The shoulder rotator cuff, which acts as a stabilizer in the joint and is responsible for its rotational movements, consists of four muscles with corresponding tendons: the supraspinatus, subspinatus, subscapularis and teres minor. Finally, the acromion is a protrusion of the scapula that articulates with the clavicle.

How is the Shoulder Arthroscopy technique applied?

“Arthroscopy comes to provide the most modern answer to shoulder problems, with a minimally invasive surgical method. This is a huge advance in medical surgery, since in the past, the only treatment option was open surgery with all the consequences that could bring, such as injuries, acute pain, multi-day hospitalization of the patient and immobilization of the shoulder for a long time.

In the operation, the surgeon begins by administering general or local anesthesia to the patient, before inserting a special tool, the arthroscope in his body, through small holes, about 3-5 mm, which has a tiny camera with strong illumination and is connected to a special high-resolution screen, where it is projected at a magnification of about 20 times, an extremely clear and colorful image,” summarizes physician.

What are the advantages it offers to the surgeon?

• “It allows him to carefully examine the inside of the joint and diagnose with great precision any damage, even the very small ones that occur in the most inaccessible places.
• To repair complex intra-articular and peri-articular injuries, such as repair of ruptured tendons and resolution of adhesions, with the help of specially designed instruments.

What are the advantages it offers to the patient?

• The operation usually takes a maximum of one hour, with light anesthesia, depending on the patient’s history, and allows him to return home even the same day.
• Offers gentler, faster and safer recovery without many side effects.
• The risk of complications is minimal.
• As the incisions made are very small, the injury to the skin and the rest of the healthy adjacent tissues is minimal, while a better aesthetic result is achieved.
• Post-operative pain is greatly reduced, with limited use of painkillers and anti-inflammatory drugs” explains Dr. Ferousis.

What ailments does it address?

“Arthroscopy is applied to rotator cuff disease in cases where non-surgical treatments fail to relieve symptoms, such as persistent pain and inability to move the limb. On the other hand, arthroscopy for shoulder instability, which often occurs after injuries, is deemed necessary when the shoulder joint repeatedly loosens and dislocates,” he emphasizes, outlining the conditions in which arthroscopy can be applied.
Typically, it is applied for the following ailments:
• Rupture (partial, complete, massive) of the rotator cuff and shoulder tendon
• The subacromial impingement syndrome
• Calcifying tendinitis
• Symphytic folliculitis
• Rupture of the labial cartilage of the scapula
• Osteoarthritis and intra-articular meniscus tear of the acromioclavicular joint
• The pressure of the suprascapular nerve
• Certain intra-articular fractures
• Injuries of the articular cartilage
• The existence of intra-articular foreign bodies

The recovery process

Recovery from shoulder arthroscopy varies greatly depending on the complexity of the procedure and the condition each patient is dealing with. In general, sutures are usually removed after 8-10 days and patients wear a brace for 1-2 weeks after surgery, while they begin physical therapy, first with mild passive exercises to regain range of motion, followed by active exercises and finally training empowerment.

“From the very first days, the patient can return, without pain, to his daily activities, such as driving. But even in cases where recovery is slower, it is achieved with fewer restrictions compared to those required by older techniques. And the long-term results are very satisfying for patients, with no pain and full return to daily and sports activities.
In the early stages of recovery, it is important to avoid activities that put undue stress on the shoulder, including swimming. Because although simple swimming is a low burden exercise for the shoulder, intense sports in the water should be avoided for the first time and at least until the healing of the small skin incisions”, points out the expert.

How to return to the pool or the sea?

“For recreational swimmers, you may be able to return to light swimming as early as 3 weeks after surgery, but it is important to start slowly and avoid sudden movements. Simple swimming is preferred for the first time after surgery and can help regain range of motion. For competitive swimmers and those doing intensive swimming training, a longer period may be required, possibly up to 4-6 months after surgery. This gives the shoulder sufficient time to fully heal and regain the necessary strength. It’s also important to gradually build back training volume and intensity, focusing on shoulder-friendly technique and exercises to minimize the risk of re-injury,” he recommends.

Personalized Approach

“Beyond the general guidelines, the actual timeline may vary by patient. Factors affecting recovery include the type of surgery performed, the patient’s health status, age, degree of preoperative shoulder damage, and adherence to postoperative rehabilitation. That’s why, in any case, communication with your surgeon is vital during recovery, as they can provide you with personalized advice based on your progress and any symptoms you’re experiencing. Pain or discomfort during or after swimming may indicate that you are pushing your shoulder too hard or too soon and may require adjustments to your recovery plan.

Additionally, you should keep in mind that even after a successful recovery, it’s important to continue with shoulder-strengthening exercises and maintain good swimming technique to protect your shoulder from future problems, as well as getting checked regularly, concludes Dr. Ioannis X. Ferousis.

*The Special Orthopedic Shoulder Surgery Clinic created in 2023 by Dr. Ioannis Feroussi at the Metropolitan Hospital, is made up of experienced doctors who are allied with innovative technology. The new Clinic is a point of reference for shoulder surgery in Greece. It combines the comfort and multifactorial support that every patient needs for their shoulder, offering a multitude of appropriate treatments, from arthroscopy to biological therapies, and from arthroplasty to osteosynthesis.