Comprehensive arthroscopic management (CAM)

You may be recommended CAM surgery if you have osteoarthritis in your shoulder joint that is causing you significant pain and loss of movement. In particular, CAM may be suitable for you if you are considered too young for shoulder replacement surgery, if you lead an active lifestyle, or if you regularly participate in sports.

At your first consultation, you will be seen by a consultant orthopaedic surgeon, a doctor specialising in problems with the bones and joints.

Your consultant will ask you about your general health and medical history. They will ask you about your symptoms and perform a physical examination.

Your consultant may want to confirm your diagnosis with tests and scans including:

• X-ray - to check your shoulder joint for signs of arthritis
• Computerised tomography (CT) scan - to examine the shoulder joint in more detail
• Magnetic resonance imaging (MRI) - to look at the soft tissue around the shoulder joint

Why is this first consultation so important?

At Circle Health Group, your first appointment is very important as it's where your consultant will examine you, ask you about your symptoms, order any necessary tests, and discuss possible treatments.

Your first consultation is also where we get to know you, discuss your expectations for treatment and encourage you to ask any questions you may have. It is important to us that you are as well-informed and comfortable as possible before, during, and after your treatment, so please ask your consultant any questions you have about the procedure.

Your consultant will decide if CAM surgery is suitable for you based on your diagnosis, general health, and lifestyle, as well as your preferences and expectations for treatment.

Your consultant will tell you everything you need to know to prepare for your surgery. Make sure you tell your consultant about any medical conditions or allergies you have and any medications you are taking.

If you are taking blood thinners like aspirin or warfarin, your consultant may tell you to stop taking them for a few days before the procedure. This is to reduce the risk of bleeding during and after your surgery.

Being as fit as possible before your operation will help your surgery and recovery go more smoothly. Some things you can do to ensure you are as healthy as you can be before your operation include:

• Stopping smoking
• Eating a healthy, balanced diet
• Losing weight if you need to

You may not be able to eat or drink anything from midnight on the day of your surgery.

Let your consultant or hospital know if you have any questions about preparing for your surgery.

CAM surgery is normally performed under general anaesthetic, with or without a regional block (anaesthetic that numbs a specific part of the body).

It is a type of arthroscopic (keyhole) surgery meaning it is performed through small incisions (cuts) using a flexible camera to see what's happening inside the joint and specially designed small instruments to operate inside it.

There are three stages to CAM surgery:

Stage one

Your consultant will remove any damaged labral tissue (the tissue attached to the shoulder socket that keeps the shoulder in place) and smooth over the bone.

Stage two

Scar tissue is removed from the joint capsule freeing the joint and restoring mobility.

Stage three

Any bone spurs and scar tissue are removed, releasing the trapped axillary nerve and relieving pain.

When your surgery is complete, your incisions will be closed, and a sterile dressing applied.

CAM surgery may be different for everyone and what happens during your procedure will depend on your diagnosis, general health, and individual circumstances. Talk to your consultant about what will happen during your surgery.

Recovery from CAM surgery varies from person to person and depends on factors such as your age, general health, and individual progress.

CAM surgery is a minimally invasive procedure and recovery is usually faster than with other types of surgery.

In general, your incisions will heal and pain will improve after around two weeks. You will have physiotherapy on your shoulder for between six and twelve weeks after your surgery.

How many nights will I be in hospital?

CAM surgery is sometimes performed as a day case, meaning you will be able to go home the same day, or you may need to spend one night in hospital.

Will I be able to drive home?

No. After your procedure, you will have your arm immobilised in a sling and will not be able to drive yourself home. Ask someone to pick you up from the hospital, or we can arrange a taxi for you.

How soon can I go back to work?

When you can go back to work after your surgery depends on your individual recovery and the type of job you do.

You can normally return to office work within two to four weeks, light physical work within six to twelve weeks and heavier physical work after around four to six months.

Talk to your consultant about when you can expect to return to work after your surgery.

How soon can I drive?

You can drive when you are able to perform emergency and non-emergency manoeuvres comfortably. It will probably be at least four weeks after your surgery before you can drive.

When will I be back to normal?

Recovering from any type of surgery is a gradual process and is different for everyone. You can help speed your recovery by being as well prepared as possible before your surgery and following your consultant's instructions carefully after your procedure.

Your consultant will schedule follow-up appointments with you to check your progress after your surgery.

Most people feel their shoulder is back to normal around six months after CAM surgery.

Benefits of CAM surgery include:

• It is less invasive, with a faster recovery time and a lower risk of complications than shoulder replacement surgery
• It can delay shoulder replacement surgery for up to five years
• Studies have shown that CAM surgery reduces pain and improves shoulder function in the majority of patients

Arthroscopic (keyhole) surgery is generally very safe, but like any surgical procedure, there is a small risk of complications.

Your consultant will explain all the possible risks and complications of CAM surgery before your procedure. Please ask any questions and discuss any concerns you may have about your surgery. Being fully informed about what to expect before, during and after your operation will help put your mind at rest and allow you to make an informed decision.

General risks of surgery include:

• Bleeding
• Infection
• Blood clots
• Adverse reaction to the anaesthetic
• Damage to surrounding tissues
• Nerve damage

Risks specific to CAM surgery include:

• Stiffness in the shoulder joint
• Injury to the axillary nerve resulting in muscle weakness
• Tearing of the tendon in the bicep (Popeye's sign) causing pain and bulging in the bicep

We answer some of your most commonly asked questions about comprehensive arthroscopic management surgery.

What is arthroscopic surgery?

Arthroscopic (keyhole) surgery is a type of procedure where a flexible camera is inserted through small incisions in the skin and the surgeon performs the operation using images transmitted from the camera on a large screen. The technique allows surgery to be performed without making large incisions and is safer and carries less risk of complications than regular (open) surgery.

Is arthroscopic shoulder surgery worth it?

Whether arthroscopic surgery is worth it is a very personal decision and depends on your symptoms, how much they impact your life and your expectations for surgery. Talk to your consultant about what arthroscopic surgery involves, an estimated timeline for recovery and what outcomes you can expect from your surgery.

How many incisions are made for arthroscopic shoulder surgery?

During arthroscopic shoulder surgery, your consultant usually makes between three and four small incisions (about 1cm in length).

How long does arthroscopic shoulder surgery take?

How long your surgery takes depends on your individual surgery, but on average arthroscopic shoulder surgery takes around one hour.

At Circle Health Group we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group you can expect the highest standards of care including:

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant best suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about comprehensive arthroscopic management, book your appointment online today or call a member of our team directly on 0141 300 5009.

Content reviewed by Circle in-house team in January 2023. Next review due January 2026.

1. Comprehensive Arthroscopic Management (CAM) procedure: clinical results of a joint-preserving arthroscopic treatment for young, active patients with advanced shoulder osteoarthritis,  PubMed
2. The Comprehensive Arthroscopic Management Procedure for Treatment of Glenohumeral Osteoarthritis, Science Direct
3. Comprehensive Arthroscopic Management (CAM) Procedure: Clinical Results of a Joint-Preserving Arthroscopic Treatment for Young, Active Patients With Advanced Shoulder Osteoarthritis, The Journal of Arthroscopic and Related Surgery
4. Comprehensive Arthroscopic Management (CAM) Procedure for Shoulder Osteoarthritis, Techniques in Shoulder and Elbow Surgery