Can shoulder arthroscopy cause pitting edema in the lower extremities?

Shoulder Arthroscopy and Lower Extremity Pitting Edema

Shoulder arthroscopy does not typically cause pitting edema in the lower extremities, and such a finding should prompt evaluation for other underlying causes.

Mechanism and Complications of Shoulder Arthroscopy

Shoulder arthroscopy is generally considered a safe procedure with relatively low complication rates (4.6-10.6%) 1. The most common complications associated with shoulder arthroscopy include:

• Local complications:
  • Fluid extravasation into surrounding tissues
  • Infection (rare)
  • Stiffness
  • Iatrogenic tendon injury
  • Equipment failure

Fluid Extravasation

When fluid extravasation occurs during shoulder arthroscopy, it typically affects the:

• Neck
• Face
• Upper chest

This can lead to:

• Airway compromise requiring prolonged intubation 2
• Severe facial and neck swelling 2
• Negative-pressure pulmonary edema in severe cases 3

However, there is no evidence in the medical literature supporting that shoulder arthroscopy causes lower extremity pitting edema.

Evaluation of Lower Extremity Pitting Edema After Shoulder Surgery

If a patient presents with lower extremity pitting edema following shoulder arthroscopy, consider these more likely causes:

1. Venous thromboembolism (VTE):

   • Although rare in shoulder surgery compared to lower extremity procedures
   • The American Academy of Orthopaedic Surgeons recommends considering mechanical and/or chemical VTE prophylaxis for shoulder arthroplasty patients 4

2. Systemic fluid overload:

   • From IV fluids during perioperative period
   • More common in patients with underlying cardiac or renal dysfunction

3. Unrelated medical conditions:

   • Heart failure
   • Renal insufficiency
   • Liver disease
   • Medication side effects (e.g., calcium channel blockers)

Diagnostic Approach

For a patient presenting with lower extremity pitting edema after shoulder arthroscopy:

1. Assess for DVT risk factors and symptoms:

   • Calf pain, tenderness, swelling
   • Asymmetric edema (one leg more affected)

2. Evaluate for systemic causes:

   • Cardiac examination (heart sounds, JVP)
   • Pulmonary examination
   • Abdominal examination (hepatomegaly, ascites)

3. Laboratory testing:

   • BNP/NT-proBNP
   • Renal function tests
   • Liver function tests
   • D-dimer if DVT suspected

4. Imaging:

   • Lower extremity ultrasound if DVT suspected
   • Chest X-ray if heart failure suspected

Conclusion

Lower extremity pitting edema is not a recognized complication of shoulder arthroscopy based on current medical literature. When encountered after shoulder arthroscopy, clinicians should evaluate for more common systemic causes of lower extremity edema rather than attributing it to the shoulder procedure itself.