After Your Operation

After your operation

Shoulder Arthroscopy and Anterior Stabilisation

An Elective Orthopaedic Centre patient information booklet for you to take home Anterior Stabilisation

This booklet has been produced to enable you to gain the most out of your Anterior Stabilisation operation. It is not a substitute for professional medical advice and should be used in conjunction with out patient physiotherapy. Be aware that this booklet is for guidance only as your rehabilitation may need to vary depending on specifics of your operation.

Shoulder Dislocation

The shoulder is a ball and socket joint. The ball of the joint (head of the humerus) fits into the socket (glenoid) which is part of the shoulder blade. The socket is deepened by cartilage (labrum) which gives the shoulder more stability. However, the shoulder joint is very mobile and the large amount of movement at the joint can sometimes lead to a dislocation (most commonly the humeral head comes forward in the joint). Following a dislocation the capsule and ligaments at the front of the joint become stretched and the labrum can be torn (Bankart lesion). This can lead to further dislocations, recurrent subluxation (part dislocation) or feelings of instability.

If rest and physiotherapy are unsuccessful in stabilising the shoulder joint surgery will be required to repair the labral tear (Bankart lesion) and possibly to ‘tighten up’ the front of the joint by shortening the capsule and ligaments. The operation is typically done arthroscopically (keyhole) with 2 – 3 incisions.

Although there are only 2-3 small incisions the surgery can often be painful due to the work carried out within the joint. After the surgery your arm will feel numb and this may remain for 24 hours. Pain relieving medication will be given to you whilst you are in hospital and supplies will be arranged for you to take home. If you require further medication seek advice from your GP.

Ice packs are also important in relieving swelling as well as pain. Apply ice over the operated shoulder at least 4 times a day. Use a frozen pack of peas with a tea towel between your skin and the ice pack. Apply the ice for 15 minutes at a time. A layer of cling film between the ice and your skin is recommended. The Stages of Rehabilitation.

Your rehabilitation following surgery is critical to the success of the operation. It can be broken down into a few phases as highlighted below. 0-3 weeks: Immediate after care – management of wound and sling. Commence hand, wrist and elbow exercises. Minimal or no movement of the shoulder 3-6 weeks: commence active-assisted and active exercises at the shoulder as instructed by your physiotherapist 6-12 weeks: under the guidance of your physiotherapist you will be aiming to achieve full range of motion at the shoulder by the end of this phase 12 weeks onwards: physiotherapy will continue, aiming to build up strength once you have achieved full range of movement.

Exercises

In order to aid the healing of the anterior stabilisation surgery it is important to restrict exercising the shoulder joint for the first three weeks. After this you will be shown exercises to increase the range of movement and improve the strength at the shoulder. On the day of your surgery you may start doing shoulder rolls, hand, wrist and elbow exercises to prevent stiffness. These exercises are explained below and must be carried out until you attend out-patient physiotherapy.

Wrist Exercises

Move wrist forwards and backwards and side to side. Hold each position for 5 seconds. Repeat 10 times for each movement.

Elbow exercises.

These exercises must be carried out with your hand starting next to your stomach. Do not turn your hand to face the front.

Bend elbow so that you touch your nose with your thumb. Straighten elbow out fully. Repeat 10 times. With elbow bent and arm by side, turn palm up, hold for 5 seconds. Turn palm down, hold for 5 seconds. Repeat 10 times.

Shoulder Rolls

Sit and roll your shoulders in both directions. Repeat slowly 10 times

Sling application

Some patients must not take off their sling at all, you will be told if this applies to you. You will need to wear the sling as instructed by your physiotherapist but this is likely to be for 3 weeks, day and night.

If fitting the sling without assistance, ensure that you are seated, with your elbow bent to 90 degrees. You will find it more comfortable if your arm is supported on a pillow

Fasten the strap across your forearm, it should be approximately one inch below your elbow crease

Attach the wrist strap approximately one inch from your wrist (towards your elbow). The lower 'D' ring should rest against your body and the higher 'D' ring should face upwards.

Take the shoulder strap over the opposite shoulder and feed it through the upper 'D' ring

Attach the strap back onto itself so that your elbow is held at right angles (90 degrees flexion)

If you require a body belt, attach it to the sling, wrap around your back at waist level, and then attach back onto the sling.

Wound Care

The wound is closed with small plaster strips. You will return from surgery with a bulky dressing over your shoulder. This bulky dressing may be taken off the day after the operation. You can shower but keep the clear adhesive dressing in place (extra dressings will be provided on discharge) Between 10 - 14 days the wound should be healed and you can remove the clear adhesive dressing and the plaster strips will fall off naturally.

Dressing:

You will find it easier to wear front opening clothes. Always dress your operated arm first. Sit on the edge of a chair or stand with your arm ‘hanging’ by your side. Slide your operated arm into the garment first using your un-operated arm. Do not assist with your operated arm, just let it hang loose. Once this arm is fully in the sleeve bring the garment around your back and put the other arm in. any fasteners must be fastened only with your un -operated arm. Once you have dressed your upper body, place your arm back in the sling.

Day To Day Activites:

You must not use your arm whilst you have been advised to keep it in the sling. You must use the good arm only to eat with for 4 weeks. Equally when transferring on or off a chair, bed , toilet etc, use your good arm initially and this is usually for about 3-4 weeks. For the initial 6 weeks you must not lift anything with your operated arm. After that you can gradually start to use your affected arm to lift light items initially i.e. things you can do easily with one hand. Avoid any heavy lifting for 3 months. Similarly you can begin light housework at 6 weeks post-op and build up to more strenuous work as your shoulder allows, usually at 6 months. If you are in any doubt about any of these activities please speak to your physiotherapist or consultant.

Leisure Activities

Your physiotherapist and surgeon will advise you when it is safe to resume your leisure activities. This will vary according to your sport and level, as well as the period required to retrain your shoulder muscles with physiotherapy.

Below is a rough guide but again, everyone is different so you need to check with your physiotherapist/surgeon

Swimming 8 weeks minimum Golf 3 months Contact Sports 6 months

Driving/Return To Work

You will not be able to drive for a minimum of 8 weeks. Your surgeon will confirm when you may begin. Your return to work will depend upon your occupation. You will need to discuss this with your surgeon. Follow Up Appointments

An appointment may be made for you to see a physiotherapist after your discharge or your surgeon will do this from clinic when you see him at 3-4 weeks.

For more information contact: Physiotherapy Department Derby Ward Denbies Wing The Elective Orthopaedic Centre Epsom General Hospital Dorking Road Epsom KT18 7EG 01372 735843 Email: [email protected] www.eoc.org

The EOC does not accept responsibility for the misuse of this information.