Shoulder Surgery

YOUR GUIDE TO:

SHOULDER SURGERY

October 2017

1 NEJAC – North East Joint Assessment Centre Table of Contents

Introduction ...... 3

Shoulder Anatomy ...... 4

What to Expect ...... 5 Shoulder Surgery Patient Checklist ...... 5 Hospital Length of Stay ...... 5

Preparing for Surgery ...... 5 Pre-Admission Visit ...... 5 Day of Your Surgery ...... 5

After Surgery ...... 6 Recovery / Inpatient ...... 6 Discharge ...... 6 Taking Care of your Incision ...... 6 Physiotherapy and Exercises ...... 7

Living with a Shoulder Sling ...... 7 To Put Sling On / Off ...... 7 Getting Washed ...... 9 Feeding Yourself ...... 10 Sleeping ...... 10 Housework ...... 10 Kitchen Activities ...... 10 Stairs ...... 10

Looking after yourself at Home ...... 11

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Introduction Welcome to Health Sciences North / Horizon Santé-Nord. Together with your surgeon, you have decided that shoulder surgery is necessary to alleviate the symptoms you are now experiencing. This booklet is designed to provide you and your family with the information that you will need in order to have a successful surgical experience. It is very important that you read and understand the information provided in this booklet. You do not need to memorize it. Active involvement in your care is essential for a healthy recovery.

Read this booklet before your surgery and write down any questions that you may have.

Questions to Ask

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Shoulder Anatomy The bones of the shoulder joint include the shoulder blade (scapula), the upper arm bone (humerus) and the collar bone (clavicle). The socket is very shallow. A circular ring of cartilage (labrum) is attached to the edge of the socket. The labrum makes the socket a little deeper and gives it a suction seal. This gives more stability to hold the head of the humerus against the socket. The joint is also reinforced by the joint capsule and ligaments.

The rotator cuff muscles are a group of deep-seated muscles that keep the head of humerus centered in the socket. They also help lift your arm overhead.

The rotator cuff is made of 4 muscles: Supraspinatus -Infraspinatus -Teres minor –Subscapularis. The long head biceps is another muscle that keeps the head of humerus in the socket, as well as helps lift the arm forward.

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What to Expect Shoulder Surgery Patient Checklist Things that you can consider doing before your shoulder surgery to be prepared:  Practice doing things using only the arm that will not be operated on (e.g. preparing meals, washing yourself, toileting), since your operated arm may be in a sling for up to 6 – 8 weeks

 Make sure you have a few extra pillows to support your shoulder when sleeping

 Have one or more loose fitting shirts that fasten in the front

 Make arrangements for someone to drive you to and from the hospital and appointments, and for help at home (e.g. grocery shopping, meal preparation, cleaning, laundry and general errands). You will not drive for 6-8 weeks after surgery

 Prepare and freeze meals in advance

 Make ready-to-use ice packs or other arrangements to obtain a cold therapy device which will reduce pain and swelling

 ****Arrange for outpatient physiotherapy. Learn about location of physiotherapy clinics, hours and cost / insurance coverage. There are some OHIP options, including the hospital and a few clinics in the community

Hospital Length of Stay

Day Surgery Surgery requiring 1-2 days stay

 Rotator Cuff Repair  Total or Hemi Shoulder Replacement  Arthroscopy, Acromioplasty,  Reverse Shoulder Replacement Decompression, Debridement, AC resection  Stabilization (Bankart) repair  Biceps Tenodesis

Preparing for Surgery Pre-Admission Visit Your surgeon’s office will call you to inform you the date of your surgery. The hospital will then call you prior to your surgery to inform you of your appointment at the Pre-Admission Clinic (PAC). This visit is a pre-operative screening to ensure that your shoulder surgery will go smoothly.

Day of Your Surgery • Come to the Hospital’s Main Registration area as instructed • You will be prepared for your procedure by a nurse and escorted to the operating room 5 NEJAC – North East Joint Assessment Centre

After Surgery Recovery / Inpatient • You will wake up in the Recovery Room • You will have a dressing over your operated shoulder and your arm will be in a sling • Pain medication will be given as prescribed by your surgeon • You will meet a physiotherapist who will teach you exercises for your recovery

Discharge • You will be given a prescription for pain medication. Make sure you have a plan to have it filled and picked up on the way home • You will not be able to drive for 6 – 8 weeks following your operation, regardless of the operated side • You will be given an appointment with your surgeon for suture or staple removal and a follow- up visit • You and your hospital physiotherapist will arrange your 1st outpatient physiotherapy appointment • You will receive an exercise guide as a reference when you are at home

Taking Care of your Incision • You will go home with staples or stitches on your incision. Check your discharge instructions for when you can remove or change your bandage, and when / how to bathe / shower with your incision. • The dressings must be kept dry and clean. Leave the Steri-strips in place, and they may fall off on their own.

IMPORTANT Contact your surgeon if you develop any of the following: • Chills or fever over 38.5 °C (100.5 °F) • Signs of infection such as increase warmth, redness, pain, or drainage from the incision • Changes in sensation such as tingling, numbness in your fingers/ arm (if you received a nerve block, this may be present immediately after the operation) • Chest pain or difficulty breathing • Sudden pain or swelling in your leg *** If unable to reach your surgeon, go to the closest Emergency Department *****

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Physiotherapy and Exercises • The physiotherapist will see you while in hospital and provide you with instructions on sling use, exercises, and help answer any other questions specific to your type of shoulder surgery • You will start your exercise program the first day after surgery with the help of the physiotherapist, but you must perform the exercises at home by yourself every day while waiting for your first outpatient physiotherapy appointment • Your first outpatient physiotherapy appointment should occur within 2 weeks of surgery. You will be seen once per week unless the outpatient physiotherapist believes you require more • The exercise program handout is a guideline only and may be modified by your physiotherapist according to surgeon orders. • Your body needs time to heal. Don’t try and speed up the healing by doing more than what is prescribed. DO NOT progress the exercises until you see and are advised by your outpatient physiotherapist.

***Refer to your exercise program handout that you were given while in hospital***

Living with a Shoulder Sling • The sling is to be worn at all times and must only be taken off to wash, change clothes and do exercises. You must wear it to sleep • You may need a special sling with an abduction pillow and hand ball depending on your type of surgery • No driving while your arm is in a sling, for 6-8 weeks, even if it is not your dominant arm. There may be insurance liability issues. • No lifting of the operated arm until directed to do so • No repetitive movement of the hand/arm even while in the sling, such as typing, using computer mouse, writing, etc. • Don’t be afraid to ask for help while you are living with a shoulder sling

*** Ignoring these instructions could damage the repair in your shoulder

To Put Sling On / Off • This video will demonstrate the application and the care of the Don-Joy- Ultrasling III https://www.youtube.com/watch?v=ycNyHliuzsU • This video will demonstrate the application for a universal Velpeau sling https://www.youtube.com/watch?v=C-IjZj14Rrg

After sleeping, dressing or exercises, you will need to know how to put the sling back on. If someone is fitting the sling for you, support your operated arm with your elbow bent to 90 degrees using your un-operated arm. Slide the sling in from behind so that your elbow fits snuggly into it.

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If fitting the sling by yourself, ensure that you are seated with arm supported on table or pillow, with your elbow bent to 90 degrees.

Fasten the forearm strap across your forearm; it should be approximately 1” below your elbow crease. Attach the wrist strap 1” from your wrist. The lower ring should rest against your body and the higher ring should face upwards. Ensure your wrist is supported and not dangling outside the sling.

Take the shoulder strap that attaches to the back of the sling and go around your back and over the opposite shoulder, across your neck, then feed it through the upper ring. Attach the strap back onto itself so that your elbow is held at right angles. Your hand and wrist should be neutral and supported in sling.

If you are wearing a body belt, feed the other strap through the lower ring and attach it onto itself with the Velcro tab. If you have the abduction pillow, it should be nestled between your ribcage and your elbow.

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Take the body belt around your back and attach it over the front of the elbow section of the sling. Adjust as necessary so that your arm is held snugly against your body. The foam neck pillow should be behind the neck.

To take the sling off reverse the above process

Getting Washed • For 6 weeks, you may need assistance to wash your un-operated arm, as you will not be able to use your operated arm for this. Keep your operated arm down by your side. Remember…DO NOT REACH for objects with your operated arm! • Remember to keep your incision dry and protected while washing. Waterproof dressings may be provided by the hospital or bought at a local pharmacy. • After the shower, you must put your sling back on

Getting Dressed • You will find it easier to dress using shirts that fasten in the front • Always dress your operated arm first, and it is last arm to come out of sleeve when undressing • 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.

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Feeding Yourself • For the first 6 weeks after your operation, you will feed yourself with your un-operated hand only. • After 6 weeks, your surgeon will let you know if you are allowed to feed yourself ‘normally’ using both hands

Sleeping • For the first 6 weeks your sling should be kept on while you are in bed. Initially, you may find it more comfortable to sleep on your back with a pillow under your operated arm for support. You may also find it more comfortable to sleep in a semi-sitting position in a recliner.

Housework • Light housework may resume after 6 weeks. • More strenuous housework should be avoided until 3 months after your operation.

Kitchen Activities • For the first 6 weeks you must use your un-operated arm for kitchen activities. This includes making meals, snacks and drinks. • AVOID LIFTING ANYTHING HEAVY ( greater than 10lbs) FOR 3 MONTHS.

Stairs • When climbing/descending the stairs, hold the banister with your un-operated arm. This may mean that a second banister is required. • After 6 weeks, you may hold the banister with either arm.

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Looking after yourself at Home Pain • You can expect to have pain in your operated shoulder; however, the need for pain medication will decrease with time. • Take your pain medication as prescribed by your surgeon • Managing pain allows you to perform your basic activities of daily living and do your exercises more comfortably • If your pain is not well managed once you are home, discuss it with your pharmacist or family physician

Driving • You will not be able to drive for up to 6 weeks after your surgery. Check with your surgeon to let you know when you can return to driving • It is the law in Canada that a driver uses both arms to control the steering wheel. To be able to do this, the driver requires sufficient strength, pain relief and mobility

Icing • Ice packs or a cold compression wrap may will help reduce pain and swelling • Apply the ice 10 – 15 minutes at a time, especially after your exercises, up to 3 – 5 times per day • Keep your incision dry, and have a thin layer of material between your skin and the ice • The best icing methods are crushed ice with some rubbing alcohol in a baggie or small garbage bag. Wrap this with a thin layer of cloth and apply directly to the shoulder • It is normal to experience 4 different progressive sensations when applying ice: cold → burning → pain → numbness.

Return to Work • This will depend upon the type of surgery that you are having and will need to be discussed with your surgeon • Typically, you may not be able to return to physical work requiring overhead or lifting activities for about 4 months unless modified work/ other arrangements can be made

Returning to Leisure Activities / Sports • Typically at 4 – 6 months, you may return to sports depending on the surgery and the surgeon’s instructions • This may vary according to your operation, sport and level, as well as the period required to retrain your shoulder muscles with physiotherapy • Sometimes, it can take up to 1 year before you feel comfortable returning to your sport.

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