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Shoulder Surgery (immobilised)

Introduction

This leaflet will provide you with some information and exercises for you to follow after your shoulder surgery. This leaflet is for rehabilitation following shoulder surgeries that involve immobilisation which means your arm will be in a sling for 4 – 6 weeks.  

Your surgery may be planned weeks in advance (Elective) or done at short notice due to trauma.

Elective Surgeries:  surgeries that are planned in advance and may include repairs of the shoulder joint structures such as rotator cuff or joint replacement.

Trauma Surgeries: surgeries that are undertaken at short notice due to fall or accident which has caused damage to the shoulder bone or soft tissues.

Next: What Surgery Involves

What Surgery Involves

Your surgery maybe keyhole (arthroscopy); this involves the surgeon making small incisions around your shoulder and using a tiny camera to look inside your shoulder joint. Some surgeries require larger incisions but your surgeon will inform you prior to your surgery which approach they will take.

They will look for any areas of possible damage and undertake any treatment. Scans and x-rays allow your surgeon to plan surgery but sometimes the treatment required can be more or less than anticipated prior to surgery.

You will have a general anaesthetic which means you will be asleep. In some cases, we may use a nerve block to numb the area. You will have little or no movement of your full arm or hand initially after your surgery. This should return within 24 hours of surgery. The anaesthetist will speak to your before surgery about these.

Next: After Surgery

After Surgery

Most patients go home on the day of their surgery or the day after. Your arm will be in a sling after your surgery.

A physiotherapist and/or Occupational Therapist will see you on the ward after your surgery to provide advice, sling education and complete exercises with you. They will refer you for further physiotherapy as an outpatient. You will be contacted with an appointment by telephone or letter with your outpatient appointment.

Next: Post Operative Advice

Post Operative Advice

Pain:

There will be some pain and discomfort after your surgery. You should take painkillers as prescribed, do not wait for your pain to worsen prior to taking pain relief. Ensure your sling is in correct position; your arm should rest in it across your stomach with your elbow at 90 degrees. Your arm should feel fully supported by the sling.

Swelling/ bruising:

It is normal to have some swelling/ bruising around your shoulder and down your arm or chest. Often this is worse following trauma or more complicated surgeries. Bruising can be more common if you are medication to thin your blood.  You can reduce swelling in your hand and elbow by ensuring you complete the exercises provided and ensuring your sling is applied correctly. If your sling is too loose your arm will hang downwards allowing swelling to gather in your fingers and hand.

If you have swelling around your shoulder you can apply an ice pack to help reduce swelling and ease pain. This should be wrapped in a towel and applied for 15 minutes at a time, monitor your skin to ensure you are not getting ice burns.

Wound:

You will go home from the ward with a dressing over your wound. The nursing staff will give you dressings to use at home and tell you about when and where to get your stitches out. This is usually about ten days after your surgery.

Sleeping:

We advise you to sleep in any comfortable position. However, sleeping on your operated shoulder will probably increase your pain. Your sling will need to remain on during the night.

Washing and dressing:

Avoid getting your wound dressing very wet.

If showering you can remove your arm from your sling and let it hang by your side. Do not lift your arm to assist with washing. To clean under your operated arm, lean to that side so there is a gap between your body and arm, do not lift your operated arm.

When dressing your upper body place your operated arm into your clothes first for comfort. When undressing remove your operated arm last.

The physiotherapist will have shown you how to remove and apply your sling on the ward but below is a link if you need some assistance.

Your sling should only be removed for washing, dressing and completing your exercises. 

Very occasionally, some people are advised to where their sling under clothes to avoid excess movement. We will advise you if this applies to you.  

Next: When Can I Start to Drive Again?

When can I start to drive again?

 You should not drive will your arm is in a sling. Do not drive until you have regained full control and movement of your arm.

Before driving sit in your car and try using all of your controls to make sure you are able to do so comfortably. When you return to driving, start with a short journey to ensure you are comfortable and in control.

We also recommend that you speak with your insurance company before you start to drive. The law states you should be in complete control of a car to drive.

Next: When Can I Return to Work?

When Can I Return to Work?

This depends on your occupation, most people can return to work around 6 -12 weeks after their surgery. If your job does not involve use of your operated arm you may be able to return sooner.

Please discuss this with your surgeon, doctor or physiotherapist.

Next: When Can I Return to Hobbies and Sport?

When Can I Return to Hobbies and Sport?

Your physiotherapist will guide your return to heavy activities and sport.

This will depend on your pain, shoulder movement and strength as your rehabilitation progresses. Pain would be a sign that you are not ready to return to a specific activity.

Next: Physiotherapy

Physiotherapy

You will be referred for physiotherapy by the ward physiotherapist or from fracture clinic when they are happy for you to start rehabilitation following surgery for trauma. You will need to attend physiotherapy to regain movement and strength of your arm.

Rehabilitation will not start until after your period of immobilisation around 4-6weeks after your surgery. 

While your shoulder is immobilised it is important to maintain the other joints of your arm such as your elbow to stop these from stiffening up. The exercises included in this booklet are safe to start once you have the feeling back in your arm, normally the same day or the day after your surgery. 

Next: Exercises

Exercises
  • Hand and fingers: Make a fist (thumb over fingers). Straighten your fingers and bring them apart.

Repeat 10 times 3 x daily

  • Wrist movement: Bend and straighten your wrist keeping your fingers straight throughout the exercise.

Repeat 10 times 3 x daily

  • Elbow Rotation: With your arm in your sling across your stomach , turn your palm up and down rotating your forearm.
  • Or with your arm out of sling across your stomach with your elbow bent at 90 degrees, turn your palm up and down rotating your forearm.

Repeat 10 times 3 x daily

  • Elbow bend and straighten: Stand with your arm out of your sling, your elbow bent at 90degrees and forearm across your stomach.
  •   Bend your elbow and then straighten your elbow.

Repeat 10 times 3 x daily

  • Shoulder blades: Stand. Pinch shoulder blades together as shown.

Repeat 10 times 3 daily

Next: Follow Up

Follow Up

All patients will attend follow up appointment but trauma and elective patients will be seen at different clinic types and at different timescales post-operatively.

You will be given your first return appointment by the nursing staff prior to discharge from the ward.

If you have any concerns following surgery please contact your follow up clinic, your GP or physiotherapist for advice.

If you have any urgent concerns please call NHS 24 on 111.