Anterior stabilisation of the shoulder: after surgery care
The regional nerve block (interscaline block) should provide excellent pain relief for the duration of the local anaesthetic affect. This can last anything between five and 24 hours. You will be encouraged to take pain relief regularly, even while the block is working, as it is better to have started this before the block wears off. You will be given pain relief in hospital and also to take home with you. You will be given advice about the nerve block and which pain relief to take.
You may find icepacks over the area helpful. Consider using a packet of frozen peas, placing a towel between your skin and the icepack.
Wearing a sling
Your arm will be in a sling for the first three to four weeks. It is vital that you take great care of your arm while it is numb following the regional nerve block. The sling is designed to protect the surgery during the early phases of healing and to make your arm more comfortable. You will be shown how to get your arm in and out of the sling and you will be able to wash and dress immediately after the operation.
While sleeping, you may find it comfortable to place a small pillow or towel underneath your arm and elbow.
For the first three to four weeks you will be performing gentle, protected movements of the shoulder joint. The physiotherapist on the ward will give you instructions before you leave hospital. You will also need to maintain movement in your neck, elbow, wrist and hand. You will need to continue these exercises at home.
Outpatient physiotherapy will be arranged to start at about three weeks after your operation. You will then start an exercise programme to gradually regain the movements and strength in your shoulder. Shoulder exercises will be changed as you progress with your rehabilitation.
It is important that you do these exercises regularly at home for up to six months. They will enable you to gain maximum benefit from your operation.
Stitches and dressings
Mostly any stitches used are dissolvable but occasionally the ends of the stitches need to be snipped flush to the skin at around ten to 14 days after the surgery. You will receive advice on the ward with regards to this.
Normally waterproof dressings are used so you can wash and shower after the surgery, but occasionally these dressings require replacing.
We will advise your practice or district nurse to perform a wound check at five and 14 days after the surgery. It is normal for the dressings and steri-strips to be removed at ten to 14 days after the operation. The stitches do not need to be pulled through the skin as they will dissolve under the skin.
A follow-up appointment at the outpatient clinic is usually arranged for around two to four weeks after your surgery and further follow-up appointments are arranged thereafter.
What not to do after surgery
In the first three weeks, do not remove your arm from the sling to perform normal daily activities without clear instructions.
At four to eight weeks, avoid moving your arm out to the side and twisting it backwards away from your body. Try not to reach up and behind you, for example putting your hand behind your head. Do not force this movement for 12 weeks after the surgery. Moving your arm up and away from your body stretches the ligaments and rim of cartilage that have been repaired. These require time to heal after the surgery. It is important not to over stretch them but the shoulder will benefit from gentle exercises and you will be advised specifically of these by your physiotherapist.
Progress after surgery
Phase 1 – sling on with gentle protected movements as taught by the physiotherapist
Over the first three weeks you will be able to do only very little with the shoulder. This will affect your ability to do everyday activities, especially if your dominant hand is the side of the operation. It is likely that you will need someone to help you, especially with dressing, shopping, preparing meals or looking after children.
Phase 2 – regaining everyday movements
After three to four weeks you can gradually wean off using the sling and you will start outpatient physiotherapy. Exercises will help you regain muscle strength and control of your shoulder and slowly improve the movement. It may be six to eight weeks after your operation before you can use your arm above shoulder height.
Phase 3 – regaining strength with movement
After eight to 12 weeks you will be increasing your level of activity using the arm away from the body for heavier tasks. You will be building up the strength in your arm with the guidance of your physiotherapist. You should not do contact sports for six to nine months following the surgery.
Around 90% of people have a stable shoulder in the long-term following this surgery, with many returning to their previous levels of activity. Some adaptation however, particularly with vigorous sports and overhead activity, may be required in some cases.
Going back to work
When you go back to work will depend upon the level of activity you do. Most patients are back to a desk job between two and four weeks, but are not driving for four to six weeks after the surgery. If your job involves lifting or overhead activities, it is likely that you will be off work for 12 weeks after the surgery.
Most patients are back to driving at around four to six weeks after the surgery. You must be confident that you will be safe to drive and in complete and competent charge of the vehicle before you may drive.
Please discuss the activities you wish to perform with your physiotherapist or consultant. Your level of activity will increase as your rehabilitation progresses.
Examples: cycling ten to 12 weeks, gentle swimming ten to 12 weeks, light racket sports using operated arm 16 weeks, contact sports six to nine months.