Arthroscopic subacromial decompression: after surgery care
You will not feel any pain during the procedure. Afterwards you may experience pain due to the surgery performed inside your shoulder, although you will only have small scars following keyhole surgery.
During the operation you will be given a nerve block, which is an injection of local anaesthetic around the nerves in your neck to numb the arm. This may last several hours or even up to a day after the procedure. As the nerve block starts to wear off, the feeling of sensation will return to the arm, often in the form of pins and needles to start with.
You should start taking pain relief before the block wears off and continue to take this medication regularly to begin with, in order to keep the pain under control. You will be sent home with adequate pain relief and clear advice on how to use these and look after your arm.
You should take great care of your arm while it is numb as it is possible to injure it if you cannot feel it.
Wearing a sling
You must wear a sling at all times while your arm is still numb. Once normal sensation has returned you should use the sling for comfort only. You can take it on and off as you wish, especially at night. The sling is normally discarded between a few days and a few weeks after the operation. You may find it helpful to wear the sling at night, or alternatively you can rest your arm on the pillow placed in front of you. If you lie on your back to sleep, you may find placing a pillow under your upper arm will make it more comfortable.
It is important to do the exercises described in the exercise section. You will be shown exercises by the physiotherapist while you are in hospital and you will need to continue with these exercises once you go home. These exercises are designed to prevent shoulder stiffness and to strengthen the muscles around your shoulder after the operation.
You will also be seen as an outpatient in the physiotherapy department and will be guided through physiotherapy rehabilitation during the weeks and months after your surgery.
The wounds after keyhole surgery are very small, although the dressings may seem quite large. You will not have stitches, but will have small sticking plaster strips (Steri-Strips) to keep the skin edges together. You will have waterproof dressngs over these so you can wash and shower. If the dressings do become soaked through, they will need to be changed.
A wound check will be organised for you with your GP practise or district nurse at around five days and 14 days, when the Steri-Strips will be removed.
Outpatient follow-up is usually arranged at around two to three weeks after your operation, to check on your progress and again at around six to eight weeks after your operation. Further clinic appointments are made after this as necessary.
Using your arm after surgery
You may mobilise your shoulder as you feel comfortable. Do not be frightened to start moving the arm as much as you can within the limits of your pain. Gradually the movements will become less painful as time goes on.
Avoid heavy lifting for one to two weeks after surgery
Be aware that activities at or above shoulder height stress the area that has been operated on and may cause more pain. Try to avoid these activities in the early stages after surgery.
You should be able to move your arm comfortably below shoulder height by two to four weeks after surgery and above shoulder height by six to eight weeks. It may take a number of months, even up to a year however, to see the full benefit from surgery.
Going back to work
When you can go back to work will depend on your occupation. Most people in desk based jobs are able to return to work at around three to four weeks but jobs requiring significant manual work or heaving lifting often require at least six weeks off work.
You can drive as son as you feel confident, competent and in complete control of a vehicle. It is advisable to start with short journeys initially.
It is best to start with gentle activities and build up slowly, avoiding heavy activities with the arm at or above shoulder height in the early stages after your surgery. You will be able to build up your level of activites dependent on pain, range of movement and strength that you have in your shoulder.