The shoulder is the most mobile joint in the body. This flexibility makes it susceptible to instability and injury. A shoulder injury can be very debilitating. Completing all of the usual activities of daily living including personal grooming and hygiene can be near impossible with a shoulder impairment.
Depending on the nature of your shoulder problem, non-surgical interventions may be the first line of treatment. Physiotherapy can play a vital role in many shoulder conditions.
The aim of surgery is to restore the normal function of your shoulder.
The operation is performed usually under general anaesthetic and a nerve block in your neck or upper chest that will make your arm ‘dead’ for 8-24 hours after surgery. This is for post-operative pain relief. After this the shoulder may well be sore and you will be given painkillers to help this.
Your arm will remain in a special sling for 5-6 weeks. This means that you will be unable to use the arm throughout this time except for very minor things, like carrying some papers. Usually you will be in hospital for 1 night before being discharged.
Recovery times vary depending on your specific surgery. It is recommended that you take at least two weeks off work.
Rehabilitation of your shoulder after surgery is essential and will ultimately determine the success or failure of your surgery. Your surgeon and your physiotherapist will be able to guide your rehabilitation program appropriately. However, it is ultimately your role in performing regular home exercises that will deliver the best outcome.
In the early stages post surgery you may experience shoulder pain and discomfort. The best management for this is a combination of ice and medication. Apply an ice pack (or a bag of frozen peas) wrapped in a tea towel for 15 minutes every hour to the painful area of your shoulder. You should continue to do this for the first few days post surgery.
Pain medications will be provided on discharge from the hospital. These are discussed between the surgeon and the anaesthetist during your surgery to ensure the best mix of long and short-acting medications is available for you.
You should contact the surgeon’s rooms if you have any concerns regarding:
~ Pain that is persistent and not manageable with the above measures
~ Onset of fevers or sweats
~ Swelling &/or unusual redness of the wound
~ Increased numbness or weakness in the fingers
~ Discomfort caused by tight bandages or dressings that have become loose and therefore ineffective
~ Any pain or persistent discomfort from your brace, bandages or plaster
It is important for you to wear your sling at ALL times except for when you are performing your exercise program. You may also take the sling off for showers although it is very important that you do not use your arm at all and let it hang by your side. Alternatively, you can have a spare sling that you use just in the shower for support and protection and the shower can be a high risk area for slips and falls. You can wash and dry under the arm of your operated shoulder by leaning over and letting your arm passively move away from your body. Don’t attempt to actively move your shoulder away from your body.
It is important that you start to gently move your arm on the first day post surgery. Your physiotherapist will guide you with this and may make changes to your exercises depending on your specific surgery, pain and stiffness.
Please respond to your pain. Do not force your arm against unreasonable amounts of pain. Sharp pain is almost always to be avoided. Stretching discomfort is expected.
You will need to take all your pain medications 20 minutes before your exercises or your physiotherapy session so they have a chance to make you achieve the best possible results.
RESUMING NORMAL ACTIVITIES
Driving: Once your surgeon advises you to remove your sling and you feel you are able, you may resume driving. This will likely mean you will need to expect being unable to drive for at least 6 weeks. This may affect your ability to return to work. We advise driving an automatic car initially.
Leisure activities:
This will depend upon the type and extent of your operation. Your physiotherapist or occupational therapist and surgeon will advise you when it is safe to resume your leisure activities. Generally, no force will be allowed for the first 8 – 12 weeks.
Follow up appointments and physiotherapy
‘Prehab’ You may want to consider having an appointment with your physiotherapist before your surgery to ensure the range of movement and strength of the shoulder is at its optimum. This can have a very positive impact on how well you do after your surgery.
At your initial post-operative appointment, your surgeon will discuss with you your choice of physiotherapist. You will be monitored and advised by a physiotherapist throughout your rehabilitation. The most intensive period of rehabilitation is from week 6 to week 14 post operatively but you may stay involved with your physiotherapist for range of movement, strengthening and advice on a graduated return to work and sport for up to 6 months or more. It can be beneficial to pre- arrange private health insurance extras coverage or discuss a Medicare Care Plan with your GP to help cover the costs.
THE FIRST FIVE WEEKS – THE PROTECTION STAGE
Tendon and other tissue healing is a slow process. It takes five weeks before it is safe to start using the arm under its own power. That is why you are placed in sling for five weeks. The sling should stay on at all times apart from when showering or doing the exercises. This includes sleeping.
During this PROTECTION STAGE you must avoid activities to allow the tendon to start healing to the bone. DO NOT raise your arm or elbow away from your body. DO NOT lift objects, no reaching behind your back, no excessive (painful) stretching or sudden movements.
What to do if you develop a wound infection?
Then you need to see the Surgeon straight away. Call your surgeon’s rooms or outside of rooms hours, please call the hospital switchboard where you had your operation.
When can I have a shower?
From 48 hours after the surgery, you can safely have a shower as the dressings are splashproof.
When can I go to hydrotherapy or go swimming?
Following the initial post operative review with your surgeon, as following complete wound closure, hydrotherapy and swimming are to be encouraged under the guidance of your physiotherapist. They lead to better results, with a decrease in pain and much greater flexibility.
How should I get home after my surgery?
After your operation and anaesthetic, the Surgeon and the Hospital require that you go home in the care of a responsible adult. You cannot drive yourself home from the hospital.
What should I bring with me to hospital?
Loose fitting clothing is advisable. T-shirts are very difficult to put on for the first week after surgery. A loose button up shirt is better. Usually, the arm goes underneath the shirt, in the sling, for the first week after surgery. Therefore, the shirt is best oversized.
The team at Peninsula Hand Therapy are specialists of the upper limb.
Book today at Peninsula Hand Therapy with Kate Large, our Titled APA Musculoskeletal Physiotherapist who specialises in neck, thoracic spine and Shoulder rehabilitation.