Reverse Shoulder Replacement Operation
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1 Reverse Shoulder Replacement Operation Information for patients The Nottingham Shoulder and Elbow Unit This document can be provided in different languages and formats. For more information please contact: Physiotherapy Department Nottingham City Hospital Campus Hucknall Road, Nottingham. NG5 1PB Tel: ext Public information
2 This booklet contains information about your recommended shoulder surgery. It aims to answer some of the questions you may have about the operation and your stay in hospital. About shoulder surgery at City Hospital There are three orthopaedic wards at City Hospital: Theatres Admissions Lounge, Edward 2 and Harvey 1. You will be admitted to one of these wards during your stay in hospital. On each ward a named nurse will be allocated to co-ordinate your nursing care. A physiotherapist will supervise your rehabilitation. The physio may see you before, rather than after your surgery. You will usually be admitted to the hospital on the day of your operation, and you will usually go home on day 2/3 after your operation. If you think you will need transport to get home or help when you get home please tell your named nurse when you first come in. What to bring You need to bring in with you any medicines that you are taking, toiletries, towel, nightwear and some loose and comfortable clothing. Please leave valuables at home. Operation day Your anaesthetist will see you either on the morning or during your pre-op visit to discuss your anaesthetic with you. You will be able to eat and drink as usual the day before your operation. You may be able to have an early morning drink even on the day of your operation. The time you have to stop eating will depend upon the time of your operation. You must not smoke after midnight the day before the operation. 2
3 What is a Reverse Shoulder Replacement? In a healthy shoulder, your upper arm bone (humerus) ends in a ball shape. This fits into a socket formed by your shoulder blade (scapula). Together this ball and socket form your shoulder joint. With the Reverse Shoulder Replacement, the anatomy or structure of your healthy shoulder is reversed (your ball and socket are swapped over). Right shoulder from the front Right reverse shoulder replacement Shoulder surgery pre-operative information video A video detailing the information in this booklet can be found here. 3
4 Why am I having a Reverse Shoulder Replacement? The Reverse Shoulder Replacement is mainly used for older patients with rotator cuff tears (the muscles around your shoulder joint that support the joint). Your rotator cuff muscles may have torn or weakened to a point where they can no longer support your shoulder joint, or allow you to fully use your arm. In many cases, the cause of your weakness may be arthritis. It could also be secondary to a previous shoulder injury; such as a shoulder fracture, rotator cuff tear or unsuccessful shoulder surgery. What will the Reverse Shoulder Replacement do? A shoulder replacement is an operation to relieve your pain. It should take away most, if not all, of the pain that you have in your shoulder. It may take several months before you feel the full benefit of your new shoulder, so please do not be disappointed if it is still painful after the operation. A reverse shoulder replacement does not guarantee an improvement in your shoulder movement or function. The therapists will help you to try and get as much movement as possible from your new joint. 4
5 How is the operation done? A Reverse Shoulder Replacement is done as an open operation, which will leave a scar about 7-10cms in length along the front of your shoulder, along the bra (or vest) strap line. Operation scar How will I look after my operation? Your shoulder wounds will have dressings on them, and you may have a small tube going into your shoulder to give pain relief. Your shoulder may look a little different following the operation. This is normal, and is simply because of the new anatomy of your Reverse Shoulder Replacement. 5
6 Will I have to wear a splint or sling? You will have your arm supported in a sling straight after your operation. You will be taught how to manage your sling by the physiotherapists. 1 Make sure your arm is well supported on a pillow / table before you start. Do not lift your arm at any point. Slide the sling under your arm. Make sure your elbow is tucked into the corner of the sling. You can put your fingers and thumb in the loops inside the sling as long as you have normal hand sensation. 2 1 Get hold of the strap by your elbow and move along it until you reach the triangle. The strap at the front of the triangle is strap A B Strap 1 goes around your back and over your unaffected shoulder. It inserts in to the loop at the front of the sling. The white velcro piece, can be moved further along the strap for a better fit if necessary. You should aim to have your hand just above your elbow. Strap 2 will already be attached to the corner side of the sling, it s length should not need amending as this will have already been done for you. Strap 3 goes round your back and underneath your unaffected arm. It 6
7 How do I fit my sling? You can view a demonstration on how to fit your sling here. What will happen after my operation? You will have x-rays after your surgery before you go home. Your surgeons will check these to make sure your shoulder is sitting correctly. The Physiotherapist will show you how to remove your sling and do the exercises in this booklet. An Occupational Therapist may come and review how you are getting on to ensure you do not need any equipment when you go home to help with day to day activities. When will the stitches come out? Your stitches will be removed on the ward or at your GP s surgery, usually 10 days after your operation. 7
8 How can I sleep? You must not lie on your operated shoulder. We would recommend that you lie on your back or the opposite side, as you prefer. Ordinary pillows can be used to give you comfort and support (feather pillows are easier to use than foam ones). You should sleep in your sling and ear your sling with the waistband fastened. If sleeping on your side, one pillow slightly folded under your neck gives enough support for most people. A pillow tucked along your back helps to prevent you rolling onto your operated shoulder in the night. If sleeping on your back, tie a pillow tightly in the middle (a butterfly pillow ), or use the folded pillow shown before. This will support your neck. Fold another pillow to go under the elbow of your operated arm. Rehabilitation Rehabilitation is important to get the most out of your shoulder after the operation. The first stage is to get your shoulder moving again, with the following exercises. Please be guided by your level of discomfort, we do not expect you to get full range of movement on the first day - you can do too much and exacerbate your pain. 8
9 Exercises Try to do 5-10 repetitions of each exercise. You should do your exercises in this order at least twice a day at home, until your follow-up physiotherapy appointment. They can then be altered or increased under the guidance of your physiotherapist. Only do these exercises if you have been shown them by your physiotherapist. You can watch a demonstration of these exercises here. Lean forwards from your hips, circle your arms from your shoulder in gentle, pendulum type movements. Keep your palms facing forwards as you go clockwise and anticlockwise. Shrug your shoulders up and backwards in a smooth, circular motion. 9
10 Lie on your back with your elbows on folded towels so that they are level with your shoulders. Bend your elbows to at least 90 degrees, and use a stick to turn your operated arm out to the side. Keep your elbows tucked in. From lying on your back with your elbows supported as before, use your un-operated arm to lift the other up towards your head. Try to get your hands level with your head if you can. It is best to do this with your palm facing you. Use the pulleys 2-4 times a day for 2-5 minutes depending on your pain and stiffness. Try to hold your arm up in the highest position whilst easing off with your unoperated hand. Remember to keep your shoulder down, elbow tucked in and your palm towards you. 10
11 When can I go home? When your pain is controlled When you have learnt your exercises When you have some control over your new shoulder Is that the end of my treatment? You will usually have an appointment at a local physiotherapy department within 14 days of leaving the ward. You will usually be seen in clinic between six weeks and twelve weeks after your operation. At around six months and one year, you will have another clinic check-up. These clinic reviews are important as they: Provide answers to any questions you may have Pick up on any complications Monitor your progress with your rehab If you are at all worried about your shoulder you should contact the Shoulder and Elbow Unit at Nottingham University Hospitals, City Campus. The telephone numbers are given at the end of this booklet. 11
12 What will I do as an outpatient? You will continue with your exercises with the help of a physiotherapist. You will be given more exercises if you need them. You will gradually work on developing the strength in your shoulder, progressing as far as you can manage. We will encourage you to learn how to use your shoulder comfortably. If you have a heavy or demanding job, you may also be helped by our occupational therapists. You should discuss this with your surgeon before your operation. Are there any restrictions to what I can do with my arm immediately after surgery? Yes, you can use your arm for light activities only for the first six weeks. Light activities include eating and drinking/ washing and dressing. For the rest of the time over the first six weeks you will usually need to rest your arm in the sling. You should sleep with your arm in the sling for the first six weeks. You will not be allowed to push up through your arm for example to get out of the chair/ off the bed for the first six weeks or to pull on your arm for example to go up stairs. You should not take your hand behind your back until your physiotherapist advises you that you are safe to do so. You are not allowed to drive for at least six weeks after your surgery.
13 When can I do my normal activities? This depends upon your symptoms. As you recover from the procedure it is normal to experience pain. This should be manageable with medication. Most people are comfortable by between six to twelve weeks after surgery Driving can be resumed when you are comfortable and safe to control a car. It is wise to discuss this with your insurance company. You must not drive whilst you are still using a sling. The following table gives you the timescales for the amount of rest required by your arm before resuming a particular type of activity. Type of activity Rest Light work (no lifting) 10 days 6 weeks Medium (light lifting below shoulder level) 6 weeks onwards If you feel that your work or leisure activities come into the heavy category, please discuss this with the physiotherapists and occupational therapists, so that we can plan the best rehabilitation for you.
14 Nottingham Shoulder and Elbow Unit Therapy website Useful contact numbers City Hospital Campus: (0115) Dial the City Hospital Campus number above, listen to the recorded message and then dial the appropriate extension from the list below. Available Extension Clinic reception (To alter a clinic appointment) Shoulder and Elbow secretaries: Genevieve Stewart-Smith Amy Martin Mon Fri 9am-5pm Mon Fri am 5pm Occupational Therapy Physiotherapy Shoulder and Elbow Team Mon Fri Therapy Reception (To alter a therapy appointment) 8am 4pm Wards Edward 2 Ward 24 hours Harvey 1 Ward if urgent 55904/6 Theatres Admissions Lounge 51441
15 Notes
16 Feedback We appreciate and encourage feedback. If you need advice or are concerned about any aspect of care or treatment please speak to a member of staff or contact the Patient Advice and Liaison Service (PALS): Freephone: From a mobile or abroad: ext or pals@nuh.nhs.uk Letter: NUH NHS Trust, c/o PALS, Freepost NEA 14614, Nottingham NG7 1BR Nottingham Shoulder and Elbow Unit, Physiotherapy Department October All rights reserved. Nottingham University Hospitals NHS Trust. Review October Ref: 1074/v2/0115/AS.
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