Shoulder Stabilisation A guide for patients Gateshead Upper Limb Unit Mr Andreas Hinsche Mr John Harrison Mr Jagannath Chakravarthy

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Johnathan York
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1 Shoulder Stabilisation A guide for patients Gateshead Upper Limb Unit Mr Andreas Hinsche Mr John Harrison Mr Jagannath Chakravarthy Page 1 of 7

Shoulder Instability Your shoulder is a ball and socket joint and is the most mobile joint in the body. It depends on strong muscles and ligaments to move and stabilise it.

The socket (also called the glenoid) of your shoulder is very shallow. The socket has a soft tissue rim called the labrum. This deepens the socket and acts as a bumper to the front and the back.

2 Shoulder Instability Your shoulder is a ball and socket joint and is the most mobile joint in the body. It depends on strong muscles and ligaments to move and stabilise it. The most important muscles for this are the rotator cuff muscles. The rotator cuff muscles originate from your shoulder blade and their tendons form a hood covering the ball of your shoulder joint. The socket (also called the glenoid) of your shoulder is very shallow. The socket has a soft tissue rim called the labrum. This deepens the socket and acts as a bumper to the front and the back. This (along with your shoulder muscles and ligaments) prevents the ball of the shoulder from slipping out of joint. An injury such as a dislocation (shoulder coming out of joint) can damage the labrum, ligaments and rotator cuff, resulting in instability of the joint. The injury is commonly to the labrum (called a Bankart lesion) or to the bony socket (called a bony Bankart lesion). It is not uncommon for the ball of the shoulder to be damaged as well. This could influence what procedure your surgeon offers you. Diagrams showing joint instability caused by a Bankart lesion and its surgical stabilisation. Who gets shoulder instability? Most commonly this follows a shoulder dislocation. This usually happens in the young male patients or the elderly patients. The younger you are the more likely you are to develop instability. This is very rare in the elderly population. Some shoulders become unstable after minimal or no injury. In such cases the problem could be laxity (looseness) of the ligaments or lack of shoulder muscle coordination. This typically requires intensive physiotherapy as the treatment of choice Page 2 of 7

3 Will I need any tests? You would normally have some x-rays in A&E or the orthopaedic clinic. If your surgeon is considering surgery he/she will need more information to find out the extent of the injury and typically will request a special scan (called an MR Arthrogram) This involves an injection into your shoulder followed by an MRI scan (a magnetic scan which is radiation free). Occasionally a CT scan (a more advanced type of x-ray) may be requested to look at the bones in greater detail. What are the treatment options? Physiotherapy is recommended for all patients. This is all you might need if you are middle aged or above or if you have joint laxity Surgery is typically offered to patients who have significant injury to the shoulder or in whom the shoulder is repeatedly coming out (instability). Different surgical procedures are available to repair and reconstruct these damaged structures in order to make the shoulder joint stable again. How is it done? Bankart Repair: This is an operation to reconstruct or repair the damaged labrum. Capsular Shift: This is an operation to tighten the stretched joint capsule and ligaments. Bone Block: This is an operation to reconstruct and replace bone loss from the glenoid. The decision on which procedure is needed depends on which structures are damaged. Some of these operations can be done by keyhole surgery (arthroscopy) which involves several small wounds around the shoulder. An open procedure requires an incision at the front of the shoulder. Are there any complications with this operation? The risk of complications may vary from patient to patient. This is because this type of surgery is specific to individual patients. Your consultant or physiotherapist will discuss any individual risks or complications with you. Generally the most common problems with this type of surgery are: Shoulder stiffness You may not get full pain relief Recurrent instability Page 3 of 7

4 How long will I be in hospital? The majority of patients are admitted to hospital on the day of their surgery. However it may be necessary to admit you the day prior to surgery. The anaesthetist will make this decision and inform you. You may be able to go home on the day of surgery but you may need a short stay in hospital, advice will be given on the day, once the operation is completed. What happens before the operation? Before you are admitted you may need to have a pre-operative assessment. This is an assessment of your health to make sure you are fully prepared for your admission, treatment and discharge. Before the date of your admission please, read very closely, the instructions given to you. If you are undergoing a general anaesthetic you will be given specific instructions about when to stop eating and drinking, please follow these carefully as otherwise this may pose an anaesthetic risk and we may have to cancel your surgery. You should bath or shower before coming to hospital. The surgeon and anaesthetist will visit you and answer any questions that you have. You will be asked to sign a consent form. A cuff will be put on your arm, some leads placed on your chest, and a clip attached to your finger. This will allow the anaesthetist to check your heart rate, blood pressure and oxygen levels during the operation. A needle will be put into the back of your hand to give you the drugs to send you to sleep. Occasionally you might just receive an injection into the side of your neck to numb your shoulder and you will remain awake during the procedure if this is the case. What happens after the operation? After your operation you will then be taken to the recovery area where you will be closely monitored by a recovery nurse until you are awake and comfortable. A nurse will check your blood pressure, pulse and the area where the operation has been done. You will have a clear oxygen mask in place and sometimes the oxygen will be continued on the ward. Once your initial recovery period is over you may be transferred to the ward. You will normally be able to have a drink shortly after the procedure and eat as soon as you feel hungry. You can usually get out of bed an hour or so after you wake up and you should wait for the nurses to help you as you may feel a little dizzy at first. It is likely to be a bit painful where the operation has been carried out, but if you move carefully, the pain is not usually severe. The nurses will monitor your pain and give you painkillers, if necessary. It is quite normal for a small amount of blood to soak through the dressing and this can easily be changed. Recovery after surgery? You will also be monitored by a physiotherapist on discharge from hospital. If you have not been given your physiotherapy appointment within 2 weeks following your surgery, please contact us, tel (see numbers at back of booklet). An appointment will be made for you to be reviewed by a member of the upper limb team in the follow up clinic after your operation. Page 4 of 7

When do the stitches come out? The stitches will be removed at your GP surgery, usually 10-14 days after your operation. Keep the wound dry until it is well healed.

Wearing a sling You will return from theatre wearing a sling or an immobiliser, this is to protect the shoulder whilst it heals.

5 When do the stitches come out? The stitches will be removed at your GP surgery, usually days after your operation. Keep the wound dry until it is well healed. The nursing staff will advise you about this before your discharge from hospital. Wearing a sling You will return from theatre wearing a sling or an immobiliser, this is to protect the shoulder whilst it heals. This will have a belt that goes around your waist and one that goes around your neck. The surgeon or physiotherapist will advise you on how long you have to are to continue wearing the sling, however, this is usually between 3-6 weeks. You must not remove your sling except for washing, dressing and exercises. The sling must be worn at all times including in bed. You will be shown how to remove the sling safely. Sleeping Your sling must be worn in bed. Sleeping can be uncomfortable if you try and lie on the affected arm. We would recommend that you lie on your back or on the opposite side. Use ordinary pillows to give yourself comfort and support. You should not lie on your operated shoulder for the first 6 weeks. Lying on your side: One pillow folded under your neck gives enough support for most people. A pillow folded in half supports the sling and your arm in front. You may also require a pillow along your back to help prevent you rolling onto your shoulder in the night. Lying on your back: Tie a pillow tightly in the middle or use a folded pillow to support your neck. Fold another pillow to go under the elbow of your operated arm. Washing Washing You can remove your sling to wash, however it is very important that no movement takes place at your shoulder. The easiest way to do this is to allow your arm to hang down by your side and lean your body away. Page 5 of 7

6 Physiotherapy Rehabilitation is important if you are to get the most out of your shoulder after the operation. The first stage is to let your shoulder heal by resting it in the sling for 3-6 weeks as advised by your physiotherapist. During this time you can move your elbow, wrist and hand to make sure they do not get stiff and swollen. Exercises For the first six weeks you will be allowed some shoulder movement. Your physiotherapist will guide you regarding this. You will also perform elbow, wrist and hand exercises. Please check with your physiotherapist before starting. 1. Keep your arm in the sling and move your hand up and down at the wrist. 2. Keep your arm in the sling and turn your hand to face the ceiling and then the ground. 3. Keep your arm in the sling and shrug shoulders up and down. 4. Carefully removing your sling, bend and straighten your elbow, you must keep your upper arm close to your side i.e. not moving your shoulder. Repeat exercises four times a day, you will be instructed how many repetitions of each exercise to do by your physiotherapist. Continue these exercises until otherwise instructed by your physiotherapist. Return to functional activities Return to work Sedentary job: as tolerated Manual job: 3 months Driving 6-8 weeks (please contact your insurance company as well) Swimming Breaststroke: 12 weeks Freestyle: 12 weeks Golf 3 Months Lifting Light lifting can begin at 3 weeks. Avoid lifting heavy items for 3 months. Contact Sport E.g. Horse riding, football, martial arts, racket sports and rock climbing: 3 months If you are at all worried by your shoulder please contact us, see telephone numbers at the back of this booklet. Page 6 of 7

7 Telephone numbers During the hours of 8am -8pm contact the Day Surgery Unit, North East NHS Surgery Centre, Queen Elizabeth Hospital During the hours of 8pm -8am contact Level 1, North East NHS Surgery Centre, Queen Elizabeth Hospital During the hours of contact the Physiotherapy Department (please ask for a member of the upper limb team) Main switchboard Useful Organisations Please go to the patient information link on the website 1. Patients Association PO Box 935 Harrow Middlesex HA1 3YJ Tel Helpline: Provides a helpline, information and advisory service. It also campaigns for a better health care service for patients. Data Protection Any personal information is kept confidential. There may be occasions where your information needs to be shared with other care professionals to ensure you receive the best care possible. In order to assist us improve the services available your information may be used for clinical audit, research, teaching and anonymised for National NHS Reviews. Further information is available in the leaflet Disclosure of Confidential Information IL137, via Gateshead Health NHS Foundation Trust website or the PALS Service. Information Leaflet: NoIL259 Version: 3 Title: Shoulder Stabilisation First Published: July 2006 Review Date: October 2016 Author: Gateshead Upper Limb Team This leaflet can be made available in other languages and formats upon request Page 7 of 7

INFORMATION FOR PATIENTS. Arthroscopic Bankart repair

INFORMATION FOR PATIENTS. Arthroscopic Bankart repair INFORMATION FOR PATIENTS Arthroscopic Bankart repair This booklet contains information about the shoulder surgery that you have been advised to have, and aims to answer some of the questions you may have