Manipulation under Anaesthetic (MUA) and Arthroscopic Release Operation

Transcription

1 Manipulation under Anaesthetic (MUA) and Arthroscopic Release 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 the shoulder surgery that you have been advised to have and 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: Surgical Short Stay, Harvey 1, and Edward 2. You will be admitted to one of these wards during your stay in hospital. On each ward a named nurse will be allocated to you to co-ordinate your nursing care. You will also have named physiotherapists to supervise your rehabilitation. For further information about the ward, please refer to the ward information leaflet. You will usually be admitted to the hospital on the day of your operation, and you will usually go home the same day occasionally you may be required to stay overnight. 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 on the morning of the operation 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 Frozen shoulder What is the problem? Frozen shoulder is a condition that causes pain and restricted movement of your shoulder joint. It occurs in 2-5% of the general population. A frozen shoulder can last from one to two years. Generally it is found to be a self-limiting disorder, which means that it usually gets better by itself, given enough time. However, some people continue to have a stiff, painful shoulder. In these cases one of the methods of treatment is a manipulation under anaesthetic. What is a Manipulation Under Anaesthetic? To do manipulation under anaesthetic or MUA, you will first be given an anaesthetic. While you are asleep, the surgeons will stretch your shoulder joint through its full range of movement, breaking any adhesions that have been restricting it. At the same time a local anaesthetic and a steroid will be injected into your shoulder to help relieve any soreness you may have afterwards. What is an Arthroscopic Release? An arthroscopic release is similar to a MUA where the surgeon will release the adhesions. The surgeon will make a small incision (key hole surgery) and cut the adhesions from inside the joint. Will I have to wear a splint or sling? No. After your MUA/ release the best thing to do is to lie or sit with your hand behind your head and your elbow out to the side. You should remove the collar and cuff as soon as the nerve block wears off. 3

4 What will happen? You will stay on the ward while you recover from your anaesthetic. You will practice your exercises with a physiotherapist and will be lent a pulley if you need it. How can I sleep? Sleeping can be a little uncomfortable if you try to 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). One pillow slightly folded under your neck gives enough support for most people. A pillow folded in half supports your arm in front. A pillow tucked along your back helps to prevent you rolling onto your 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. Fold a pillow to go under the elbow of your operated arm. 4

5 Rehabilitation Rehabilitation is important if you are 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. You should be trying to move your shoulder as far as the surgeons could get it while you were asleep. To help ease your discomfort at home you can apply an ice pack to the shoulder, for example a bag of frozen peas wrapped in a wet towel. You may need to do this regularly for the first few days. Exercises Try to do five 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. You can watch these exercises electronically following this link: Click here to link to the NUH Shoulder Unit Physiotherapy website 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 anti-clockwise. 5

6 Shrug your shoulders up and backwards in a smooth, circular motion. Stand tall, grasp a stick with both hands behind your back, keep your palms facing upwards. Roll your shoulders back and down. Now use the stick to help take your operated arm up and out behind you. In the position above, pull your operated arm up behind your back. You may use a stick or a towel if you can't reach it with your hand 6

7 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 over head if you can. now resting your hands upon your head, try to lower your elbows out to the side. Reverse the movement to come down. Stand facing a kitchen worktop, windowsill or other stable surface. Lean forward and rest your elbows upon the surface - you may use a pad for comfort. Place your palms upwards. Try and hold your hands together as you slowly walk backwards, leaning on your elbows until the shoulder is stretched. Walk forwards again to ease off. 7

8 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. When can I go home? When you have recovered from your anaesthetic. When you have learnt your exercises. Is that the end of my treatment? You will carry on with physiotherapy at your usual hospital or clinic from about a week after your operation, if necessary. At the City Hospital the follow-up clinic where your progress is monitored is run by specialist orthopaedic physiotherapists who will see you around six weeks after you go home. They will see you again at three months. They can arrange a quick appointment with your surgeon if necessary. At six months, you have your final clinic check-up. If you are at all worried about your shoulder you should contact the Shoulder and Elbow Unit at the City Hospital. The telephone numbers are at the end of this booklet. 8

9 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. When can I do my normal activities? We would encourage you to try and use your shoulder as normally as possible, as soon as you can. This will help to keep it loose and pain free. You must not drive until you are safe to control the car in an emergency situation. We advise you to contact your insurance company to inform them you have had this procedure prior to returning to driving. 9

10 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 Lucy Richardson Mon Fri 9am-5pm Mon Fri am 5pm Occupational Therapy Physiotherapy Shoulder and Elbow Team Therapy Reception (To alter a therapy appointment) Wards Click here to link to the NUH Shoulder Unit Physiotherapy website 10 Mon Fri 8am 4pm Edward 2 Ward 24 hours Harvey 1 Ward if urgent 55904/6 Surgical Short Stay Unit (SSSU) 53182

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12 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 The Trust endeavours to ensure that the information given here is accurate and impartial. Shoulder Unit, Physiotherapy Department March All rights reserved. Nottingham University Hospitals NHS Trust. Review March Ref: 0970/v2/0115/AS.