In Space Balloon A guide 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: 0115 969 1169 ext 54580 Public information
This booklet contains information about the shoulder surgery that you have been advised to have and answers 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: Theatre Admission 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. You will also have a named physiotherapist to supervise your rehabilitation. The physio may see you before, rather than after, your surgery to organise outpatient physiotherapy and answer any questions you may have. 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 later that day or the day afterwards. 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
Why do you need an in space balloon - what is the problem? Your shoulder is the most mobile joint in your body and is therefore dependent on strong muscles to move and stabilise it. The most important muscles for this purpose are your rotator cuff muscles. These muscles originate from your shoulder blade and their tendons form a hood covering the ball of your shoulder joint. Side view of the right shoulder These tendons can get damaged in two ways, either by an accident, or by weakening and wearing out over time. Bony spurs (a small build-up of bone) can develop underneath the arch of bone above your shoulder joint (the acromion). When you move your arm into certain positions, such as reaching up or behind your back, these spurs can press on your tendons or your torn tendon may be stretched, making them feel painful. After the operation it may take at least two to three months for the inflammation of your shoulder to settle down. This is quite usual. Over 75% of people make a full recovery, but there is a slight chance that you may have had some permanent changes or small tears in your tendons. 3
What is an In Space balloon operation? An in-space balloon operation involves inserting a balloon filled with liquid into the shoulder joint in order to create a cushion between the shoulder joint and the muscles. Any scarred or inflamed tissues will be cleared out. How is it done? The procedure may be carried out as a keyhole procedure (arthroscopically) using a telescope about 5mm in diameter and instruments of similar size. This will give you two to four small scars of about 5-7mm in length on the back, the side and the front of your shoulder. During your operation your surgeon will also examine your shoulder joint. Arthroscopic Open There may be technical reasons why your surgeon cannot carry out the procedure arthroscopically. This means it will be done in the traditional way (open), which will leave a scar about 4-7cms in length along the front of your shoulder, along the bra (or vest) strap line. You will probably have a little pain after your operation - slightly more if you have had the open procedure. You will normally be given a nerve block through a small tube (catheter) that leads into your shoulder to manage your pain at the time of the operation. 4
How will I look after the operation? When you return to the ward your shoulder wounds will have dressings on them. You will be wearing a collar and cuff sling as you won t be able to control your arm due to the nerve block. This should be removed as soon as the block wears off (within 24-48 hours). When will the stitches come out? If you have had stitches, they will be removed at your GP s surgery, usually 10 days after your operation. An arthroscopic wound does not usually need stitches. Will I have to wear a splint or sling? No. It is important to get your shoulder moving as soon as possible. How can I sleep? You should not lie on your operated shoulder if it is uncomfortable. 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). 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 ) to use under your neck. A slightly folded pillow under your neck will also give you enough support. Fold a pillow to go under the elbow of your operated arm. 5
Shoulder surgery pre-operative information video A video detailing the information in this booklet can be found here. 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 make your pain worse if you do too much! Do not start any exercises until a physiotherapist has shown you. Exercises Try to do five repetitions of each exercise twice a day. 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. (see the following pages). You can watch a demonstration of these exercises here. 6
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. 7 Stand tall grasping a stick with both hands behind your back. (Palms up) Roll your shoulders back and down. Now use the stick to help take your operated arm up and out behind you. In the position shown, 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. (Hold as above if this is needed)
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. Lie on your back, with your elbows supported as before, use the arm which hasn t been operated on to lift the other up towards your head. Try to get your hands over your head if you can. Then rest your hands upon your head, then 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 up. Try and hold your hands together as you slowly walk backwards, lean on your elbows until the shoulder is stretched. Walk forwards again to ease off. 8
When can I go home? When you have recovered from your anaesthetic and have been seen by the physiotherapist. Is that the end of my treatment? If the physiotherapists did not see you on the ward before you were discharged you will be directed to see the physiotherapist at the out-patient physiotherapy department opposite the Elizabeth Suite to go through your exercises the day after your operation alternatively they may contact you by phone. A physiotherapy appointment for ongoing treatment will be made for you at your local hospital physiotherapy department (usually two to three weeks after your operation). You will also go to the follow-up clinic at the City Hospital Campus. This is run by Specialist Orthopaedic Physiotherapists. They will see you around six weeks after your operation. They will see you again at three months. You will normally have your final clinic check-up at six months. The specialist orthopaedic physiotherapists can arrange a quick appointment with your surgical team at any time if necessary. These clinic reviews are important as they provide answers to any questions you may have, they pick up on any complications and they monitor your progress with your rehab. 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. You will gradually work on developing the movement and strength in your shoulder, progressing to full functional movement. 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. When can I do my normal activities? This depends upon your symptoms. As you recover from the procedure and any swelling settles down it is normal to have some pain. This should be manageable with medication. Most people are comfortable by between 6-12 weeks after surgery. As you recover from the procedure and any swelling settles down it is normal to have some pain. This should be manageable with pain medication. Driving can be resumed when you are comfortable and safe to control a car. It is wise to discuss this with your insurance company. 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 Light work (no lifting) Medium (light lifting below shoulder level) Heavy (above shoulder level) Rest 10 days to 6 weeks 6 weeks onwards 3 to 6 months 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. If you are at all worried about your shoulder you should contact your surgeon. 10
Nottingham Shoulder and Elbow Unit Therapy website https://www.nuh.nhs.uk/our-services/services/physiotherapy/ shoulder-and-elbow-unit-physiotherapy/ Useful contact numbers City Hospital Campus: (0115) 969 1169 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 55306 9am 5pm 55047 56899 Occupational Therapy 55330 Physiotherapy Shoulder and Elbow Team Mon Fri 54580 Therapy Reception (To alter a therapy appointment) 8am 4pm 55310 55330 56119 Wards Edward 2 Ward 24 hours 55879 Harvey 1 Ward if urgent 55904/6 Theatre Admission Lounge 51441 11
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: 0800 183 0204 From a mobile or abroad: 0115 924 9924 ext 65412 or 62301 E-mail: pals@nuh.nhs.uk Letter: NUH NHS Trust, c/o PALS, Freepost NEA 14614, Nottingham NG7 1BR www.nuh.nhs.uk The Trust endeavours to ensure that the information given here is accurate and impartial. Nottingham Shoulder and Elbow Unit, Physiotherapy Department October 2018. All rights reserved. Nottingham University Hospitals NHS Trust. Review October 2020. Ref: 1076/v3/0115/AS