Trauma and Orthopaedic Therapy Services Physiotherapy following shoulder surgery Issued By: To:.. By Hand / By Post Date: Information
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Shoulder Surgery Your surgery may have been done either open i.e. with a wound incision or arthroscopically i.e. with an instrument that looks inside the joint through small puncture wounds. Your anaesthetist (the doctor who sends you off to sleep) may also have given you a local anaesthetic block. After the block, when you wake up your shoulder should be pain free. The whole arm will feel heavy and numb; this will gradually lessen over a number of hours. You will be given a sling to wear during this time to support your arm. As there are many different operations for the shoulder area, the instructions on how much you are allowed to do vary. Please follow the instructions indicated. 3
Post-Operative Instructions The doctor has given you one of the following instructions: Movement There is no limit to how far you can move your shoulder There is a limit to how far you can move your shoulder (your Physiotherapist will advise you further) Do not move your shoulder without assistance You should follow this recommendation until.. You have a sling to wear No / Yes (see below for advice) When to wear your sling Please wear the sling provided for:. Days / Weeks You should wear this sling: All the time - removing it carefully only to wash All the time removing it only for exercising as instructed and to wash Only when walking For comfort only, reducing the amount of time you wear your sling for during the day 4
How to apply your sling There are several types of sling. You have been issued a: Forearm Sling Sober (Shoulder Immobiliser) Sling Forearm Sling Place the elbow in the sling Apply the shoulder strap from the elbow edge of the sling. This may be attached to the sling or need to be attached by passing the strap through the upper most ring at the elbow and Velcro onto itself. Pass this strap across the patient s back and over the unaffected shoulder The strap then loops through both rings at the hand edge of the sling and Velcros onto itself. The thumb should also be placed in the soft loop inside the sling to ensure a neutral positioning of the forearm and prevent the sling slipping back along the forearm. NOTE: Please try and position the hand at a level higher than the elbow If required, a second strap may be wrapped around the waist and through a second ring at the base of the sling; this strap prevents the arm from turning outwards. 5
Sober (Shoulder Immobiliser) Sling Secure the body belt around the waist with the opening to the front and the attached arm cuff next to the affected arm. Secure the arm cuff around the affected arm just above the elbow. Secure the wrist cuff around the affected wrist with the white plastic ring pointing upwards and the velcro fastening on the back of the wrist. Attach the long shoulder strap to the body belt from the centre of the back with the blue side showing as it passes over the non-affected shoulder. Pass the shoulder strap through the white plastic ring and fasten onto the blue shoulder strap at a comfortable height. NOTE: Please try to position the hand at a level higher than the elbow Your Nurse or Physiotherapist will ensure you are happy with the application of your sling prior to discharge. 6
Activities of daily living wearing a sling You will be one handed for a period of time and need to think how you will do certain tasks at home. Here are some tips on how to manage Washing and dressing You will require loose clothing that preferably buttons down the front. Avoid clothing with small buttons, hooks and zips. Ladies may find a bra uncomfortable and may prefer to wear a strapless or front fastening bra. Consider slip-on, easy fitting shoes. You will be allowed to wear your sling over clothes. Always dress your operated arm first and undress it last. If you are in a sling you will probably need help with washing and dressing yourself. For safety it is best to avoid stepping into and standing in a bath whilst your arm is in a sling unless you are certain of your own balance. If you do, a non-slip mat and some assistance nearby would be advisable. Sleeping Avoid lying on your operated arm initially. Lying on your back may be the most comfortable position. A pillow placed behind the operated arm will prevent the arm from falling backwards. Domestic Tasks Use ready prepared meals or items that need little preparation e.g. pre-chopped vegetables. There is equipment available which can help with food preparation, e.g. easy grip jar openers, pizza cutters. You may manage light domestic tasks one handed but you should avoid heavy household duties. 7
Standing/sitting Always maintain a good posture and avoid hunched or drooped shoulders. When getting up from a chair do not lean on your operated arm until your therapist advises you to do so. Adjust the height of work surfaces to elbow height if possible. Lifting/carrying Since your muscles will not have been used for a while, they will not be as strong as they were before the operation. It is advisable not to lift heavy objects until you are guided by your therapist or until it feels comfortable to do so. Returning to work You should discuss when you can return to work with your doctor or therapist. Jobs involving heavy labouring/lifting should be avoided until your shoulder is sufficiently strong enough to manage these activities. A light job may be resumed as soon as you feel able after the operation. Driving You should not attempt to drive until you are out of your sling, your pain has subsided and you feel confident in your own ability. If your ability to drive has been affected you are required by law to contact the DVLA. 8
Ice You may use an ice pack to help with any swelling or pain you are experiencing after surgery. If you have shoulder exercises to do you may wish to use an ice pack before or after you do your exercises. How to Apply Ice Packs at Home ** Do Not Use Whole Ice Cubes ** If you want to use proper ice you must crush it first. It is easier, and less messy, to use a packet of frozen peas. Mark them as an ice pack so you do not eat them. Keep refreezing them to reuse them. 1. Apply a dry paper towel over the top of existing dressings. 2. Wrap packet of frozen peas/crushed ice in a dry tea towel. 3. Put the ice on area to be treated. A towel may be wrapped around the whole area to keep the ice pack in place if you wish. 4. If you feel a painful burning sensation, remove the ice immediately; otherwise leave the ice pack in position for 10 minutes before removing. If you are using frozen peas put them back in the freezer for the next time. Ice may be applied up to 4 times a day 9
Exercises The following exercises are suitable for everyone; please start them immediately after your operation. If you have been given a local anaesthetic block you may not be able to feel or move your arm for some hours. Do not worry, start the exercises as soon as you are able to do so. Hand, Wrist and Elbow Exercises These exercises are to be done with your operated arm. Make a fist, then straighten your fingers Repeat 5 times Up to 3 times / day With your thumb touch each finger tip Repeat 5 times Up to 3 times / day Bend and then straighten your elbow. You may help with your unoperated hand holding your wrist, but do not move the operated shoulder. Repeat 5 times Up to 3 times / day 10
After your discharge home Please continue with the exercises you have been taught You have been referred to Out Patient Physiotherapy You have NOT been referred to Out Patient Physiotherapy Further exercises You do not have any further exercises to do. You have further exercises please refer to the individual sheet provided and do only the exercises that have been marked for you You will be advised of any further exercises during your outpatient physiotherapy appointment You will be advised of any further exercises after your clinic appointment with the consultant Out patient Physiotherapy appointment: Location: Date: Time: 11
Contact Details If you have any queries regarding your physiotherapy whilst you were on the ward please contact: The Inpatient Physiotherapy Team Monday Friday 8.30am 4.30pm Telephone 01536 492450. If you have a query relating to an outpatient physiotherapy appointment please contact: The Central Booking Line Monday, Wednesday & Friday 8.30am 4.30pm Tuesday & Thursday 8.30am 6.00pm Telephone 0330 555 6789 (select option 5) If you need this information in another format or language, please telephone 01536 492510. Further information about the Trust is available on the following websites: KGH - www.kgh.nhs.uk NHS Choices - www.nhs.uk Ref: PI 913 September 2014 Review: June 2016