James Paget University Hospitals NHS Foundation Trust James Paget University Hospitals NHS Foundation Trust Shoulder Arthroscopy and Subacromial Decompression Courtesy and respect A welcoming and positive attitude Polite, friendly and interested in people Value and respect people as individuals So people feel welcome Attentively kind and helpful Look out for dignity, privacy & humanity Attentive, responsive & take time to help Visible presence of staff to provide care So people feel cared for Responsive communication Listen to people & answer their questions Keep people clearly informed Involve people So people feel in control Effective and professional Safe, knowledgeable and reassuring Effective care / services from joined up teams Organised and timely, looking to improve So people feel safe The hospital is able to arrange for an interpreter to assist you in communicating effectively with staff during your stay through INTRAN. If you need an interpreter or a person to sign, please let us know. If you require a large print version of this booklet, please contact PALS on 01493 453240 Patient Information Author: Lyndsey Smith, Senior Physiotherapist, Therapy Services 12 January 2015 James Paget University Hospitals NHS Foundation Trust Review Date: January 2018 PH 26 version 1
Introduction This booklet provides information and advice about your shoulder surgery and to aid your recovery and rehabilitation during your stay at the James Paget University Hospital and once you are discharged from hospital. The aim of your surgery and post-operative advice is to regain as much range of movement of your shoulder as soon as pain allows. What happens when I m discharged? You are expected to complete your exercise regime on discharge. On discharge, your physiotherapist from the ward will refer you for outpatient physiotherapy. The location of the outpatient physiotherapist will depend upon you GP address. They will typically contact you within the first four weeks of your surgery. They will aim to improve your shoulder movements and function. Contact numbers Ward 7: 01493 452007 Orthopaedic Therapy Office: 01493 453849 2 11
Exercise 5 Reasons for your operation In the shoulder there are tendons that pass under a bony arch (acromion). A tendon can rub on this arch, causing swelling and pain when moving your shoulder. An arthroscopy is a procedure where a tiny camera is inserted into the shoulder area, to investigate the cause of your shoulder pain. A subacromial decompression may be necessary to relieve the symptoms. This involves enlarging the space under the arch, to prevent the pinching and rubbing of the tendons. Move operated hand up towards your face. Return to start position. Exercise 6 Open and close your hand as shown. 10 3
Post-operative advice The wound You will have two to three small puncture wounds which will be closed with small sticking plaster strips. Keep the wounds dry until they are healed, which is normally within eight to 10 days. You can wash or shower with your waterproof dressing straight after your operation but do not submerge under water e.g. bath. After 10 days, you may shower without the dressing. Avoid using spray deodorant, talcum powder or perfumes near or on the wounds until they are healed to reduce the risk of infection. The dressing will normally be removed at your GP practice between 10 and 14 days post-surgery. The sling Exercise 3 Clasp hands together. Use good arm to move your operated arm out, away from body. Return to start position. Exercise 4 Holding a stick/pole with both hands, use your un-operated arm to move the stick out away from the body on operated side. 4 9
Exercise 1 Sleeping It is best to avoid sleeping on the side of your operation. If you choose to lie on the other side, you can rest your arm on pillows placed in front of you. You may find it comfortable to sleep in a more upright position initially. Movement and function You should aim to increase your range of movement immediately after your operation as pain allows. Once full movement has been achieved you may begin to carry out light tasks. It can take from six to nine months to fully recover. With fingers entwined and palms together push away from you as far as pain allows, then return to the start position. Exercise 2 Return to work Discuss with your consultant in the first instance but expect to return to light work at two to four weeks. Heavy lifting and overhead work may require a longer time period. Driving It is best to avoid driving for the first few weeks after your procedure. You must feel comfortable and be able to safely operate the vehicle before returning to driving. Talk with your GP or consultant to discuss this further. It is advisable to contact your insurance company to inform them of your procedure. With fingers entwined and palms together push upwards in front of your chin as far as pain allows, then return to the start position. 8 5
Peripheral Nerve Blocks Some patients will have had a peripheral nerve block during the operation. This may result in reduced feeling and movement in your operated arm and shoulder. This anaesthetic technique is very safe and effective. Serious complications are very rare. Normal side effects of regional anaesthesia include numbness and heaviness in your limb. These symptoms might still be present when you are discharged home. They should resolve within 48 hours, and strength and feeling in your limbs should return to normal. Remember to protect your limb from potential hazards while there is still numbness and weakness (for example hot surfaces). Please call us for advice if you have any concerns regarding your anaesthetic management once you are at home or experience any of the following symptoms within your first week at home. A suspicion of infection around the injection site of the nerve block. Signs include a temperature, localized redness, tenderness, swelling or oozing from the wound site. Any pain or weakness in your arm which did not exist before your surgery and you do not think was caused by your surgery. Persisted numbness or altered sensation in your arm. Any new numbness or weakness in your arm which develops after your discharge home. If you have had a peripheral nerve block and have any queries during the week between 07.00 and 19.00, please contact the Hospital switchboard on 01493 452452 and ask to speak to the Anaesthetist of the Day/Trouble Shooter. Out of hours or at weekends please ask to speak to the Anaesthetist-on-call. Physiotherapy shoulder exercises The shoulder exercises should begin straight away following your procedure. Movement in all directions should be as far as your pain allows. It is important to have a balance between rest and exercising your shoulder. Aim to complete your exercises three to four times daily. It is important that you have adequate pain relief to allow you to complete your exercises effectively so take the analgesia offered to you and tell your nurse, doctor or physiotherapist if your pain is preventing you from completing your exercises. 6 7