Dislocation > Treatments
Arthroscopic Reconstructive Surgery
Preparing for Surgery
The decisions you make
and the actions you take before surgery can be as important
as the procedure itself in giving you the best possibility
of a healthy recovery.
to your return home from the hospital, make sure that
you have received any equipment you will need when you
get home from the hospital. This may include a shoulder
sling, ice packs or coolers, or physical therapy equipment.
You should receive prescriptions for any of these from
your doctor before you go home from the hospital.
the potential risks and benefits of the surgery by asking
your surgeon any questions that will help you better
understand the procedure. It can also help to talk to
someone else who has undergone the same surgery.
physical problems or changes in your overall health,
such as a fever or infection, should be reported to
your surgeon, and you should notify your surgeon of
any new medications you are taking.
a second opinion from another surgeon who is as qualified
as the surgeon who gave the initial diagnosis is often
sure your orthopedic surgeon is board-certified. This
can be determined by calling the American Board of Orthopaedic
Surgery at 919-929-7103.
At most medical centers, you will
go to "patient admissions" to check in for
your arthroscopic shoulder reconstruction. There may
be separate areas for ambulatory outpatients (patients
who go home the same day after surgery) and for overnight
inpatient surgery check-in, so be sure to ask your doctor
or one of his assistants about this. After you have
checked in to the hospital, you will go to a holding
area where the final preparations are made. The mandatory
paperwork is completed, and your shoulder area may be
shaved, though this is not always necessary). You will
be asked to change into a hospital gown and remove,
if applicable, your watch, glasses, dentures, and jewelry.
You will have the opportunity to speak with your orthopedic
surgeon or one of his assistants and meet the anesthesiologist
or nurse anesthetist (a nurse who has done graduate
training to provide anesthesia under the supervision
of an anesthesiologist). Then, you will walk or ride
on a stretcher to the operating room. Unless requested,
most patients are not sedated until they go into the
operating room. Here are some important things to remember
for the day of your surgery:
will probably be told not to eat or drink anything after
midnight on the night before your surgery. In general,
you should not eat for eight hours before surgery. This
will reduce the risk of vomiting while you are under
the anesthetic and pain medications may make you drowsy
and you will be unable to drive, arrange for someone
to help take you out of the hospital and drive you home
when you are released.
a soft, large, and comfortable shirt that will fit over
your dressing, arm, shoulder and sling.
it easy. Keeping a good frame of mind can help ease
any nerves or anxiety about undergoing surgery. Distractions
such as reading, watching television, chatting with
visitors, or talking on the telephone can also help.
Prior to arthroscopic reconstructive
surgery on your shoulder, you will be given either regional
or general anesthesia. An arthroscope (a tiny camera
about 3 1/2 millimeters in diameter) is inserted into
your shoulder, which provides images on television monitors
so the surgeon can see the inside of your shoulder join
and all of its parts, including the shoulder joint surfaces,
capsule, labrum, and ligaments.
instruments are inserted through two to four small incisions
that are about one centimeter long.
torn labrum and ligaments in the shoulder joint are
reattached to the shoulder socket (glenoid) with sutures.
Occasionally, the stretched out capsule is tightened
up with a heating probe. These steps tighten the shoulder
and hold the upper arm bone in the socket.
tears in the protective joint lining (labrum) can also
be smoothed or sewn together.
small incisions are closed with stitches.
surgery, you will be taken to the recovery room.
When you awaken in the recovery room
following arthroscopic reconstruction, your shoulder
usually will be bandaged, immobilized in a sling, and
covered with an ice pack. You may feel a moderate amount
of pain, depending on the extent of your operation.
You usually stay in the recovery room for one to two
hours. General anesthesia wears off in about an hour
and regional anesthesia may take about two hours to
wear off. You will be given adequate pain medicine,
either orally or through an IV (intravenous) line, as
well as instructions for what to do over the next couple
of days. In addition, you will be given an appointment
to return and a prescription for oral pain medicine.
You should try to move your fingers and wrist while
you are in the recovery room to improve circulation.
Your shoulder and upper extremity will be in a sling,
and you should refrain from moving your shoulder. Your
temperature, blood pressure, and heartbeat will be monitored
by a nurse, who, with the assistance of the doctor,
will determine when you are ready to leave the hospital
or, if necessary, be admitted for an overnight stay.
The majority of patients leave the hospital after two
or three hours. As soon as you are fully awakened, you
are usually allowed to go home. You will be unable to
drive a car, so be sure to have arranged a ride home.
arthroscopic reconstruction of an unstable shoulder,
you will need to take steps to reduce the pain and inflammation
in the shoulder. Rest, icing, and anti-inflammatory
painkillers, such as ibuprofen or aspirin can ease pain
and swelling, and immobilizing the shoulder will allow
the reconstruction to heal. Here is what you can expect
and how you can cope with a sling immobilizing your
first concern is to monitor swelling for the first 48
hours while wearing your sling. Physicians generally
prescribe ice packs to be applied as much as possible
during the first few days after surgery to decrease
pain and swelling.
should wear the sling as prescribed by your orthopedic
surgeon. Physicians generally recommend wearing the
sling at all times except for daily hygiene for between
two and eight weeks. Almost all shoulder reconstructions
heal better when the shoulder is immobilized for a period
can usually remove the gauze bandage and shower after
a few days. You can remove the sling for brief periods
to shower, but remember to avoid moving the shoulder.
bleeding and fluid drainage is normal for the first
two days. Call your physician if bleeding continues.
are usually removed about two weeks after surgery.
your shoulder starts to heal, your physician may recommend
that you remove the sling for short periods to perform
some light, early-motion exercises.
should move your fingers and hands in the sling as much
as possible to help circulate blood.
you develop a rash or irritated skin around your sling,
call your physician.
you notice any abnormal wear or discomfort in the sling,
contact your physician as early as possible. In general,
do not try to "grin and bear it" if discomfort
does not go away within a few days. The sling should
not irritate your skin.
Rehabilitation can usually begin within a few weeks
after surgery, but you should visit your physician a
week or two after surgery for a routine check-up. Until
cleared by your physician, you should keep the shoulder
immobilized in the sling. The sling may make it difficult
to use the hand of the injured shoulder. Some people
may need to take about six weeks off from work after
a shoulder dislocation, depending on how much they rely
on the immobilized arm.
After about two or three weeks of
immobilization, your physician usually refers you to
a physical therapist to begin rehabilitation exercises.
Successful rehab may take between four and six months
to complete. The first stage of physical therapy usually
involves passive motion exercises with the assistance
of your physical therapist. Most patients begin with
forward motion in the shoulder. Because your arm has
been held across your chest for weeks, rotating or turning
the shoulder outward may be painful will be difficult
when rehabiltation begins. Most patients cannot externally
rotate their shoulders further than 30 degrees. With
the shoulder held in place, you usually begin strengthening
your wrist and elbow by flexing and extending your hand
and arm. After two to four weeks, you may be able to
start moving your hand, arm, and shoulder with the assistance
of the therapist. Usually within eight weeks, your therapist
can start adding resistance to your exercises with weights
or elastic bands. After eight weeks, many patients can
rotate their shoulders outward with little pain and
rotator cuff strengthening exercises can begin. The
four muscles in the rotator cuff generally should be
made stronger than they were before the injury to properly
support and stabilize your shoulder. When your rotator
cuff muscles are strong enough to withstand stress,
rehabilitation tends to become more activity oriented.
Sport-specific exercises and coordination drills help
prepare you to return to sports and activities. Non-contact
sports, like tennis and swimming, can often be resumed
within four months. Contact sports should usually not
be resumed until at least six months after reconstructive
surgery for a shoulder dislocation. Your physician may
prescribe a modification to the above regimen to suit
your specific situation.
The best way to prevent multiple shoulder
dislocations is to make the shoulder strengthening exercises
you learned in rehabilitation part of your everyday
routine. After you suffer an initial dislocation, your
shoulder may be more vulnerable to instability. The
natural integrity of the socket may not be strong enough
to withstand the force of contact sports or repeated
overhead motion. You may have to rely much more on the
muscles in the rotator cuff (supraspinatus, infraspinatus,
subscapularis, and the teres minor), lower neck, and
upper back to hold your shoulder in place. Remember
to warm up your shoulders before physical exercise by
rotating your arms in different directions. Depending
on the severity of your dislocation and the success
of your rehabilitation program, your physician may recommend
that you avoid contact sports or risky, high-speed activities.
In general, your shoulder can become healthy and stable
after a dislocation, but you may need to be cautious
of activities that could result in accidental collisions
or falls. You should wear shoulder pads during contact
sports. Your physician can recommend the best types
of protective gear for your shoulders.
| Treatment Introduction
Shoulder dislocations can disrupt
or tear the soft tissues stabilizing your shoulder.
The soft tissues that connect the upper arm bone (humerus)
to the shoulder socket (glenoid), are injured during
a dislocation. These soft tissues include the capsule
(labrum) and ligaments of the shoulder. The labrum is
a special type of soft tissue that lines the rim of
the upper arm bone and helps to prevent dislocation
of the humeral head out of the shoulder socket. A dislocated
shoulder is an emergency and should be put back in place
(reduced) as soon as possible. The longer the delay,
the more difficult it is to reduce the dislocated shoulder.
As soon as a dislocated shoulder is diagnosed, a physician
will reduce your dislocated shoulder. If the dislocated
shoulder is complicated, an orthopedic surgeon will
be called to evaluate and treat you. In any case, you
will be referred to an orthopedic surgeon for further
evaluation and treatment. If non-operative treatment
is unsuccessful and your shoulder is unstable, your
orthopedic surgeon may suggest arthroscopic or open
surgical reconstruction to stabilize your shoulder,
especially if your shoulder dislocates again. The decision
to operate or not operate for instability after a shoulder
dislocation is often difficult. There is a high risk
of recurrent dislocation without surgery in some patients,
particularly in young, active patients or high-energy
dislocations. You and your surgeon may decide that the
risk of repeat dislocation is so high that you would
benefit more from operative treatment to stabilize your
shoulder sooner rather than later. Once the shoulder
is put back in socket, the surgery to stabilize your
shoulder is rarely urgent. It may be done a few days
after a dislocation or much later.