Shoulder > Shoulder Dislocation > Treatments

    Open 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.

   Prior 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.

   Learn 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.

   Any 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.

   Getting a second opinion from another surgeon who is as qualified as the surgeon who gave the initial diagnosis is often advisable.

   Make sure your orthopedic surgeon is board-certified. This can be determined by calling the American Board of Orthopaedic Surgery at 919-929-7103.

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At most medical centers, you will go to "patient admissions" to check in for your open shoulder reconstruction. Your surgery is probably going to require an overnight stay, so be sure to ask your doctor if there is a separate department for checking in to the hospital. After you have checked in to the hospital or clinic, you will go to a holding area where the final preparations are made. The paperwork is completed and your shoulder area may be shaved (this is not always necessary). You will wear a hospital gown and remove all of your jewelry. You will meet the anesthesiologist or 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. Most patients are not sedated until they go into the operating room. Here are some important steps to remember for the day of your surgery:

   You will probably be told not to eat or drink anything after midnight on the night before your surgery. This will reduce the risk of vomiting while you are under general anesthesia.

   Because 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.

   Wear a soft, comfortable shirt that will not irritate your skin when worn under a shoulder sling.

   Take 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.

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Open reconstructive surgery on the shoulder typically takes about two to three hours. You are usually given general anesthesia, but some patients are given a regional anesthesia shot above the collarbone called an interscalene block.

   A three- to five-inch incision is made in the skin creases rising up the front of the arm from the armpit. Surgeons typically use drills and suture anchors or tacks to perform the procedure.

   The torn labrum and ligaments in the shoulder joint are reattached to the shoulder socket (glenoid) with sutures, suture anchors, and/or tacks. Usually, the stretched out capsule is tightened up. These steps tighten the shoulder and hold the upper arm bone in the socket.

   Your wound will be closed with sutures for the deep layers and staples or sutures for the skin layer before a sterile dressing and arm sling are applied.

   After surgery, you will be taken to the recovery room.

When you awaken in the recovery room following open 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 the extent of your operation. You usually stay in the recovery room for one to two hours while the anesthetic wears off. General anesthesia wears off in about an hour and regional anesthesia may take about two hours to wear off. 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.

Post-op in Hospital

After an open shoulder reconstruction, some patients remain overnight in the hospital and go home in one or two days. It is normal to have some pain after surgery, and you will be given pain medications as needed. Be sure to ask for medications as soon as you feel pain coming on, because pain medication works best on pain that is building rather than on pain that is already present. The nurses will not give you more than your doctor has prescribed and what is considered to be safe. Ice also helps control pain and swelling. Physicians generally suggest that you immobilize your shoulder in a sling for about six to eight weeks. You will be taught how remove the sling and bend your elbow if necessary. In addition, you will be given an appointment to return and a prescription for pain medicine. You will not be able to drive, so be sure to have arranged for a ride home.

After open reconstruction of a 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 shoulder:

   The 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.

   There may be some minor drainage on the bandage since fluid may have accumulated during the surgery. Expect some blood to show through the bandage during the first 24 to 48 hours. Call your physician if bleeding continues.

   You 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 dislocations reconstructions heal better when the shoulder is immobilized for a period of time.

   You 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.

   Stitches are usually removed about two weeks after surgery.

   When your shoulder starts to heal, your physician may recommend that you remove the sling for short periods to perform some light, early-motion exercises.

   You should move your fingers and hands in the sling as much as possible to help circulate blood.

   If you develop a rash or irritated skin around your sling, call your physician.

   If 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 one two weeks 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.

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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 and 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. Depending on your specific situation your physician may prescribe a modification to the above regimen.

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   Shoulder injury rehabilitation exercises: Shoulder dislocation

The best way to prevent multiple shoulder dislocations is to make the shoulder strengthening exercises you learned in rehab 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. The best way to prevent multiple shoulder dislocations is to make the shoulder strengthening exercises you learned in rehabilitation part of your everyday routine.

Shoulder dislocations can disrupt or tear the soft-tissue structures that stabilize 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 glenoid and helps to prevent dislocation of the humeral head out of the shoulder socket. The most common type of surgery for repairing shoulder ligaments after a dislocation is an open, or, in some cases, arthroscopic procedure called a Bankart Repair. Most patients who undergo open surgery have failed non-operative treatment for a period of weeks or months.