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.
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.
to ask the doctor
to take to the hospital
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:
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
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, comfortable shirt that will not irritate your
skin when worn under a shoulder 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.
to take to the hospital
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.
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.
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.
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.
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
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:
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.
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.
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.
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.
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 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.
to call the doctor after surgery
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.
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
| Treatment Introduction
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.