Separation > Treatments
After a separation, torn ligaments
often are repaired with an open reconstruction procedure.
Patients who undergo open surgery often have tried non-operative
treatment for a period of weeks or months, but have
been unable to stabilize the shoulder. The decisions
you make and the actions you take before surgery can
be every bit as important as the procedure itself in
ensuring a healthy recovery.
sure 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 heating pads. You should
receive prescriptions for any of these from your doctor
when your surgery is scheduled.
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, such as a fever or infection, should
be reported to your surgeon, and you should notify your
surgeon of any medication you are taking.
use of any anti-inflammatory medicine, especially aspirin,
a week prior to surgery, to prevent excessive bleeding
during the surgical procedure.
a second opinion is advisable, particularly in rare
or unique cases.
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 physician 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. You are instructed
to not eat anything for eight hours prior to surgery.
This will reduce the risk of vomiting while you are
under general anesthesia.
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.
Reconstructive shoulder surgery typically
takes about two hours. Torn ligaments need to be sewn
together and your collarbone may need to be repositioned
in the AC joint. You are usually given general anesthesia,
but some patients are given a regional anesthesia, called
an interscalene block, injected above the collarbone.
two-inch incision is made over the bony bump on the
top of your shoulder.
ligaments around the acromioclavicular (AC) joint are
reattached with sutures. Sewing the ligaments back into
proper position helps tighten the shoulder and hold
the collarbone in place.
screw or heavy sutures may be needed to hold your collarbone
in place while the ligaments heal.
incision is stitched up and you are taken to the recovery
When you awaken in the recovery room
following open reconstruction, your shoulder usually
is wrapped in gauze, immobilized in a sling, and covered
with an ice pack. You may feel a moderate amount of
pain, depending on the severity of the separation, and
you will receive pain medication through an IV (intravenous)
line. You usually stay in the recovery room for at least
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 while you are in the recovery room
to improve circulation. Moving your wrist may be painful
and you usually should not try to move your elbow. 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 open shoulder reconstruction,
some patients remain in the hospital for as long as
24 hours. There will likely be pain, and you can expect
to be given pain medication as needed. Be sure to ask
for medication as soon as you feel pain coming on, as
pain medication works best on pain that is building
rather than 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 perform gentle range of motion exercises. In addition,
you will be given an appointment to return and a prescription
for pain medicine. Screws and heavy sutures usually
are removed within six months after surgery, which requires
a return visit to your surgeon. You will not be able
to drive, so be sure to have arranged for a ride home.
open reconstruction of a shoulder separation, 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 immobilizing the shoulder will keep it stabilized.
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 for 20 minutes at
a time, three or four times a day.
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.
generally recommend that you wear the sling day and
night for between two and four weeks. Almost all shoulder
separations heal better when the shoulder is immobilized.
can usually remove the gauze bandage and bathe regularly
after about seven days. Call your physician if bleeding
continues. You can remove the sling for brief periods
to shower, but remember to avoid moving the injured
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.
Rehabilitation can usually begin within a few weeks
after surgery, but you should visit your physician a
week after the injury for a 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 surgery,
depending on how much they rely on the immobilized hand.
After about one to three weeks of
immobilization and gentle range of motion exercises,
your physician usually refers you to a physical therapist
to begin specific shoulder rehabilitation exercises.
A typical physical therapy schedule progresses as follows:
one – Begin pendulum exercises, swinging your
arm in pendulum-like motions with the assistance of
your physical therapist. You may continue wearing the
sling to rest your shoulder after exercise.
two to six – Light resistance exercises, moving
your arm up to shoulder height and rotating your arm
while pulling against elastic bands.
six to 12 – Add more resistance and weight training,
lifting your arm above your head. Work to strengthen
rotator cuff, chest, and back muscles.
Most patients can return to sports and activities in
four to six months if they remain dedicated to physical
The best way to prevent a repeat shoulder
separation is to make the shoulder strengthening exercises
you learned in physical therapy part of your everyday
routine. Rotator cuff strengthening helps reduce the
risk of overuse problems during athletic or work activities
that require repetitive overhead motions. You should
wear shoulder pads during contact sports and try to
avoid activities like tackling if possible. In some
cases, your physician may prescribe shoulder braces
that are designed to help prevent your shoulder from
moving out and back. These braces can help decrease
stress on the shoulder ligaments. Having an athletic
trainer tape your shoulder may also help to hold it
in position. However, braces and taping should never
be used as a substitute for strong and flexible muscles.
Be sure to warm up before activities by rotating your
arms and shoulders in different directions. After a
shoulder separation, you should be careful to notice
any pain or discomfort in your shoulder during athletics.
Avoid playing through shoulder pain. The more often
you separate your shoulder, the weaker the ligaments
become, and the greater your risk of developing complications
such as arthritis.
Patients with Type 3-6 shoulder separations
who need to return to vigorous activities may need to
undergo surgical rather than non-operative treatment.
Shoulder separations can disrupt or tear the main ligaments
stabilizing the AC (acromioclavicular) joint between
your collarbone and shoulder blade. After a separation,
torn ligaments often are repaired with an open reconstruction
procedure. Patients who undergo open surgery often have
tried non-operative treatment for a period of weeks
or months, but have been unable to stabilize the shoulder.