Arthroscopic Shoulder Surgery
Arthroscopic shoulder surgery (also called microsurgery) is performed on the shoulder for a variety reasons,
among the most common is repair and/or decompression of the supraspinatus or rotator cuff (rotocuff) tendon of
the shoulder. It is also used to remove an arthritic end of the collarbone, or repair a dislocating shoulder.
Pre Surgery Preparation
A complete health assessment and patient profile is given to an anesthesiologist, who is a doctor of medicine
experienced in matching the proper anesthetic and dosage to the patient.
Patients are encouraged to fill prescriptions for pain and other medications on or before the day of their surgery, as
pain following arthroscopic surgery can be moderate. Pain medication is prescribed by
Dr. Sanders and administered to the patient in the operating room.
Medication
Medications that may be prescribed include a mild to moderate narcotic analgesic (Class 3 medication), and
strong narcotic analgesics (Class 2 medication) that are generally not necessary for arthroscopic surgery of the
shoulder but occasionally prescribed. Patients are urged to take the prescribed medications as directed, usually
not more than one to two pills every three to four hours.
Most of the Class 3 medications are a combination of Hydrocodone (an effective pain relief medication and NOT a
form of "Codeine") and Acetaminophen (the active ingredient in Tylenol). These medicines frequently cause side
effects such as nausea and/or constipation. Phenergan is prescribed to help with nausea. Taking two Tylenol every four hours is a good alternative.
And Tylenol PM (a preparation that includes Benedryl) is encouraged over other medications late post surgery in
the event of sleep disturbance, which is common after such procedures.
Ambien, which is also prescribed, is a stronger sleep aid.
Post Operative Care
Rehydration
Too often patients come in for surgery, particularly out patient surgery, having had very little to drink
and subsequently become dehydrated following the surgery. It is important that patients rehydrate following a
surgical procedure – consuming sufficient quantities of water and a sports aid drink containing sugar and
electrolytes. Proper hydration is key for the body, particularly one in recovery.
Dressing
Since the wound is not sutured to allow for any excess water used in the arthroscopy to drain, surgical dressing
may appear bloody early post-surgery. This is not a cause for concern. The small amount of blood combined with
the large amount of water used produces the red color of fresh blood - though it is not. Simply reinforce the
dressing should it become saturated.
A Cryo/Cuff® is placed over the dressing, delivering cold therapy as well
as compression. With the exception of showering, it should remain on for one complete week.
Avoiding Infection
During surgery, antibiotics are administered by vein to prevent the risk of infection. No other antibiotics are
needed, but patients are encouraged to follow all instructions regarding the care of their wound and monitor it
closely to further reduce the risk of infection.
The day after surgery the patient may remove the compression stocking and shower. The cuts should be washed with a 50/50 mixture of Hibiclens® (4% Chlorhexadine Gluconate) and water and used as soap. Following the shower and whenever the dressing is changed, the incision should be dressed with triple antibiotic ointment and fresh gauze. The compression stocking is then reapplied and worn for ten days. During this time no baths are allowed, only showers.
If a portion of the surgery was performed through an open incision, the wound may be closed with nylon sutures. The sutures should be left in for three weeks or until determined by Dr. Sanders. Occasionally, there is a small amount of drainage from the wound - a normal
bodily response and NOT an infection.
Regaining Mobility
Following shoulder surgery, postoperative stiffness is a serious - though entirely preventable - complication.
Movement is key to avoiding this complication.
Subacromial decompression, and/or an excision of the distal clavicle
For patients who have had a subacromial decompression, and/or an excision of the distal clavicle, the sling
may be discarded upon arrival home or on the first postoperative day. He or she may start using the shoulder as if
a simple sprain or strain. Patients then begin Codman exercises the first postoperative day. These are done by
removing the arm from the sling and resting the elbow straight. The torso must be bent forward and nearly parallel
to the floor (bending maximally at the hips and lumbar spine). When this is achieved, the arm hangs perpendicularly
(at right angles) to the floor. The patient makes small then increasingly larger circles with their arms. This mobilizes
the shoulder and prevents stiffness. In another exercise, a patient places a broomstick in their hands and use the
opposite side to help raise the operated side such that your arm is over your head, like a child raising his hand in
class. Then you should bring the arm down and then repeat 10 times. This should be done 6 times per day. After a few
days, you should perform this exercise without the broomstick. Dr. Sanders or your Trainer
will instruct you in the remainder of the exercises. The patient returns for their first postoperative visit one week
following the procedure, where Dr. Sanders evaluates the progress and recommends a course of shoulder exercises with a
Thera-Band®
to strengthen shoulder flexors, abductors, external rotators, and internal rotators. The use of the Theraband is also
emphasized in order stretch into internal rotation. Other exercises with hand weights help strengthen the scapula
rotators. Three sets of 12 repetitions of each exercise are necessary each day. These exercises should be done regularly
for at least one year.
Surgery for Shoulder Instability or SLAP Lesion
During a healing period of six weeks, patients undergoing procedures for a shoulder instability should generally keep the arm at the side in a sling. The sling should be worn at all times except for showering, during which time the arm can be moved away from the body just enough to wash the arm pit. Over the past few years we have learned that, unlike the knee, the ligamentous structures of the shoulder heal best with six weeks of immobilization. After that time motion is begun, first passively and then actively. Strengthening is begun at three months and return to sports can occur as early as four months.
Rotator Cuff and/or Biceps Tenodesis
Similar to issues of shoulder instability, the most up to date research indicates that, because of the special nature of the rotator cuff tendons' insertion into the humerus, immobilization of the shoulder in a sling is the best way to manage the repaired rotator cuff. Following six weeks, passive exercises leading up to active exercises are begun. Return to sports is reasonable at four months, though specific exercises must continue. Improvement in strength and range of motion will continue during the entire first year.
