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Once one has decided to proceed with surgery, the next step is to agree a date for the operation with the practice manager. A procedure code can be obtained at this time for insured patients, who would then seek appropriate approval from the insurance team. Self paying patients may wish to obtain quotes from the hospital and the practice manager can facilitate this. NHS patients would usually be contacted by the waiting list officer.
Preoperative assessment is usually carried out by nurses to assess one’s fitness for the anaesthetic. This involves questions about one’s health and usually includes swabs. Such assessment may also include blood tests, ECG, X-rays and specialist medical / anaesthesiologist consultations.
Rings and bangles should be removed before surgery. If they don't come off easily, try using soapy water. Occasionally one may have to visit the jewellers, who would be able to cut them before surgery. On the day of surgery it is advised to not have anything to eat for 6 hours before the surgery. Chewing gum, milk and all cloudy / fizzy drinks count as solid food! Small amount of still water is allowed up to 2 hours before the operation.
One of the key changes seen in modern medical practice is shared decision making. Surgeons would be happy to discuss all aspects of surgical care including alternatives to surgery, benefits, risks and recovery times. In fact, for non-emergency operations, it is imperative for patients to take time to consider all aspects of surgical care and be convinced about the appropriateness of surgery before proceeding. Such information exchange and decision making starts at the time of the initial consultation and is an ongoing process through the patient’s journey. It is normal for patients to feel anxious about surgery. However, it is never too late to ask something, nor a question too trivial to ask even on the day of surgery.
After day surgery, it is mandatory that an adult accompanies the patient back and stays with the patient for the first night. Driving is not allowed after an anaesthetic and hence suitable arrangements are to be made in advance for this. Do think about which clothes to bring as you would have a sling around the arm and dressings over the shoulder after surgery. If you have had a nerve block for pain management, you would not be able to move your arm till it wears off. Hence, be prepared to not be able to use this arm during this period.
Successful outcomes from shoulder operations frequently need the involvement of a physiotherapist after surgery. It is good to book an appointment with a physiotherapist between a week to 10 days after surgery, although this duration may vary amongst different setups and medical practices.
Before your Surgery
Once your surgeon has discussed surgery with you and you have agreed the procedure, you may want to run through this checklist . If you are comfortable and confident with the surgeon and the benefits and risks of the surgery you can arrange a date for the operation.
Once a date for your surgery has been agreed, you will be contacted by the hospital for a pre-operative assessment. This may be done by telephone or in person. The nurse who does this with you will also be able to answer any other questions you might have.
You will need to have MRSA screening performed prior to admission. If you live near the hospital it can be done at the hospital, but if you are not local it can be arranged by your GP.
Your surgeon will discuss the benefits, risks, potential complications and the recovery with you. You should also be made aware of alternative treatment options, if applicable. It is important that you ask any questions at this stage and discuss any concerns. You will be asked to sign a Consent Form, which documents the consent process.
If you are having a general anaesthetic or sedation you will need to be driven home and should not drive for 24hours after treatment. You will also need someone to stay with you overnight after the surgery.
After the Surgery:
When you wake up following the procedure you will be wearing a sling.
The type of sling may vary depending on the type of procedure undertaken.
Your surgeon should have discussed this with you prior to the operation, so that you know how to cope with it. Depending on the surgery and surgeon's preferences the sling may be needed for a few days to about six weeks.
Again, this will have been made clear to you prior to the surgery.
Generally, for surgical repairs the sling is required for 3 to 6 weeks, depending on surgeon preference. You can find more details in the rehabilitation section on Bone2date including information on Living with a Shoulder Sling
You may be in hospital overnight after your operation, so please bring overnight wear and toiletries. If you are having day-case surgery you should be able to go home about 4 hours after the surgery. A physiotherapist will see you in hospital to teach you the appropriate exercises.
You will need physiotherapy after the surgery and should return to your own therapist.
The surgery may be done by keyhole (arthroscopic) or open approaches.
The keyhole operation is usually done through two or three 5mm puncture wounds. There will be no stitches only small sticking plaster strips over the wounds. These should be kept dry until healed. This usually takes 5 to 7 days. You may shower with waterproof plasters (eg. Tegaderm) in the meantime. You may need to get these from a pharmacy if the hospital cannot provide them.
The open procedure is usually closed with a dissolvable stitch. If there is an exposed stitch it can be trimmed at 2-3 weeks. This can be done at your follow-up appointment or by your GP. Keep the wound dry until it is well healed. This usually takes 2 weeks. As above, you may wash with waterproof plasters.
Sleeping can be uncomfortable for the first few weeks, particularly if you try and lie on the operated arm. We recommend that you lie on your back or on the opposite side, as you prefer. Ordinary pillows can be used to give you comfort and support. If you are lying on your side one pillow slightly folded under your neck gives enough support for most people. A pillow folded in half supports the arm in front and a pillow tucked along your back helps to prevent you rolling onto the operated shoulder during the night. If you are lying on your back, tie a pillow tightly in the middle (a "butterfly pillow") or use a folded pillow to support your neck. Place a folded pillow under the elbow of the operated arm to support that.
First twelve weeks after surgery
An appointment will be made for you to see the surgeon or specialist therapist 2-6 weeks post-operatively. This may be sent by post or given to you on discharge from hospital. Please remember to ensure you have post-operative physiotherapy arranged.
For the first few weeks all activities of daily living for example feeding, dressing, cooking etc may be difficult using your un-operated arm. Be guided by your physiotherapist and surgeon. If appropriate an occupational therapist can be available to give you advice on how to do this.
Your physiotherapist and surgeon will advise you when it is safe to resume your leisure activities . This will vary according to your operation, sport and level, as well as the period required to retrain your shoulder muscles with physiotherapy. For more details of our guidelines, please see the relevant rehabilitation page or your particular operation.
Below is a rough guide for patients requiring a sling for 3-6 weeks:
6 weeks: Swimming
6-12 weeks: Golf, Non-contact sports
12+ weeks: Contact Sport ; Includes horse riding, rugby, football, martial arts, racquet sports, and rock climbing
Driving and return to work
This again will vary according to your operation, sport and level, as well as the period required to retrain your shoulder muscles with physiotherapy. For more details of our guidelines, please see the relevant rehabilitation protocol for your particular operation.
One of the commonest concerns of patients undergoing shoulder surgery is when they will be able to return to driving their vehicles. On this site and in our information books we provide guidelines for returning to driving. These are based on the time period when you should be able to safely actively move your shoulder without assistance without damaging the surgical repair or causing yourself or others injury due to lack of control.
It is a requirement in the UK that a driver uses both arms to control the steering wheel. To be able to do this the driver requires sufficient strength, pain relief and mobility.
It is the responsibility of the driver to ensure that he/she is in control of the vehicle at all times and to be able to demonstrate that is so, if stopped by the police.
Drivers should check with their therapist, surgeon and their insurance policy before returning to drive after surgery, particularly if you intend to return earlier than the recommended period provided by your surgeon.
Drivers do not need to notify DVLA unless the medical conditions likely to affect safe driving persist for longer than 3 months after the date of surgery.
Drivers must not drive under the influence of narcotic medications or within 48 hours after an anaesthetic.
Returning to Work
This will depend upon the size of your tear and your occupation. You will need to discuss this with your surgeon.