Surgery

Prior to Your Admission

Your admission will be coordinated by Michele Gilbert, Alistair’s PA, and the Hospital’s Booking Office including written instructions concerning admission time and starvation details (necessary for General Anaesthesia). It is sometimes necessary for patients to undergo a Pre-Operative Assessment by an Anaesthetist or a Nurse if there are any medical issues needing assessment.

Surgery

Surgery is usually performed on a Monday afternoon or evening, and all operations are undertaken at the BMI Three Shires Hospital with patient accommodation in private rooms. An overnight stay is usual, except for operations undertaken under Local Anaesthetic.

Once you are admitted you can expect a number of visits. The nurse on ward will admit you, the physiotherapist will discuss post-operative exercises, the anaesthetist will discuss the anaesthetic and supplemental Regional Anaesthetic blocks (an effective way of controlling post operative pain), and Alistair too will further review you and check you are marked and consented.

You should take your usual medications e.g. antihypertensive tablets on the morning of surgery with small sip of water.

Please take off any rings from your hands before coming to hospital (helpful tips); if the ring still cannot be removed manually, then it must be cut off – this is service that all good jewellers can offer. The reason for this is that following any surgery to the upper extremity, the swelling is likely to accumulate in the hand and fingers and the blood circulation to the finger tips can be compromised if there is a tight ring present.

After Surgery

Before your discharge from hospital Alistair will review you to discuss the details of your operation and pass on any specific instructions. For many upper limb operations a polysling or a Smartsling is usual and using this can at first seem complicated so the physiotherapists will take some time to show you how to apply and remove this, and also instruct you on some immediate exercises before your definitive post operative physiotherapy commences. The nursing staff will ensure you understand how to manage your wounds and the dressings and that you are discharged with appropriate pain relief.

It is common for the operated arm and sometimes even the hand and chest wall to be swollen and puffy following surgery; this usually last a few days but may last up to a few weeks. There may also be some clear, pink or even red fluid coming from the surgical wounds, this is not infection or bleeding and merely represent some of the fluid pumped around the shoulder during surgery making its way out. Fluid discharge is most common from the surgical wound at the front.

As soon after surgery as possible you should start to ice the operated area; in the case of the shoulder a Iceband is something Alistair recommends (this is a contoured shoulder ice pack which is offered to all patients for purchase by the hospital physiotherapists.

Wound care

To minimise the risk of infection, your wounds should be kept dry for at least ten days. The dressings applied immediately following surgery are sterile and do not need to be changed at all unless they become wet (if they have lost their adhesion to the skin they may well be changed before discharge). Although mostly waterproof dressings are used, experience suggests they are not 100% waterproof and therefore it is best to avoid directly showering on the wounds. Consider protecting the wounds with a large piece of cling film. For shoulder surgery there is usually one deep dissolvable stitch per keyhole wound, and this is reinforced with steristrips (sometimes also known as ‘butterfly’ stitches) over the top – these steristrips can be peeled off after 12-14 days (easiest after a shower or bath). For other operations there is often a non-dissolvable stitch (recognised by its blue colour) which will normally be removed at your first follow up appointment, with or without steristrips.

Follow up

Physiotherapy and/or Hand Therapy frequently form an important part of you rehabilitation and arrangements will usually made for these to commence at an appropriate interval after surgery (with your therapist receiving written instructions from Alistair about the details of your operation). Whilst Physiotherapy is almost always covered by medical insurance, the total number of sessions may be limited; regrettably not all insurers cover Hand Therapy though. It is important therefore to be aware of any such restrictions in advance of your operation.

Alistair will always be available on his mobile out of hours should there be any post-operative problems with which the ward staff or duty hospital doctor are unable to help.

Recovery

The time required for recovery following surgery will vary from person to person and depend on the severity of the condition and the surgery performed. The period of time which you need to wear the sling after surgery will also vary, but the times below offer a rough guide for those undergoing shoulder surgery.

Condition

Period of immobilisation in sling

Frozen shoulder release 24 hours or so (if arm still numb from the regional anaesthetic)
Subacromial decompression Comfort only (usually 2-5 days)
Decompression with AC joint excision Comfort only (usually 5-7 days)
Rotator cuff repair 3 to 4 weeks, rarely 6 weeks
SLAP /labral repair 2 to 3 weeks
Stabilisation 3 to 6 weeks
Acromioclavicular joint repair 6 weeks
Shoulder replacement 3 weeks
Humeral fracture fixation 4 to 6 weeks
Clavicle fracture fixation 4 to 6 weeks

Driving after Surgery

You should not drive until your arm is out of the sling and your pain has subsided to the extent that you are not taking regular pain killers, specifically you should have ceased taking Co-codamol or Tramadol. Additionally you should be able to place your hands on the steering wheel between 3 and 9 o’clock positions, and be able to safely swerve to avoid danger. Above all, you need to feel confident in your own ability to drive; if you feel that your ability to drive has been affected, you are required by law to contact the DVLA.

Returning to Work

The period of time off work will depend on your condition and the type of work that you do. Generally, most patients can usually return to work within 2-3 weeks doing a ‘low demand’ type of work. There will still be restrictions on lifting and overhead use, hence why those with higher demand jobs or repetitive arm use usually need at least 6 weeks off (and at least 3 months before returning to work after a rotator cuff repair).

Returning to Sports

This is very dependent on the specifics of the surgery, and Alistair will endeavour to give you some idea of this during your consultation, but sometimes there are unexpected findings during surgery which may alter the time to return to sports. You will work closely with your physiotherapist too and once certain milestones are reached, in terms of range of motion etc, then sports specific rehabilitation will commence with a progressive return to your sporting activities.

Treatment Areas

ShoulderElbowWristHand