Why shoulder surgery?
- There are various reasons why you may have shoulder surgery including:
- Rotator cuff tears
- Shoulder instability
- Fractures
- Cartilage damage
- Arthritis
- Recalcitrant tendinopathy
- Chronic shoulder impingement with a demonstrated structural cause
The most common shoulder surgery is rotator cuff repair.
Anatomy
The shoulder is a highly mobile ball and socket joint. The humerus articulates with a shallow socket and cartilage rim (labrum) located on the shoulder blade. The stability of this joint is largely provided by the muscles of the rotator cuff (supraspinatus, infraspinatus, subscapularis, and teres minor). These muscles arise from the shoulder blade and attach around the head of the humerus in a cuff like manner, thus the name rotator cuff. Each of these muscles has a different function such that when they act together the shoulder is stable and functions optimally.
Post surgery
After your surgery it is expected that you will have pain and swelling, however, it is important that you manage this pain so you can engage in your rehabilitation. You will be provided with pain relief and directed on how best to use this; if it is not adequate to manage your pain or you are experiencing adverse reactions to the medication consult your surgeon or GP. You can also ice the area to help with pain and swelling; if you are icing frequently you may find a cryo cuff to be beneficial.
Restrictions
Your surgeon will advise you on what you should and shouldn’t do after your surgery, this will be individual to you as it will depend on the structures that have been repaired, and you may be required to wear a sling for up to six weeks. These restrictions protect the repair until it is strong enough to tolerate low levels of active loading.
Returning to activities such as driving typically takes 6-12 weeks, but you must seek clearance from your surgeon and check with your insurer. Returning to sport will depend on the physical requirements of the sport and may take anywhere between 4 and 12 months.
Physiotherapy
You should be provided with exercises before you leave the hospital that will likely include:
- Passive movement exercises
- Neck stretches
- Scapular setting exercises
- Hand, wrist and elbow exercises
The aim of these exercises is to prevent capsular restriction, manage pain, and maintain upper limb strength and control for optimal and early rehabilitation.
When you first see your physiotherapist after leaving the hospital you should expect to discuss:
- How you are recovering and coping, including sleep patterns and pain management over a 24 hour period
- Your pre-surgery functional capacity and rehabilitation goals
- Specific advice the surgeon may have given you
- They may also ask you to fill out some questionnaires so that they can track your progress against them as well as measures such as range of movement and strength
Initial assessment will include:
- Measuring your passive range of movement, swelling and strength if appropriate
- Checking your exercises and how they impact your pain
Treatment may include:
- Manual therapy, such as massage, for management of pain and swelling
- Progression of your exercises, although this will be dependent on meeting milestones, healing time frames, range of movement, pain, and neuromuscular control.
- Expect to gradually progress through passive, assisted and active exercises until your functional goals are met
Author: Sascha Wise, Physiotherapist (B. Biotech, B. Physio)