‍Shoulder Therapeutic Surgery

Shoulder Therapeutic Surgery Information Leaflet

Sulis Hospital: 01761422222
Bath Clinic Circle Health Group: 01225809343
St Joseph’s Hospital: 01633820344

Introduction

This information booklet has been produced to help you understand why your shoulder is painful and assist in gaining maximum benefit from shoulder surgery, if required. It should be used as guidance alongside the advice from your Orthopaedic Consultant and Physiotherapist. Individual variations may require specific instructions not mentioned here.

Summary

The shoulder is a highly mobile ball-and-socket joint that relies on stabilizing muscles (rotator cuff) for function. Two common conditions are sub-acromial impingement and frozen shoulder, which are assessed using your symptoms, examination, and imaging. Non-surgical treatments should have been attempted prior to considering surgery.

After surgery, you will experience discomfort in the shoulder, neck, or arm, but regular analgesia will help manage this. You will likely require a sling for 1 to 7 days, and shoulder movement/function will be limited for several weeks, continuing for up to several months. Regular rehabilitation exercises are essential for your long-term outcome, and full function may take between six to nine months to return.

Shoulder Anatomy

The main shoulder joint, glenohumeral joint (GHJ), is a ball-and-socket joint with a wide range of motion. The ball (humeral head) sits in a shallow socket (glenoid) on the shoulder blade. The joint is surrounded by a fibrous capsule that helps hold it together. Above this joint is the acromion, a bony prominence that forms an arch over the shoulder joint, creating the sub-acromial space.

The rotator cuff muscles and tendons stabilize the shoulder, passing through the sub-acromial space. The supraspinatus tendon sits in the middle of this space, cushioned by a small fluid lining (bursa) to protect it from friction.

Shoulder Conditions

Sub-acromial Impingement
Pain in this condition is typically felt at the top of the arm or around the shoulder, especially when moving the arm overhead or away from the body. Factors that contribute to sub-acromial impingement include:

• Overuse or repetitive strain (e.g., poor posture during prolonged computer work or overhead tasks)
• Shoulder injury (e.g., a fall)
• Rotator cuff issues (weakness, tendonopathy, tears)
• Poor muscle control of the shoulder blade
• Other conditions like frozen shoulder

This leads to wear and tear, pinching of the soft tissues (rotator cuff, bursa, biceps tendon) in the sub-acromial space, causing inflammation, swelling, and pain. Sub-acromial impingement is common, especially between ages 45-65.

Frozen Shoulder
Frozen shoulder involves inflammation and fibrosis of the shoulder capsule, restricting movement and causing pain. It often follows an injury, heart attack, or stroke, and is more common in people with diabetes. The condition progresses through three stages:

1. Painful stage (2–9 months): Increasing pain with movement, progressing to constant pain, including at night.
2. Freezing stage (4–12 months): Stiffening of the shoulder joint, reducing movement.
3. Thawing stage (12–42 months): Pain decreases, and shoulder movement improves.

Assessment

What tests are needed?
Shoulder conditions are diagnosed through symptoms, examination, and imaging (ultrasound, MRI, or X-ray). An ultrasound or MRI shows soft tissue damage and tendon compression, while X-rays help assess bone conditions and rule out other issues.

Treatment Options

Initial treatment options are non-surgical, including education, pain management, physiotherapy, and injections. However, if these measures are unsuccessful, surgical options may be explored, such as:

• Sub-acromial decompression
• Acromioclavicular joint excision
• Long-head of biceps tenotomy
• Capsular release or manipulation under anaesthetic (MUA)

Surgery

The surgery is performed arthroscopically (using a camera inside the joint) and may include:

• Sub-acromial decompression: Increases the size of the sub-acromial space, releasing the ligament and trimming the acromion, removing the inflamed bursa to prevent tendon rubbing.
• Acromioclavicular joint excision: Removal of a small section of the collarbone (clavicle) for more space.
• Long-head of biceps tenotomy: Releases the inflamed tendon from its attachment in the shoulder joint.
• Capsular release or MUA: Releases or stretches the shoulder joint capsule to increase movement.

Anaesthesia:
A combination of regional nerve block (numbing the shoulder) and light general anaesthetic (or sedation) is typically used. You will remain numb for 12–24 hours post-surgery.

Pre-Surgery Considerations

Pain After Surgery
Pain is expected post-surgery, though manageable with medication. This pain will subside over time as you progress through rehabilitation.

Pain Relief
You will be prescribed pain relief, including paracetamol and NSAIDs, and stronger medication (e.g., codeine) if necessary. Ice packs can help reduce swelling and discomfort.

Hospital Stay
You will likely not stay overnight unless surgery is late in the day. Wounds will need monitoring and stitches will be removed after 10 days.

Sling
A sling is for comfort and will be used for 1–7 days depending on the procedure. You may remove it yourself but can keep it for comfort longer if needed.

Post-Surgery Considerations

Returning to Normal Activities
Gradual use of the shoulder is expected. Return to normal activities may take 6-9 months, depending on discomfort and healing.

Driving
You may drive after 7 days if you feel comfortable, but always ensure you are capable of performing emergency maneuvers.

Work
Recovery time for non-manual work is around 3–4 weeks, light manual work 6–8 weeks, and heavy manual work 10–12 weeks.

Sport
Return to sporting activities typically occurs between 3–6 months, depending on recovery progress.

Physiotherapy
Rehabilitation is essential, and you will start with exercises 2-3 weeks after surgery, progressing as guided by your physiotherapist.

Post-Operative Exercises

Perform mobility exercises out of the sling, such as neck and shoulder blade movements, and arm exercises to avoid stiffness. Specific shoulder exercises include passive forward flexion, passive external rotation, and shoulder passive elevation. Exercises should not increase pain significantly.

Frozen Shoulder Release
In cases of frozen shoulder release, exercises for movement restoration should be performed 5-6 times a day.

Complications to Watch For

Seek medical advice if you experience:

• Temperature or fever
• Increasing pain
• Redness, swelling, or infection around the wound
• Numbness in the arm/hand
• Severe bleeding
• Difficulty passing urine
• Issues with pain management

Outcome Questionnaire
One year post-surgery, you will receive an Outcome Questionnaire to evaluate the effectiveness of the surgery.

For additional assistance or concerns, please contact your hospital directly.

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