Most surgical procedures of the shoulder are now performed with arthroscopy. This involves the inserting of a telescope (fibre optic) through a thin tube in small incisions around the shoulder. The incisions are between 0,5 to 1,0 cm in size and between 2 and 6 incisions are used depending what operation is done. A single stitch or suture is used to close the incisions after the operation.
This is less invasive but the operation inside is the same as those done with an open operation and thus recovery may still take months depending on the procedure performed.
To facilitate the arthroscopic (keyhole) surgery, fluid is pumped into the shoulder. This opens the spaces in the shoulder and prevents bleeding. During the procedure some fluid leaks into the tissues around the shoulder which can become very swollen. This fluid is absorbed over the following few hours and patients may find that they pass more urine during this period as this fluid is excreted. Some of this fluid which is blood stained leaks out the small incisions and an absorbent dressing (nappy) is strapped to the shoulder. This is left on overnight and is replaced with small waterproof dressings the next morning so that the patient can shower normally.
This bloody fluid tracks down between the skin layer and muscle and patients may develop quite marked bruising down their arm and over their chest/breast during the week following the operation. This bruising will disappear over 2 -3 weeks.
This is done with a general anaesthetic and a regional block. It can be done with a block alone but the patient is placed into a seated position on the operating table which can be uncomfortable and thus a general anaesthetic is preferred. The block is done with local anaesthetic injected into the side of the neck where the nerves to the arm are passing. This provides excellent pain relief during the operation thus less anaesthetic drugs are required, patients thus wake up quite refreshed afterwards. The block provides excellent relieve of pain after the operation and lasts for between 8 and 24 hours. The arm may be completely dead and the patient may not even be able to move their fingers initially. Care must be taken not to put anything hot on the arm as this will not be felt and a burn may occur. In approximately 1% of cases there may be a persisting area of numbness in the arm, forearm or hand which usually disappears within 3 months. Occasionally neuralgia (nerve pain) may occur after the block and may require medication till it settles of its own accord.
Patients come in on the day of the operation and may be discharged a few hours after the operation or may stay overnight depending on the operation performed and how they are feeling.
An anti-inflammatory and a pain killer are prescribed. The anti-inflammatory is taken for a week and the pain killer if and when necessary. Most patients take the pain killer for an average of 5 days after the operation. Some patients however don’t take any medication whereas other patients may need pain killers for up to 6 weeks. This is dependent on the individual and the operation performed. More pain is usually felt following a rotator cuff repair. Patients often struggle to sleep initially and a sleeping tablet may be required.
Patients often have difficulty sleeping and besides taking sleeping tablets, sleeping propped up with pillows or sleeping in a chair will be easier. A recliner (lazy boy chair) will often be the best option.