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Shoulder Surgery

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Shoulder Surgery

Introduction

There are lots of types of shoulder surgery available. In this section we provide information on the most common surgeries previous and current patients have visited our clinics for input during their rehabilitation. Our Physiotherapists at Pure are highly skilled to ensure best outcomes both before and after surgery, supporting you throughout your recovery.

 

The shoulder is a ball and socket joint. Most shoulder movement occurs where the ball at the top of your arm bone (the Humerus) fits into the socket (the Glenoid). The socket is part of the shoulder blade (Scapula) which is where the rest of the movement comes from and plays a key role in the functionality of our upper limbs.

 

The shoulder joint is the most common cause of shoulder pain. The Rotator Cuff (RC) is a group of four muscles which work together to keep the joint in optimal position throughout movement.

The 4 muscles are:

– Supraspinatus

– Infraspinatus

– Teres Minor

– Subscapularis

Subacromial Decompression

Arthroscopic Subacromial decompression involves removal of the: bony surface of the Acromion; the bursal tissue on the under surface of the acromion; and release of the Coraco-acromial ligament. The procedure aims to increase the size of the Subacromial space reducing the painful mechanical irritation of the rotator cuff tendons.

 

In some cases the Acromio-Clavicular joint (ACJ) contributes to Subacromial pain and may need an additional procedure to free up movement.

Rotator Cuff Repair

The Rotator Cuff is the name of a group of four tendons in your shoulder as previously highlighted. These tendons allow different types of movement to occur, including elevation and rotation. Any of the tendons can tear, either due to an injury or, more commonly, due to the ‘wear and repair’ that occurs as part of the ageing process. For more information, please visit our page on shoulder pain.

 

When a tendon tears, its function can be impaired and can cause pain and weakness. During an arthroscopic repair of the torn rotator cuff tendon, a camera (arthroscope) is inserted into the shoulder to allow the tendons to be seen. Very small anchors are then used to repair the torn tendon back into the bone. Stitches are also passed through the tendon to secure it.

Shoulder Stabilisation

The procedure aims to tighten and/or repair the over-stretched and injured ligaments, rim of cartilage/Labrum and shape of socket.  Different types of operation can achieve this.  The surgical options are discussed by the Orthopaedic team with your best interests at the forefront of the decision making. Your post-operative rehabilitation will depend on the specific operation performed however our Physiotherapists can help you through this regardless.

Shoulder Replacement

The most common reason for replacing the shoulder joint is arthritis, either osteoarthritis (wear and repair) or rheumatoid arthritis. It may also be necessary following a fracture or bad accident. With all forms of arthritis the joint becomes painful and difficult to move. Sometimes the Rotator Cuff can also be worn or damaged and reverse shoulder replacement is used.

 

These operations replace the damaged surfaces of the shoulder joint with a replacement joint (prosthesis). The main reason for performing the operation is to reduce the pain in the shoulder. Commonly, movement of the shoulder is preserved or sometimes improved. This will depend on how stiff the joint was before the operation and if the muscles around the shoulder are damaged and unable to work normally.

 

There are 2 types of shoulder replacement:

Your Recovery

Our Physiotherapists at Pure can design an individualised exercise plan for both before and after your operation. The reassurance and exercises given improve participation in activities, prevents the shoulder from getting stiff, strengthens the muscles and may help improve your mental health. Before and after shoulder surgery it is very important to get into the habit of doing regular daily exercises for several months. This is required to gain maximum benefit from your operation.

Before Surgery

A shared decision making model should be adopted, defining treatment goals and taking into account personal circumstances. Patients should be informed that the decision to have surgery can be a dynamic process and a decision to not undergo surgery does not exclude them from having surgery at a future time point. Ensure a multidisciplinary approach to care with availability of trained shoulder physiotherapists and shoulder surgeons.

After Surgery

Stiffness after shoulder surgery is not uncommon and occurs as a result of pre-existing conditions, surgical scarring and prolonged post -operative protection in a sling.

 

A sling is usually worn for a short time only; this protects the surgery during the early phases of healing and makes your arm more comfortable.

'Safe Zones' for Shoulder Rehabilitation

The safe zone positions are areas in space where it is safe to move your arm, preventing significant stress on the surgical repair or injury at the beginning.

 

If you have had surgery, the safe range of motion may be in the surgical operation note (where the surgeon has tested the strength of the surgical repair at the end of the operation to determine the ‘safe zones’).  The safe zone can be time or milestone driven depending on local advice. Our experienced team at Pure Physiotherapy can help explain this and guide you through your rehabilitation.

 

For more information on the ‘safe zones’ please click here which takes you to website of Professor Lennard Funk who is a Shoulder & Upper Limb Specialist and Consultant Orthopedic Surgeon in the UK.

Additional Resources

Click here to find out about Joan’s story and her post-operative recovery and return to playing tennis.

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