Shoulder > Shoulder Dislocation > Treatments

    Arthroscopic Reconstructive Surgery

Preparing for Surgery

The decisions you make and the actions you take before surgery can be as important as the procedure itself in giving you the best possibility of a healthy recovery.

   Prior to your return home from the hospital, make sure that you have received any equipment you will need when you get home from the hospital. This may include a shoulder sling, ice packs or coolers, or physical therapy equipment. You should receive prescriptions for any of these from your doctor before you go home from the hospital.

   Learn the potential risks and benefits of the surgery by asking your surgeon any questions that will help you better understand the procedure. It can also help to talk to someone else who has undergone the same surgery.

   Any physical problems or changes in your overall health, such as a fever or infection, should be reported to your surgeon, and you should notify your surgeon of any new medications you are taking.

   Getting a second opinion from another surgeon who is as qualified as the surgeon who gave the initial diagnosis is often advisable.

   Make sure your orthopedic surgeon is board-certified. This can be determined by calling the American Board of Orthopaedic Surgery at 919-929-7103.

At most medical centers, you will go to "patient admissions" to check in for your arthroscopic shoulder reconstruction. There may be separate areas for ambulatory outpatients (patients who go home the same day after surgery) and for overnight inpatient surgery check-in, so be sure to ask your doctor or one of his assistants about this. After you have checked in to the hospital, you will go to a holding area where the final preparations are made. The mandatory paperwork is completed, and your shoulder area may be shaved, though this is not always necessary). You will be asked to change into a hospital gown and remove, if applicable, your watch, glasses, dentures, and jewelry. You will have the opportunity to speak with your orthopedic surgeon or one of his assistants and meet the anesthesiologist or nurse anesthetist (a nurse who has done graduate training to provide anesthesia under the supervision of an anesthesiologist). Then, you will walk or ride on a stretcher to the operating room. Unless requested, most patients are not sedated until they go into the operating room. Here are some important things to remember for the day of your surgery:

   You will probably be told not to eat or drink anything after midnight on the night before your surgery. In general, you should not eat for eight hours before surgery. This will reduce the risk of vomiting while you are under anesthesia.

   Because the anesthetic and pain medications may make you drowsy and you will be unable to drive, arrange for someone to help take you out of the hospital and drive you home when you are released.

   Wear a soft, large, and comfortable shirt that will fit over your dressing, arm, shoulder and sling.

   Take it easy. Keeping a good frame of mind can help ease any nerves or anxiety about undergoing surgery. Distractions such as reading, watching television, chatting with visitors, or talking on the telephone can also help.

Prior to arthroscopic reconstructive surgery on your shoulder, you will be given either regional or general anesthesia. An arthroscope (a tiny camera about 3 1/2 millimeters in diameter) is inserted into your shoulder, which provides images on television monitors so the surgeon can see the inside of your shoulder join and all of its parts, including the shoulder joint surfaces, capsule, labrum, and ligaments.

   Surgical instruments are inserted through two to four small incisions that are about one centimeter long.

   The torn labrum and ligaments in the shoulder joint are reattached to the shoulder socket (glenoid) with sutures. Occasionally, the stretched out capsule is tightened up with a heating probe. These steps tighten the shoulder and hold the upper arm bone in the socket.

   Any tears in the protective joint lining (labrum) can also be smoothed or sewn together.

   The small incisions are closed with stitches.

   After surgery, you will be taken to the recovery room.

When you awaken in the recovery room following arthroscopic reconstruction, your shoulder usually will be bandaged, immobilized in a sling, and covered with an ice pack. You may feel a moderate amount of pain, depending on the extent of your operation. You usually stay in the recovery room for one to two hours. General anesthesia wears off in about an hour and regional anesthesia may take about two hours to wear off. You will be given adequate pain medicine, either orally or through an IV (intravenous) line, as well as instructions for what to do over the next couple of days. In addition, you will be given an appointment to return and a prescription for oral pain medicine. You should try to move your fingers and wrist while you are in the recovery room to improve circulation. Your shoulder and upper extremity will be in a sling, and you should refrain from moving your shoulder. Your temperature, blood pressure, and heartbeat will be monitored by a nurse, who, with the assistance of the doctor, will determine when you are ready to leave the hospital or, if necessary, be admitted for an overnight stay. The majority of patients leave the hospital after two or three hours. As soon as you are fully awakened, you are usually allowed to go home. You will be unable to drive a car, so be sure to have arranged a ride home.

After arthroscopic reconstruction of an unstable shoulder, you will need to take steps to reduce the pain and inflammation in the shoulder. Rest, icing, and anti-inflammatory painkillers, such as ibuprofen or aspirin can ease pain and swelling, and immobilizing the shoulder will allow the reconstruction to heal. Here is what you can expect and how you can cope with a sling immobilizing your shoulder:

   The first concern is to monitor swelling for the first 48 hours while wearing your sling. Physicians generally prescribe ice packs to be applied as much as possible during the first few days after surgery to decrease pain and swelling.

   You should wear the sling as prescribed by your orthopedic surgeon. Physicians generally recommend wearing the sling at all times except for daily hygiene for between two and eight weeks. Almost all shoulder reconstructions heal better when the shoulder is immobilized for a period of time.

   You can usually remove the gauze bandage and shower after a few days. You can remove the sling for brief periods to shower, but remember to avoid moving the shoulder.

   Some bleeding and fluid drainage is normal for the first two days. Call your physician if bleeding continues.

   Stitches are usually removed about two weeks after surgery.

   When your shoulder starts to heal, your physician may recommend that you remove the sling for short periods to perform some light, early-motion exercises.

   You should move your fingers and hands in the sling as much as possible to help circulate blood.

   If you develop a rash or irritated skin around your sling, call your physician.

   If you notice any abnormal wear or discomfort in the sling, contact your physician as early as possible. In general, do not try to "grin and bear it" if discomfort does not go away within a few days. The sling should not irritate your skin.

Rehabilitation can usually begin within a few weeks after surgery, but you should visit your physician a week or two after surgery for a routine check-up. Until cleared by your physician, you should keep the shoulder immobilized in the sling. The sling may make it difficult to use the hand of the injured shoulder. Some people may need to take about six weeks off from work after a shoulder dislocation, depending on how much they rely on the immobilized arm.

After about two or three weeks of immobilization, your physician usually refers you to a physical therapist to begin rehabilitation exercises. Successful rehab may take between four and six months to complete. The first stage of physical therapy usually involves passive motion exercises with the assistance of your physical therapist. Most patients begin with forward motion in the shoulder. Because your arm has been held across your chest for weeks, rotating or turning the shoulder outward may be painful will be difficult when rehabiltation begins. Most patients cannot externally rotate their shoulders further than 30 degrees. With the shoulder held in place, you usually begin strengthening your wrist and elbow by flexing and extending your hand and arm. After two to four weeks, you may be able to start moving your hand, arm, and shoulder with the assistance of the therapist. Usually within eight weeks, your therapist can start adding resistance to your exercises with weights or elastic bands. After eight weeks, many patients can rotate their shoulders outward with little pain and rotator cuff strengthening exercises can begin. The four muscles in the rotator cuff generally should be made stronger than they were before the injury to properly support and stabilize your shoulder. When your rotator cuff muscles are strong enough to withstand stress, rehabilitation tends to become more activity oriented. Sport-specific exercises and coordination drills help prepare you to return to sports and activities. Non-contact sports, like tennis and swimming, can often be resumed within four months. Contact sports should usually not be resumed until at least six months after reconstructive surgery for a shoulder dislocation. Your physician may prescribe a modification to the above regimen to suit your specific situation.

The best way to prevent multiple shoulder dislocations is to make the shoulder strengthening exercises you learned in rehabilitation part of your everyday routine. After you suffer an initial dislocation, your shoulder may be more vulnerable to instability. The natural integrity of the socket may not be strong enough to withstand the force of contact sports or repeated overhead motion. You may have to rely much more on the muscles in the rotator cuff (supraspinatus, infraspinatus, subscapularis, and the teres minor), lower neck, and upper back to hold your shoulder in place. Remember to warm up your shoulders before physical exercise by rotating your arms in different directions. Depending on the severity of your dislocation and the success of your rehabilitation program, your physician may recommend that you avoid contact sports or risky, high-speed activities. In general, your shoulder can become healthy and stable after a dislocation, but you may need to be cautious of activities that could result in accidental collisions or falls. You should wear shoulder pads during contact sports. Your physician can recommend the best types of protective gear for your shoulders.

Shoulder dislocations can disrupt or tear the soft tissues stabilizing your shoulder. The soft tissues that connect the upper arm bone (humerus) to the shoulder socket (glenoid), are injured during a dislocation. These soft tissues include the capsule (labrum) and ligaments of the shoulder. The labrum is a special type of soft tissue that lines the rim of the upper arm bone and helps to prevent dislocation of the humeral head out of the shoulder socket. A dislocated shoulder is an emergency and should be put back in place (reduced) as soon as possible. The longer the delay, the more difficult it is to reduce the dislocated shoulder. As soon as a dislocated shoulder is diagnosed, a physician will reduce your dislocated shoulder. If the dislocated shoulder is complicated, an orthopedic surgeon will be called to evaluate and treat you. In any case, you will be referred to an orthopedic surgeon for further evaluation and treatment. If non-operative treatment is unsuccessful and your shoulder is unstable, your orthopedic surgeon may suggest arthroscopic or open surgical reconstruction to stabilize your shoulder, especially if your shoulder dislocates again. The decision to operate or not operate for instability after a shoulder dislocation is often difficult. There is a high risk of recurrent dislocation without surgery in some patients, particularly in young, active patients or high-energy dislocations. You and your surgeon may decide that the risk of repeat dislocation is so high that you would benefit more from operative treatment to stabilize your shoulder sooner rather than later. Once the shoulder is put back in socket, the surgery to stabilize your shoulder is rarely urgent. It may be done a few days after a dislocation or much later.