Shoulder > Shoulder Separation > Treatments

    Reconstructive Surgery

After a separation, torn ligaments often are repaired with an open reconstruction procedure. Patients who undergo open surgery often have tried non-operative treatment for a period of weeks or months, but have been unable to stabilize the shoulder. The decisions you make and the actions you take before surgery can be every bit as important as the procedure itself in ensuring a healthy recovery.

   Make sure 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 heating pads. You should receive prescriptions for any of these from your doctor when your surgery is scheduled.

   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, such as a fever or infection, should be reported to your surgeon, and you should notify your surgeon of any medication you are taking.

   Discontinue use of any anti-inflammatory medicine, especially aspirin, a week prior to surgery, to prevent excessive bleeding during the surgical procedure.

   Getting a second opinion is advisable, particularly in rare or unique cases.

At most medical centers, you will go to "patient admissions" to check in for your open shoulder reconstruction. Your surgery is probably going to require an overnight stay, so be sure to ask your physician if there is a separate department for checking in to the hospital. After you have checked in to the hospital or clinic, you will go to a holding area where the final preparations are made. The paperwork is completed and your shoulder area may be shaved (this is not always necessary). You will wear a hospital gown and remove all of your jewelry. You will meet the anesthesiologist or 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. Most patients are not sedated until they go into the operating room. Here are some important steps 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. You are instructed to not eat anything for eight hours prior to surgery. This will reduce the risk of vomiting while you are under general 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, comfortable shirt that will not irritate your skin when worn under a shoulder 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.

Reconstructive shoulder surgery typically takes about two hours. Torn ligaments need to be sewn together and your collarbone may need to be repositioned in the AC joint. You are usually given general anesthesia, but some patients are given a regional anesthesia, called an interscalene block, injected above the collarbone.

   A two-inch incision is made over the bony bump on the top of your shoulder.

   Torn ligaments around the acromioclavicular (AC) joint are reattached with sutures. Sewing the ligaments back into proper position helps tighten the shoulder and hold the collarbone in place.

   A screw or heavy sutures may be needed to hold your collarbone in place while the ligaments heal.

   The incision is stitched up and you are taken to the recovery room.

When you awaken in the recovery room following open reconstruction, your shoulder usually is wrapped in gauze, immobilized in a sling, and covered with an ice pack. You may feel a moderate amount of pain, depending on the severity of the separation, and you will receive pain medication through an IV (intravenous) line. You usually stay in the recovery room for at least two hours while the anesthetic wears off. General anesthesia wears off in about an hour and regional anesthesia may take about two hours to wear off. You should try to move your fingers while you are in the recovery room to improve circulation. Moving your wrist may be painful and you usually should not try to move your elbow. 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.

After open shoulder reconstruction, some patients remain in the hospital for as long as 24 hours. There will likely be pain, and you can expect to be given pain medication as needed. Be sure to ask for medication as soon as you feel pain coming on, as pain medication works best on pain that is building rather than pain that is already present. The nurses will not give you more than your doctor has prescribed and what is considered to be safe. Ice also helps control pain and swelling. Physicians generally suggest that you immobilize your shoulder in a sling for about six to eight weeks. You will be taught how remove the sling and perform gentle range of motion exercises. In addition, you will be given an appointment to return and a prescription for pain medicine. Screws and heavy sutures usually are removed within six months after surgery, which requires a return visit to your surgeon. You will not be able to drive, so be sure to have arranged for a ride home.

After open reconstruction of a shoulder separation, 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 immobilizing the shoulder will keep it stabilized. 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 for 20 minutes at a time, three or four times a day.

   There may be some minor drainage on the bandage since fluid may have accumulated during the surgery. Expect some blood to show through the bandage during the first 24 to 48 hours.

   Physicians generally recommend that you wear the sling day and night for between two and four weeks. Almost all shoulder separations heal better when the shoulder is immobilized.

   You can usually remove the gauze bandage and bathe regularly after about seven days. Call your physician if bleeding continues. You can remove the sling for brief periods to shower, but remember to avoid moving the injured arm.

   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.

Rehabilitation can usually begin within a few weeks after surgery, but you should visit your physician a week after the injury for a 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 surgery, depending on how much they rely on the immobilized hand.

After about one to three weeks of immobilization and gentle range of motion exercises, your physician usually refers you to a physical therapist to begin specific shoulder rehabilitation exercises. A typical physical therapy schedule progresses as follows:

   Week one – Begin pendulum exercises, swinging your arm in pendulum-like motions with the assistance of your physical therapist. You may continue wearing the sling to rest your shoulder after exercise.

   Weeks two to six – Light resistance exercises, moving your arm up to shoulder height and rotating your arm while pulling against elastic bands.

   Weeks six to 12 – Add more resistance and weight training, lifting your arm above your head. Work to strengthen rotator cuff, chest, and back muscles.

Most patients can return to sports and activities in four to six months if they remain dedicated to physical therapy.

The best way to prevent a repeat shoulder separation is to make the shoulder strengthening exercises you learned in physical therapy part of your everyday routine. Rotator cuff strengthening helps reduce the risk of overuse problems during athletic or work activities that require repetitive overhead motions. You should wear shoulder pads during contact sports and try to avoid activities like tackling if possible. In some cases, your physician may prescribe shoulder braces that are designed to help prevent your shoulder from moving out and back. These braces can help decrease stress on the shoulder ligaments. Having an athletic trainer tape your shoulder may also help to hold it in position. However, braces and taping should never be used as a substitute for strong and flexible muscles. Be sure to warm up before activities by rotating your arms and shoulders in different directions. After a shoulder separation, you should be careful to notice any pain or discomfort in your shoulder during athletics. Avoid playing through shoulder pain. The more often you separate your shoulder, the weaker the ligaments become, and the greater your risk of developing complications such as arthritis.

Patients with Type 3-6 shoulder separations who need to return to vigorous activities may need to undergo surgical rather than non-operative treatment. Shoulder separations can disrupt or tear the main ligaments stabilizing the AC (acromioclavicular) joint between your collarbone and shoulder blade. After a separation, torn ligaments often are repaired with an open reconstruction procedure. Patients who undergo open surgery often have tried non-operative treatment for a period of weeks or months, but have been unable to stabilize the shoulder.