Obtain Tools For Bathroom Access And Safety
Stock a big supply of waterproof bandages or plastic bags and tape in the bathroom so youre prepared to shower without getting your incision wet. A detachable showerhead helps keep water away from your shoulder, and pump soap makes bathing easier when you can use only one arm.
Place non-slip bath mats in the shower and on the floor outside your bathtub or shower. A shower chair is also great for safety because you may tire easily during your recovery.
If your dominant hand and arm are immobilized, practice activities like brushing your teeth with your other arm. If its too difficult, look for hacks. For example, you can get powdered toothpaste that you can pour into a bowl and then dip a wet toothbrush in the powder.
Recovery Room And Getting Home
Following your surgery, youll remain in the recovery room for an hour or two before the doctor discharges you. Nurses will provide you with pain medicine, if necessary, and monitor your responsiveness. Youll need to have another person drive you home, because youll be wearing a sling around your arm and could still be feeling the effects of the general anesthetic, which will make driving dangerous.
The person driving you home or another person should stay with you for the first night at least and help make you feel more comfortable, prepare your meals and help with other things. You may want to have them check up on you daily for the first week home to help with daily tasks and see if you need anything. Having someone assist you will help you avoid shoulder pain and ensure you adhere to postoperative instructions and rehabilitation restrictions.
Phase Three: 12 Weeks Onward
Twelve weeks after surgery, most people can increase activities that will help them regain strength in their shoulder and allow them to utilize their full range of motion.
It is always best to follow all advice from the surgeon and physiotherapist to ensure the best possible outcome.
If a person tries to push themself and move too quickly, this can be detrimental to the recovery process.
Rotator cuff surgery, like any surgery, is not without risks.
For example, any surgery requiring anesthesia carries some risks.
Common side effects associated with anesthesia generally only last for a few days and may include:
Another complication that can arise from any kind of surgery is an infection around the incision site.
Some complications specific to rotator cuff surgery can include:
- long-term shoulder pain or stiffness
- damage to blood vessels
In rare cases of very large and chronic tears, the tendon may be too badly damaged and cannot be repaired at the time of surgery. Even in these uncommon instances, pain may improve post-operatively, but strength of the shoulder will not.
Occasionally, a surgically repaired rotator cuff may tear again, requiring a second operation to refix the tendon.
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How Can You Help Prevent Future Rotator Cuff Injuries
Once you reach full recovery, you will probably want to put the injury out of your mind and move forward with your life. While it is wonderful you can get back to the activities you love, you will want to take precautions to prevent re-injury of the rotator cuff.
- Exercise: You can continue to do the rotator cuff tear exercises you learned in physical therapy to keep your shoulder strong. Go back to the other types of exercise you loved before surgery. Maintaining physical fitness helps keep your body healthy and prevents future injuries.
- Don’t push yourself: Consider asking for help the next time you need to lift something heavy. If you do want to go back to lifting, either for exercise or work, make sure your doctor and physical therapist have cleared you to do so, and ensure you are lifting in a way that keeps your body safe. If you notice your shoulder feels sore or tender, stop what you are doing. If you push yourself too far, you can retear the repaired tendon or tendons.
If you need to get evaluated for a rotator cuff tear, schedule an appointment online or call 713-794-3457. Take the first step toward recovery today.
What Are The Types Of Shoulder Replacements
Your surgeon will have a conversation with you regarding what type of shoulder replacement you may need. There are four options:
- Hemiarthroplasty: In this procedure only the ball and stem are replaced. The stem is connected to the ball and articulated with your natural socket.
- Resurfacing Hemiarthroplasty: This involves replacing the joint surface of the humeral head with a cap-like prosthesis, without a stem.
- Anatomic Total Shoulder Replacement: The arthritic joint is replaced with a highly polished metal ball attached to a stem on the humeral side, and a plastic cup on the glenoid socket.
- Stemless Total Shoulder Arthroplasty: This is a bone-preserving version of the total shoulder arthroplasty where the metallic ball is attached to the upper arm without a stem.
- Reverse Total Shoulder Replacement: In the reverse total shoulder replacement, the joint is literally reversed meaning the metal ball is placed where the glenoid socket was and a plastic cup is attached to the stem and is moved to the upper arm bone .
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The Anatomy Of The Shoulder
The shoulder is a complex joint capable of more movement than other joints in the body. Its made up of several bones.
Besides bones, other components are responsible for function and movement.
- Ball and socket: Your upper arm bone head fits into your shoulder blade through a rounded socket known as your glenoid. Your articular cartilage, which is a slippery tissue, covers the surface of your ball and socket, creating a frictionless, smooth surface that helps your bones easily glide across one another. Strong fibrous cartilage rings your glenoid, which creates a gasket around your socket, adding stability and cushioning the joint.
- Shoulder capsule: Bands of tissue called ligaments surround your joint, forming a capsule that holds it together. Your synovium, which is a thin membrane, lines the capsules undersurface. It makes synovial fluid that provides lubrication for your shoulder joint.
- Rotator cuff: You have four tendons surrounding your shoulder capsule that help center your arm bone in your shoulder socket. This is your rotator cuff and is a thick tendon material. Your rotator cuff covers your humerus head, attaching it to your shoulder blade.
- Bursa: Your bursa is a lubricating sac between the bone on top of the shoulder and your rotator cuff. Your bursa helps your rotator cuff tendons smoothly glide when youre moving your arm.
Are There Any Potential Complications
Any surgery comes with the risk of complications. While these are rare, it is essential you become an informed patient before deciding to undergo surgery. The potential complications of shoulder arthroscopy include the following.
- Infection: Your surgeon will take every precaution to prevent surgical site infection, but bacteria are always present in our environments. Signs of postoperative infection include redness, pain, swelling and drainage at the site of the surgical incision. Infections like these typically need treatment with a long course of antibiotics. While you should be aware of this complication, only 0.16 to 1.9 percent of arthroscopic surgery patients experience deep infection postoperatively.
- Stiff shoulder: A stiff shoulder is one of the more common complications of rotator cuff surgery, with one study finding 20 percent of patients experiencing postoperative stiffness. While this stiffness may be unpleasant, the study found it typically resolved with six to 12 months after the surgery.
- Lack of improvement: Arthroscopic rotator cuff surgery has a high success rate, but it is not 100 percent. Lack of improvement is not a true complication, but the result can be disappointing for patients. It is possible patients will find they do not regain full motion, strength and function in the shoulder.
- Retears: While arthroscopic rotator cuff surgery can be successful, there is a risk of retearing the injured tendon. The risk of this is higher with larger tendon tears.
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How Much Does Rotator Cuff Surgery Cost
The price of rotator cuff surgery will depend on several factors. Estimates range from $6,628 to $11,180, but talking to your insurance carrier is the best way to get an accurate estimate for you. The price of the surgery will hinge on variables such as your insurance coverage, your annual deductible, your coinsurance and your out-of-pocket maximum. The cost of the surgery will include the surgeon, anesthesia, imaging, lab tests and the hospital. You could receive separate bills for each of these services. When talking to your insurance company, it can be helpful to reference specific codes related to shoulder arthroscopy. Commonly used codes for arthroscopic rotator cuff repair include:
- 29821: Shoulder arthroscopy
What Are The Symptoms Of A Rotator Cuff Tear Or Injury
Rotator cuff tear symptoms include the following.
- Immediate pain: A single injury causes an acute rotator cuff tear. You will likely be able to pinpoint the exact injury because it will involve a quick, sharp pain in the shoulder. Heavy lifting and falls are common causes of an acute tear.
- Dull pain: In cases of rotator cuff tears that happen as a result of overuse, you likely won’t be able to isolate one incident that started the pain. Instead, you will probably notice a continuous, dull ache in your shoulder.
- Pain while lying down: Whether acute or the result of repetitive motion, most rotator cuff injuries come with pain while lying down on the affected shoulder. You may notice this pain while you are trying to fall asleep.
- Weakness and restricted range of motion: Weakness in the affected arm is another of the common torn rotator cuff symptoms. Injury to the rotator cuff can make it difficult to move your arm in different positions. These muscles and tendons play a significant role in allowing you to move your arms above your head. If you have this type of injury, you may find it difficult to perform simple tasks that involve lifting and rotating the affected arm.
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Go For Physical Therapy
Make sure you attend your physical therapy sessions if you want to rebuild your shoulder muscles, flexibility, and mobility after the procedure.
Its easy to make excuses to skip out, but this is one of the worst things you can do for your recovery.
Improving after shoulder surgery means putting in the work necessary to get your body back into fighting condition.
Therapy is one of the best ways you can accomplish this.
The physical therapist will help you move and exercise passive motion in a safe environment, where you dont have to be afraid of accidentally hurting yourself.
Participating requires more than just showing up. Actively listen and follow the instructions your therapist gives.
Doing the movements youre assigned at home will play a big part in getting you better faster.
The Rotator Cuff And Shoulder Joint
Rotator cuff tears and disease are very common. They often result from ageing and wear and tear. They can also occur as a result of a fall or sporting injury. Impingement of the front of the scapula , where bone rubs into the tendon is believed to be a major cause of cuff tears in individuals older than 40 years of age.
The rotator cuff is important in stabilising the shoulder joint, enabling shoulder movement, and giving the shoulder and arm power and strength. Four muscles and their tendons constitute the rotator cuff. The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate your arm.
Subscapularis is the muscle at the front of the shoulder which helps rotate the arm inwards. Over the top of the shoulder are supraspinatus and infraspinatus, which help elevate or lift the arm. Teres minor is the muscle at the back of the shoulder, which helps rotate the arm outwards.
There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder . The bursa allows the rotator cuff tendons to glide freely when you move your arm. When the rotator cuff tendons are damaged or injured, the bursa can become inflamed and painful.
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Planning Ahead For Restrictions
Plan to take it easy after surgery. You may not be able to drive for a few weeks, so make arrangements to get rides as needed. You should not lift anything heavier than a cup of coffee after surgery, and you should not reach, lift, push or pull with your affected arm until your doctor says its okay.
Recovery After Shoulder Replacement: What To Expect
Shoulder replacement surgery can be life-changing. After a shoulder replacement, most people experience significant pain relief and improvement in shoulder motion. However, results are not instantaneous. Full recovery from shoulder replacement can take 4 to 6 months or longer.
Knowing what to expect after shoulder replacement can help you prepare physically and mentally. Understanding shoulder replacement recovery time allows you to establish realistic expectations and may alleviate some impatience.
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What Happens During The Procedure
Shoulder replacement surgery typically takes about two hours. You might receive general anesthesia, which means youll be unconscious during the procedure, or regional anesthesia, which means youll be awake but sedated.
During the surgery, doctors replace the damaged joint ball, known as the humeral head, of the shoulder with a metal ball. They also place a plastic surface on the socket of the shoulder, known as the glenoid.
Sometimes, a partial shoulder replacement can be performed. This involves replacing only the ball of the joint.
After your procedure, youll be taken to a recovery room for several hours. When you wake up, youll be moved to a hospital room.
What If I Feel A Tear Or Pull In Therapy
It is not uncommon to have a small “twinge” or “pull” in physical therapy, which typically does not mean that the rotator cuff repair has failed. Normally these small twinges are usually nothing to worry about. It is not really known what causes them, but it is believed that it may be scar tissue being stretched or the shoulder joint moving around normally in the socket. It would be rare for the therapy to actually cause a repaired tendon to tear, as will be discussed later.
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Diagnostic Arthorscopy For Rotator Cuff Tears
The video below is a diagnostic arthroscopy procedure as viewed from the back of the joint looking to the front. This patient has mild, partial thickness fraying at the rotator cuff insertion. This tear is analogous to the tear show in Fig. 5.
Patients undergoing arthroscopic rotator cuff repair still require a limited period in a sling with some simple range-of-motion exercises at home. They will require fairly intensive outpatient physical therapy for re-establishing pain-free motion and strengthening the shoulder muscles for a few months. Normally, a person can return to most forms of normal activity within 6 to 8 weeks, and limited athletics between 12 and 16 weeks. A return to all activities, even contact athletics, can usually be accomplished by 4 to 6 months, depending on the sport.
How Does Your Shoulder Work
Similar to the hip joint, your shoulder is a large ball and socket joint. It can rotate through a greater range of motion than any other joint in your body. The shoulder joint is made up of bones, tendons, muscles and ligaments which hold the shoulder in place and allows for its movement. Bones of the shoulder joint include the Clavicle , Scapula and Humerus .
Your clavicle connects with the shoulder blade at the acromioclavicular joint, or A.C. joint. The clavicle attaches your shoulder to your rib cage and holds it out and away from your body. The rounded head of the humerus, or upper arm bone, rests against the socket in the shoulder blade. The surfaces of the bones where they touch are covered by a smooth substance called cartilage that protects your bones and enables them to glide and move easily. The muscles and tendons that surround the shoulder provide stability and support. A thin, smooth tissue called the synovial membrane covers all remaining surfaces inside the shoulder joint. In a healthy shoulder, this membrane makes a small amount of fluid that lubricates your cartilage and eliminates almost any friction in your shoulder.
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How Long Does Shoulder Arthroscopy Pain Last
After shoulder arthroscopy, you will be out of the joint for weeks to months. It may take several weeks for you to notice any pain or swelling. Pain relief can be aided by ice and pain medications. You might also be able to sleep in a chair or bed for a few days after your surgery.
It is unknown how pain is felt after shoulder arthroscopic surgery, or how it progresses after surgery. Work-related accidents or occupational diseases are the most common risk factor for pain, with VAS values ranging from D1 to 1 year and morphine consumption increasing as well. This study found that the use of local anesthesia had an impact on the studys findings. Use of a pain pump following shoulder arthroscopy can cause joint chondrolysis. Following rotator cuff repair, an ice wrap and subacromial injection are used to treat postoperative pain and edema. There are several factors that contribute to long-term post-operative pain and analogicizability after a surgical repair of a rotator cuff.
What Are The Chances A Tear Will Heal With Surgery
There have been many studies that tell us approximate odds of tendons healing with surgery depend upon the size of the tendon . It has been demonstrated that small full thickness tears the size of a fingernail heal in a majority of cases, but approximately 5% will not heal for the reasons mentioned in the discussion above. For full thickness tears that are moderate size , the re-tear rate is around 20% . For large tears , the re-tear rate is approximately 27% . For massive tears , the re-tear rate is anywhere from 50 to 90% . The reason for this high failure rate with large to massive tears is because there is a hole too large to be filled by stretching the remaining tendon, and the edges of the tendon will not hold the stitches used in the repair of the tendons.
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