Shoulder arthroscopy is an out patient procedure. It is performed
under general anesthesia. The surgery itself takes about 1 to 1 1/2 hours, and is performed thru two or three small incisions on the upper part of the shoulder. These incisions are generally about 1/4 inch in length. A small telescope (the arthroscope) is placed into one of these incisions and the entire inside of the shoulder can be visualized. The arthroscope is connected to a tiny camera, allowing the entire surgery to be visualized on a TV monitor. The other incisions are used to place various instruments into the shoulder to perform the surgery.
Many different types of surgery can be performed thru these incisions, the most common of which are to remove bone spurs (acromioplasty), repair torn cartilage (labrum) and repair rotator cuff tears.
Before surgery, preoperative evaluation is necessary. The extent of the testing depends on each patient's age, gender, and medical condition. Everyone needs at least a history and physical examination which will usually be performed at your primary doctor's office. All females need at least a blood count, and many patients will need other blood work or a cardiogram. Our office will order the specific tests needed on an individual basis.
Instructions for scheduling your pre-admission testing (PAT's) are included in a separate instruction sheet from our office.
You will be seen in the preoperative area before your surgery to answer any questions you may have. Dr. Vernace will mark your shoulder with his initials to identify the correct shoulder for surgery. From the time you leave the preoperative area and walk back to the operating room to the time you are in the recovery room will be approximately 90 minutes. You will be in the recovery room for approximately 1 to 1 1/2 hours. Someone will need to drive you home that day.
At the time of your surgery, any and all abnormalities in your shoulder will be identified and any of those that can be corrected with the arthroscope (which are most things) will be addressed at the time.
Photographs will be taken that will be shown to you at your follow-up
visits. These will be a permanent part of your office and hospital record.
Your incisions will be closed with small stitches. A large gauze dressing and bandage will be placed on your shoulder. A sling or shoulder immobilizer may be needed depending on the specific surgery that was done.
At the end of your surgery, long acting Novocain (marcaine) will be injected into your shoulder. This should keep you fairly comfortable for several hours. You will use an ice pack frequently to keep down swelling and help control pain. Instructions on its use and full instructions
regarding your dressings and pain medicine will be given to you at the hospital.
SHOULDER ARTHROSCOPY POST-OPERATIVE CARE
The day after surgery is generally your worst day. Many patients say they are fairly comfortable the first day due to the marcaine injection. This is common and should not alarm you if your shoulder hurts more the day after surgery than it did the day of surgery. By the second postoperative day, much of the swelling is down and you will start moving your shoulder a bit more (if allowed).
Depending on the type of surgery, your postoperative instructions will vary. If you have shaving of bone spurs (acromioplasty) or removal of a torn cartilage, you will be instructed to remove the sling as soon as you are comfortable and begin motion exercises. If anything has been repaired with stitches, such as a rotator cuff tear or a labral tear, you will be in a shoulder immobilizer and
instructed on postoperative management of this device.
You will return to the office one week after surgery to have your stitches removed and to check your incisions. This appointment will have been made at the time you scheduled your surgery.
Your activity level will be discussed with you and a discussion of your surgical findings will follow.
Depending on the type of surgery that was necessary, home exercises or physical therapy may be
started. At the end of that appointment you will be given another appointment to return to the office in
3 or 4 weeks.
Icing the shoulder even 4 or 5 days after surgery is helpful at painful intervals. Taking over-the- counter medicines such as ibuprofen (Advil, Motrin, etc.) or Aleve is often helpful and can actually reduce your need for stronger pain medicine.
Returning to work depends on your specific job. Many patients who have desk jobs will be able to return to work within 3 to 4 days. For example, if surgery is on Friday, returning to a desk job is usually possible on Tuesday or Wednesday.
In general the following postoperative programs apply:
In general, shoulder surgery is more painful than knee surgery. The recovery is usually longer as well. If you try to compare your surgery with someone who has had arthroscopic knee surgery, you will be disappointed at your rate of recovery....so don't compare!!!
SHOULDER ARTHROSCOPY POST-OPERATIVE THERAPY
Recovery from shoulder surgery varies a great deal depending on the surgery and the patient.
Not all shoulder arthroscopies are the same. If you have any significant arthritis findings, recovery is usually more prolonged. If you need physical therapy (as most patients will), the therapist will help us in guiding you back to your normal activities. Some problems inside the shoulder cannot be fully corrected but can be improved temporarily.
This is true of arthritic conditions especially. This will be discussed with you when your photographs are reviewed.
Most patients having shoulder surgery will need therapy. Due to the intricate nature of shoulder rehabilitation we strongly recommend our therapy center, Founders Physical Therapy, which is located right next to our office. We have chosen our four therapists and two therapy assistants for their experience, expertise and their warm and friendly manner in which they conduct their therapy sessions.
They have rehabilitated many patients with shoulder problems.
They have over 40 years of combined experience and have been recognized by many patients as the best therapy group on the main line.
You will receive individualized therapy, tailored to your needs. Many therapy centers do not spend the time with shoulder patients that is required to regain range of motion in a timely manor. This is a very fine line with shoulder rehabilitation between going too fast and causing harm, and going to slowly which causes stiffness and prolonged recovery.We work closely with the therapists throughout your recovery. If you are having any difficulties, you will be right next door and the therapist and you will have easy access to your surgeon to promptly address any concerns. Our facility is arranged for your comfort and needs, with a full service bathroom and shower, plasma screen televisions and private treatment rooms to be used as needed by the therapists. The phone number for the therapy office is 610-527-3300.