Bankart Repair/ Rotator Cuff Repair of the Shoulder. Patient Information

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1 Bankart Repair/ Rotator Cuff Repair of the Shoulder Patient Information

2 General Information biceps tendons rotator cuff tendons acromion ligaments bursa lies over the rotator cuff tendons and cushions them from the bone Anatomy of the Right Shoulder calvicle (collar bone) Shoulder surgery is done in the Operating Room under a general anesthetic and usually a nerve block. Surgery is done through a lighted telescope called an arthroscope to directly view the inside of the shoulder joint. The procedure usually takes one to one and a half hours. The shoulder is one of the least stable joints in the body due to its anatomy; thus it can be easily injured during an accident. Two common injuries are as follows: Rotator Cuff Repair A rotator cuff injury is usually caused by a sporting injury, fall or direct blow to the upper arm. The rotator cuff is made of four muscles attached to tendons. These tendons attach to the top of the upper arm bone and allow you to lift your arm above your head. When you injure your rotator cuff, one or all of these tendons can tear away from the bone, thus restricting your arm movement. The aim of surgery is to reattach these tendons to the bone and eventually allow you greater movement of your arm. Bankart Repair A Bankart repair is done to tighten a loose shoulder joint. A loose shoulder joint can be due to anatomy, repeated dislocations, or injury resulting in muscle strain or muscle/cartilage tear. 2 3

3 The aim of surgery is to tighten the joint. Stretched muscles are overlapped and stitched as shown in figure A. Figure A Day of your Surgery An intravenous will be started before your surgery. You will receive medications and fluids in this intravenous. An anesthesiologist will see you prior to surgery to discuss the anesthetic with you and answer any questions. Overstretched Ligament/Cartilage Tightened by Overlap If the loose shoulder joint is due to torn cartilage, the cartilage is reattached to the bone by making small holes in the bone and securing the cartilage with sutures through these holes as In Figure B. Figure B Torn Ligament/Cartilage Repaired Torn Ligament/Cartilage From the pre-operative area, you will move to the Operating Room where the surgeon will perform the surgery. A General Anesthetic will be used to make you sleep during your surgery. Your shoulder may be frozen (also called a nerve block) with local anesthetic, which will provide long-lasting pain relief. After your Surgery After your operation, you will be taken to the Recovery Room. A nurse will check your blood pressure and pulse frequently. You will wear an oxygen mask for a short time. It is important to indicate to your nurse if you are having pain or feel sick to your stomach. Your nurse will give you medication as ordered by your doctor. Your arm may appear pink in colour. This is because it has been washed with a pink tinged antiseptic in the operating room. This easily washes off with soap and water. If you have had freezing (a nerve block), you may have little or no feeling or movement in your arm for 4 to 12 hours. The intravenous will be left until you are able to drink fluids and have received the last dose of antibiotic as ordered by your doctor. 4 5

4 Bleeding There may be a small amount of drainage/blood on the bandage. This is usually not a cause for concern. If the dressing becomes soaked with blood, apply firm steady pressure over the area for minutes or until the bleeding stops. Dressing You may remove the dressing (white gauze bandage) in days. If no specific instructions from your doctor, remove in 3 days. Leave the tapes (steri-strips) on that cover the incisions. If there is any drainage from the incisions, apply a new dressing. When applying a new dressing, do not touch the side that goes against the wound. Dressings may be purchased at any drugstore. In 5-7 days, remove the steri-strips. If they fall off before that, replace them with band-aids. Sling Your arm will be in a sling and positioned at a right angle. For the first few days you may take your arm out of the sling for pendulum exercises 2-3 times a day, then place it back in the sling. The sling protects your arm and takes the weight off your shoulder. It is supported in the position least stressful to your shoulder. Rest your arm supported on a pillow when sitting or lying down. The sling should stay on until you see your doctor, but you should continue with pendulum exercises for 5-10 minutes, 3-4 times a day. Swelling Your shoulder will be swollen and somewhat uncomfortable for hours after your operation. This is normal and partly due to the fact that some fluid is injected into the shoulder during the surgery. Apply covered ice packs over the shoulder for minutes every hour (as needed) to reduce swelling and pain. Do not put ice in direct contact with the skin. Your doctor may instruct you to use a cryo cuff, to provide more frequent icing. A plastic bag with ice cubes or a bag of frozen peas placed in a pillow-case or towel works well (Do not eat peas after use as an ice pack). If you have swelling in your arm or hand, you may elevate the arm on pillows for minutes and pump the hand (opening and closing your hand repeatedly) 3 times a day until the swelling goes away. This is best done when lying flat. Bathing You may shower in days. If no specific instructions from your doctor, you may shower in 5 days providing: the steri-strips have been removed, and the incisions are dry and healing Before 5 days, you may shower with a plastic wrap taped over your dressing. Do Not get the dressing wet. Do Not soak the area in the bathtub until discussed with your doctor. 6 7

5 Medications You may receive a prescription for pain medication. Some of these medications may cause drowsiness and constipation. To prevent constipation, eat full grain breads, bran cereals (All Bran, Bran Buds, Fruit and Fiber), fruits (prunes, raisins, dates, bananas, apples), and vegetables. You may ask your doctor or pharmacist about a mild laxative or stool softener, if you are having difficulty having a bowel movement. If you have a nerve block, take your pain medication before you go to bed the night of surgery. This will help the pain if the block wears off during the night. Pain medication is to be taken, as ordered by your surgeon. Taking pain medications on a regular basis during the first few days after surgery will help control the pain and stop it from becoming worse. Do Not drink alcohol when taking pain medication. Activity Unless otherwise instructed, you may be as active as you wish, as long as it does not cause undue pain or discomfort. Consult with your doctor about when you will be able to drive again. Avoid stressing the shoulder joint. Do not carry objects greater than 10 pounds or do heavy physical activities. Your surgeon will refer you to a physiotherapist for shoulder exercises. He/she may also provide you with an exercise instruction sheet. Physiotherapy will begin at 6 weeks after your surgery. Pendular Swings Spend about 10 minutes, 3 times a day exercising your shoulder to your comfort level. Putting ice packs on your shoulder before and after your exercises may reduce pain with activity. These exercises should be performed gently using the strong arm to assist the newly repaired arm if necessary. A) Rest your good arm on the edge of a table. Bend over from your waist. Allow your affected arm to hang down - it should hang limp and loose. Breathing deeply in and out can improve shoulder and arm relaxation. Swing it back and forth for a smooth pendular motion about 10 times. B) Now allow it to circle gently in a clockwise direction with circles that grow gradually larger. Repeat 10 times. Now go counter clockwise. Repeat 10 times. Plans for returning to work depend on the nature of your job, as well as your general health and recovery. Discuss this with your surgeon. 8 9

6 Going Home Usually, you go home within two to three hours of surgery. You must have a responsible adult pick you up and drive you home after the surgery. Follow up Appointment Contact your surgeon s office to arrange for a follow up appointment in Notify your surgeon or go to the Emergency Department if any of the following happen: Bleeding continues even after applying direct pressure to the area for minutes. Chills or fever (38.5 C/101.3 F or higher) Wound becomes red, swollen, warm to touch and/or with pus-like (yellow or green) discharge. Pain is not relieved by prescribed medication Nausea and vomiting continues You notice signs of circulation problems (numbness, coolness, change in skin colour, difficulty moving fingers, hand or forearm), which are not relieved by elevating the arm or loosening the bandage. Numbness for the first 2 days after surgery is normal. You are unable to pass urine for more than 8 to 10 hours even though you have been drinking plenty of fluids

7 Besides these general instructions remember also: Questions you may have: For more copies, go online at or and quote Catalogue No. FB.813.B225 Vancouver Coastal Health, February 2013 The information in this document is intended solely for the person to whom it was given by the health care team.

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