SHOULDER ARTHROSCOPY

Transcription

1 SHOULDER ARTHROSCOPY Information for Patients WHAT IS SHOULDER ARTHROSCOPY? The shoulder joint is the most mobile ball and socket joint in the human body and is the main joint of the shoulder girdle. It is formed by the head of the humerus (upper arm bone), which articulates with the scapula (shoulder blade). It is moved by the internal (rotator cuff) and external shoulder muscles (deltoid). Its stability and mobility depend on the joint capsule with the ligaments and, above all, on the function of the rotator cuff muscles. During an arthroscopic procedure, several small incisions are made in the elbow, causing less damage to its internal structures than is done during a classical operation. Other advantages of arthroscopy over traditional surgery are a better cosmetic result (smaller scar), a better or equal functional outcome, and a shorter rehabilitation period. Shoulder arthroscopy is used in the surgical treatment and diagnostic evaluation of various injuries (sprains, dislocations or fractures) and degenerative conditions of the joint and its internal muscles (rotator cuff). Patients mainly complain of pain on movement, limited motion, muscle weakness, recurrent dislocations and catching or locking in the affected shoulder. An arthroscopic procedure on the shoulder is performed to repair torn rotator cuff tendons; stabilise an unstable joint after recurrent dislocations; remove bone spurs from the shoulder blade, which interfere with motion in the shoulder and cause pain (shoulder impingement syndrome); remove loose bodies from the shoulder, which occur from various causes (dislocation, intra-articular fractures, degenerative conditions etc); treat defects of articular cartilage by cleaning its surface and promoting healing; 1

2 wash out the joint in chronic (e.g. rheumatoid arthritis) or acute inflammatory conditions of the shoulder; remove adhesions within the joint and release the joint capsule in the treatment of restricted motion in the shoulder (frozen shoulder) following fracture; remove some benign tumours from the shoulder. WHAT ARE THE EXPECTED BENEFITS OF SHOULDER ARTHROSCOPY? Shoulder arthroscopy is expected to bring about a reduction of pain, increase in mobility and improvement of muscle strength. We also expect to achieve a better cosmetic and functional outcome than with traditional open surgery. With this treatment we wish to slow down the development of degenerative changes in the shoulder and improve the patient's quality of life. Most patients are able to resume heavy physical work three to six months after the operation, depending on the degree of involvement of the joint. After the treatment is completed, we recommend the usual activities of daily life, swimming and other moderate sports activities. Intensive and more strenuous sports (running, tennis, skiing, riding, contact sports, football, basketball etc) are suitable only for patients who achieve good mobility without pain in the operated shoulder. WHAT ARE THE RISKS OF SHOULDER ARTHROSCOPY? Serious complications after shoulder arthroscopy are rare. Thus, in most patients, the benefits of the procedure outweigh its risks. However, complications can develop during or after the operation. Before deciding on this operation, you must be aware of the risks: During the operation, nerves or blood vessels can be damaged. Most of these complications can be treated directly after their occurrence. After the procedure, some patients experience transient tingling in the fingers, which subsides within a few months. 2

3 Swelling of the shoulder during the procedure is caused by the normal saline solution which is used to wash out the joint to improve visibility. The swelling can persist for a day after the operation and is not dangerous. Bacterial infection of the shoulder is a rare complication, which may have serious consequences. It can develop up to three weeks after the procedure. Infection is prevented with the use of antibiotics during and sometimes also after the operation. It is treated with infusions of antibiotics. Additional surgical procedures are often necessary. Draining of fluid from a postoperative wound (fistula) after shoulder arthroscopy is extremely rare but may require a reoperation. Stiffness in the shoulder can develop several weeks after arthroscopy as a consequence of tightness of ligaments, tendons, muscles or the joint capsule. A less common cause of stiffness is bone formation within the soft tissues (heterotopic ossification). ARE THERE ANY ALTERNATIVES TO SURGERY? If you decide not to have the operation, you may expect the pain, stiffness and loss of function in your shoulder to grow worse over time, which means that you will eventually have a constant need for pain medication and injections of medication into your painful shoulder. The operation cannot improve the status of your general health, and your deciding against it can have no life-threatening consequences. HOW SHOULD YOU PREPARE FOR ADMISSION TO HOSPITAL? While waiting for the operation at home, it is advisable to perform regular exercises for stretching and reduction of stiffness in the affected shoulder. With strengthened muscles, you will also make faster progress in your rehabilitation after the operation. 3

4 WHAT HAPPENS ON THE DAY OF SURGERY? You will be admitted to the hospital the day before the operation. You should bring to the hospital your health insurance card, and a referral note and examination findings received from your doctor. Before the operation, you will be asked to sign a consent form for the surgery and anaesthesia, and you will meet your surgeon, who will answer any questions you may have. During the morning ward round, for your safety, the doctor will mark the upper extremity on which the operation is to be performed with a pen. You will be told not to eat or drink anything for at least 6 hours before the procedure. Before the operation, you will remove all your jewellery and take a bath or a shower. Your doctor will tell you which of your regular medicines you may take in the morning of the day of the operation. A nurse from the ward will take you to the operating suite and leave you with the anaesthesia team. An anaesthesiologist and a nurse anaesthetist will check your identity and prepare you for the operation. Shoulder arthroscopy is performed in the operating theatre under general anaesthetic with the patient seated in a recliner and fast asleep or, less frequently, under regional anaesthetic (interscalene block), which causes loss of sensation in the upper extremity. HOW IS SHOULDER ARTHROSCOPY PERFORMED? The operation can last from 30 minutes to 3 hours, depending on the degree of involvement of the shoulder (torn rotator cuff tendons). During the procedure, the joint is continually irrigated with the normal saline solution to improve visibility. Arthroscopic incisions, measuring up to 1.5cm in length, are made on the posterior and anterior aspects of the shoulder. Through these wounds (portals), the surgeon inserts into the joint an arthroscope with a tiny camera and various small instruments needed for the operation (shaver, forceps, probes, anchors). 4

5 HOW LONG WILL I STAY IN HOSPITAL? The length of the hospital stay depends on a number of factors. If there are no complications, most patients complete their rehabilitation programme within 3 days. After the operation, you will return to the ward, where you will start to receive infusions of fluids, pain medication and, when necessary, an antibiotic to prevent an infection. Under the supervision of a physiotherapist, you will perform basic exercises to enhance the blood supply to your upper and lower extremities, and you will apply ice packs to the operated region. If the operation calls for immobilisation of the upper extremity, you will receive a suitable brace. Your rehabilitation programme will begin the day after surgery. You will learn exercises to increase mobility and muscle strength, and perform range-of-motion exercises for the operated shoulder. Next comes training in activities of daily life (e.g. bending forward, putting on shoes, combing hair, and brushing teeth). During the hospital stay, your wound dressings will be changed regularly, and blood tests will be performed as required. You will be taking all your regular medication that you take at home, with the exception of some diuretics (drugs that promote the excretion of water from your body) and certain blood pressure lowering drugs on the day of the operation and the first postoperative days. Detailed instructions will be given to you by your doctor. WHAT SHOULD YOU DO AFTER DISCHARGE FROM HOSPITAL? After discharge, your wound dressings will be changed every 2 to 3 days by your GP, who will also remove the sutures or clips from your wounds about days after the operation. Once you are home, until the first follow-up appointment with your surgeon (1-2 months after the operation), it is advisable that you exercise your operated upper arm, first under the supervision of a physiotherapist and then on your own. You should continue with the exercises you learned in the hospital and take your pain medication only when needed. 5

6 You can start driving once your muscle strength in the operated shoulder is sufficient to allow safe turning of the steering wheel and changing of gears usually no sooner than 5 weeks after the procedure. The same restrictions apply to household chores and swimming. Ask your surgeon during your first follow-up visit when you can safely resume these activities. WHO SHOULD I CONTACT IN CASE OF DIFFICULTIES AFTER DISCHARGE? If you have any kind of difficulties after discharge from hospital, first consult your general practitioner or, outside regular working hours, the doctor on duty in your health centre. When seeing a doctor, always bring with you your discharge summary from the hospital. In case of a major complication, your doctor will arrange an urgent appointment with an orthopaedic surgeon. If a bacterial infection is suspected, you should not take any antibiotics before seeing an orthopaedic surgeon. 6