Feedback We appreciate and encourage feedback. If you need advice or are concerned about any aspect of care or treatment please speak to a member of staff or contact the Patient Advice and Liaison Service (PALS): Freephone: 0800 183 0204 From a mobile or abroad: 0115 924 9924 ext 65412 or 62301 E-mail: pals@nuh.nhs.uk Letter: NUH NHS Trust, c/o PALS, Freepost NEA 14614, Nottingham NG7 1BR www.nuh.nhs.uk Capsular Shift Operation Information for patients The Nottingham Shoulder and Elbow Unit This document can be provided in different languages and formats. For more information please contact: The Trust endeavours to ensure that the information given here is accurate and impartial. Physiotherapy Department City Hospital Hucknall Road, Nottingham Tel: 0115 969 1169 ext 54580 Shoulder Unit, Physiotherapy Department May 2011. All rights reserved. Nottingham University Hospitals NHS Trust. Review January 2017. Ref: 0968/v2/0115/AS. Public information
This booklet contains information about the shoulder surgery that you have been advised to have and aims to answer some of the questions you may have about the operation and your stay in hospital. Notes About shoulder surgery at City Hospital There are two orthopaedic wards at City Hospital, Lister 1 for female patients and Edward 2 for male patients. You will be admitted to one of these wards during your stay in hospital. On each ward a named nurse will be allocated to you to coordinate your nursing care. You will also have named physiotherapists to supervise your rehabilitation. For further information about the ward, please refer to the ward information leaflet. You will usually be admitted to the hospital on the day of your operation, and you will usually go home the next day. If you think you will need transport to get home or help when you get home, please tell your named nurse when you first come in. What to bring You need to bring in with you any medicines that you are taking, toiletries, towel, nightwear and some loose and comfortable clothing. Please leave valuables at home. Operation day Your anaesthetist will see you either on the morning of the operation or the day before to discuss your anaesthetic with you. You will be able to eat and drink as usual the day before your operation. You may be able to have an early morning drink even on the day of your operation. The time you have to stop eating will depend upon the time of your operation. You must not smoke after midnight the day before the operation. 2
Notes Capsular Shift What is the problem? Your shoulder is the most mobile joint in your body and is therefore dependent on strong muscles to move and stabilise it. The most important muscles for this purpose are your rotator cuff muscles. These muscles originate from your shoulder blade and their tendons form a hood covering the ball of your shoulder joint. Underneath this is a fibrous capsule. Sometimes your capsule can be a little loose, allowing your arm bone to slide around a little in your shoulder joint. Doctors and other medical people call this instability. Instability can be painful, and in some people will lead to the shoulder dislocating. When your shoulder is dislocated the joint capsule is stretched or torn away from the front of the shoulder blade. If it is torn, a different operation such as a Bankart repair is done. Front view of the right shoulder 3
Capsular Shift operation - what is it? This is an operation to tighten the front and underneath parts of your shoulder capsule to prevent partial or complete dislocation. Your surgeon reattaches the loose underneath part of the capsule to a position further round at the front, making your capsule tighter. How is it done? The procedure may be carried out as a keyhole procedure (arthroscopically) using a telescope about 5mm in diameter and instruments of similar size. This will give you two to four small scars of about 5-7mm in length on the back, the side and the front of your shoulder. During your operation we will also examine your shoulder joint. Useful contact numbers City Hospital Campus 0115 969 1169 Dial the City Hospital campus number above, listen to the recorded message and then dial the appropriate extension from the list below. Professor Wallace's secretary Available Extension 56885 Mr Manning s secretary 57106 Mon Fri Mr Geoghegan s secretary 55047 8am 5pm Occupational Therapy 55330 Physiotherapy 54580 Edward 2 Ward 55879 24 hours Harvey 1 Ward 55904/6 if urgent Lister 1 Ward 55901/3 SSSU 53182 www.nuh.nhs.uk/physiotherapy www.shoulderdoc.co.uk Arthroscopic Open There may be technical reasons why we cannot carry out the procedure arthroscopically. This means it will be done in the traditional way (open), which will leave a scar about 4-7cms in length along the front of your shoulder, along the bra (or vest) strap line. 4
What will I do as an outpatient? You will continue with your exercises as given to you at the Physiotherapy Clinic. You will be given more exercises if you need them. You will gradually work on developing the strength and control of your shoulder, progressing to full functional movement. We will encourage you to learn how to use your shoulder comfortably. If you do heavy or demanding activities, you may also be helped by our occupational therapists. When can I do my normal activities? This depends upon your symptoms. Most people are comfortable by between six to 12 weeks after surgery. Driving can be resumed when you are comfortable and safe to control a car. It is wise to discuss this with your insurance company. We would advise you not to drive for at least six weeks after the operation as your arm may be in a sling. Type of activity Light work (no lifting) Medium (light lifting below shoulder level) Heavy (above shoulder level) Rest 3-6 weeks 6 weeks 3-6 months You will probably have a little pain after your operation - slightly more if you have had the open procedure. You will be given painkillers through a small tube (catheter) that leads into your shoulder. When will the stitches come out? If you have had stitches, they will be removed at your GP s surgery, usually 10 days after your operation. An arthroscopic wound does not usually need stitches. How will I look? Your shoulder wounds will have dressings on them, and you may have a small tube coming from inside your shoulder, in order to give painkillers into the shoulder. You may also have a drain. Will I have to wear a splint or sling? You will have your arm supported in a sling straight after your operation. Because this is to protect the repair to your capsule, you must wear the sling all the time for the next two to three weeks (you will be told how long). This may mean that you will need to organise for help at home. If you feel that your work or leisure activities come into the heavy category, please discuss this with the physiotherapists and occupational therapists, so that we can plan the best rehabilitation for you. 5
What will happen? You will be taught how to manage your sling by the therapists or nurses. You will be taught exercises to keep your elbow and hand moving when your drains have been removed. How can I sleep? You must not lie on your operated shoulder. We would recommend that you lie on your back or the opposite side, as you prefer. Ordinary pillows can be used to give you comfort and support (feather pillows are easier to use than foam ones). Wear your sling with the waistband fastened. One pillow slightly folded under your neck gives enough support for most people. A pillow tucked along your back helps to prevent you rolling onto your shoulder in the night. If sleeping on your back, tie a pillow tightly in the middle (a butterfly pillow ), or use the folded pillow shown before. This will support your neck. Fold another pillow to go under the elbow of your operated arm. Rehabilitation Rehabilitation is important if you are to get the most out of your shoulder after the operation. The first stage is to let your shoulder heal by resting it for two to three weeks in the sling. Meanwhile, you can bend your elbow and move your wrist and hand to make sure that they do not get stiff or swollen. Try to do 10 repetitions of each exercise twice a day. These are the only exercises you should do for the first two to three weeks. Your arm should be in the sling for the rest of the time. When can I go home? When your pain is controlled When you can manage your sling Is that the end of my treatment? If you have an anaesthetic pump in your arm you will have this removed at the hospital 48-72 hours after your operation. You may also see the physiotherapist at this time. At the City Hospital the follow-up clinic is run by specialist orthopaedic physiotherapists who will see you two to three weeks after you go home from the ward. At this point you can usually take off the sling and wear a simple band to keep your arm by your side. You will be shown some simple exercises to do. The clinic physiotherapist can arrange a quick appointment with the doctor if necessary. They will see you again at six weeks. You can now normally remove the band as well. At three months, you have another clinic check-up. This will be with your surgeons. If you are at all worried about your shoulder you should contact the Shoulder and Elbow Unit at City Hospital. The telephone numbers are at the end of this booklet. 6 7