Arthroscopic shoulder surgery for shoulder dislocation, subluxation, and instability: why, when and how it is done.
Edited By: Christopher J. Wahl, M.D., Suzanne L. Slaney, PA-C, ATC, MMS
Last updated Tuesday, January 25, 2005
Recovering from surgeryPain and pain management Recovery of comfort and function following shoulder stabilization
procedures continues over a few months. Initially, the shoulder must be
protected from overuse or stressing the repair while the shoulder heals
using a sling and a very strict rehabilitation program. Ironically,
many patients who undergo arthroscopic procedures feel very comfortable
long before the healing has taken place, probably because the approach
spares the patient from large incisions and dissection through the
muscle tissues.
Immediately postoperatively, the patient is given strong medications
(such as morphine or Demerol) to help with the discomfort of swelling
and the work of the surgery. Frequently, at the end of the operation a
surgeon can insert a temporary, easily-removable catheter (a tiny,
flexible plastic tube) into the shoulder joint that is connected to an
automatic pump filled with anesthetic solution. This “pain pump” can
help considerably with postoperative discomfort, and is removed by the
patient or their family 2 or 3 days after surgery. Most patients are
discharged to home with a prescription for oral pain medications (such
as hydrocodone or Tylenol with codeine) and an anti-inflammatory
medication. After the “pain pump” is removed 2 or 3 days after the
operation, the oral medications alone are sufficient for occasional
discomfort. Use of medications Immediately postoperatively, pain medications are given through an
intravenous (IV) line. Patients who require a hospital stay are placed
on patient controlled anesthesia (PCA) to allow them to administer
their own medication as it is needed. Most patients will go home with a
“pain pump” catheter in place connected to an automatic pump that will
administer pain medication directly into the shoulder at a constant
rate for 2 or 3 days. Oral pain medications are rarely required after
the first week or two following the procedure.Effectiveness of medications Pain medications are very powerful and effective. Their proper use lies
in the balancing of their pain-relieving effect and their other, less
desirable effects. Good pain control is an important part of
appropriate postoperative management.Important side effects The medication in the “pain pump” has a similar effect to the
medications used by the dentist during dental procedures—it “numbs” the
shoulder joint slightly so that the pain is minimal. These medications
have few side effects, and do not cause drowsiness or gastrointestinal
side effects.
Other pain medications (taken through the IV or orally) can cause
drowsiness, slowness of breathing, difficulties in emptying the bladder
or bowel, nausea, vomiting, itching, or allergic reactions. Patients
who have been on pain medications for a long time prior to surgery may
find that the usual doses of pain medication are less effective. For
some patients, balancing the benefits and side effects of medications
is challenging. Patients should notify their surgeon if they have had
previous difficulties with pain medications or pain control. Hospital stay Most patients will not require a hospital stay after a shoulder
stabilization procedure, particularly if done through the arthroscope.
Generally, a person must spend an hour or two in the recovery room
until the anesthetic medication has worn off. The instructions for the
care of their shoulder, bathing, use of medications, and potential
problems are explained to the patient and their family prior to
discharge.
Recovery and rehabilitation in the hospital When the patient is ready for discharge they should have been explained:
- What home exercises are appropriate and how often to do them
- How and when to remove the “pain pump” (if it has been inserted)
- How to take their medications
- When and how to remove the postoperative dressing
- How to use their postoperative sling
- How to care for their shoulder and incisions
- How to recognized potential problems, and what is normal and abnormal
- Who to call if there is a question
Because fluid is used to expand the shoulder joint during
arthroscopic procedures, the shoulder is frequently swollen for a few
days following surgery. Also, the incisions will “weep” fluid for a
couple of days postoperatively, and the dressing can become damp.
The patient is asked to refrain from using the shoulder and arm EVEN
IF IT FEELS GOOD for 3 to 4 weeks after the procedure and remove the
sling only to perform a strict set of limited exercises of the wrist,
elbow and shoulder. These exercises will be explained prior to
discharge.
Some patients find that finding a comfortable position to sleep can
be difficult for the first few days. Some tricks to help sleeping are
to:
- Try sleeping in a semi-reclined position or recliner chair
- When lying down, support the elbow from behind with one or two pillows so it doesn’t fall back against the bed
- The patient should not sleep on their side or stomach
For the first 3 or 4 weeks, a home program of rest and limited
self-therapy is usually recommended. Then, as healing has progressed,
the arm is removed from the sling and a formal rehabilitation program
is started with the physical therapist, on an outpatient basis.
Surgery for shoulder dislocation, subluxation, and instability at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-543-1552 or 425-646-7777 to make an appointment.
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