Arthroscopic Subacromal Decompression

WHAT TO EXPECT:

  1. This operation is performed under general anaesthesia.  It is not possible, in Mr Jacobs's opinion to undertake this surgery under local anaesthesia.  However local anaesthesia is used post-operatively via an infusion pump.  Assuming you are fit, this operation can be performed on a day case basis.
  2. The infusion pump contains enough local anaesthetic to last four days.  It is a non-mechanical device that requires no maintenance by you.  The flow of the local anaesthetic is governed by the diameter of the fine catheter that is placed in the shoulder at the time of surgery.  You simply have to carry the plastic container with you for the four days after your operation.  Removal of the catheter will be arranged with you before you leave the ward in Highfield Hospital at a convenient place and time four days after surgery.
  3. In preparation for general anaesthesia, you will have to fast for six hours prior to surgery.  Any regular oral medication can be taken with just enough water to enable you to swallow the tablets.  You should not chew gum whilst you are fasting before your operation.
  4. There will be three small incisions around your shoulder, usually only requiring one stitch, through which the surgery is performed.  A fourth incision requiring only Steristrips will also be used to insert the infusion pump catheter.
  5. The infusion pump and its catheter along with the dressings to the other wounds should not be disturbed at all until the infusion pump catheter is removed on the fourth day.  Exposure to water e.g. when washing/showering should be kept to a minimum during the four days that the pump is infusing.
  6. After the operation your arm will be in a sling that you can discard as soon as possible to allow you to start mobilising your shoulder and upper limb.  A physiotherapist will see you pre-operatively and give you an exercise sheet along with an exercise pole.  You will be instructed by the exercises to undertake and you may require formal physiotherapy sessions post-operatively after the stitches have been removed.
  7. You will find that you will not require many painkillers whilst the infusion pump is running during the first four days after surgery.  However, on the morning of the fourth day when the pump catheter is due to be removed start taking some pain killers that have been prescribed, as there can be a rebound phenomenon when the local anaesthetic infusion stops such that the pain suddenly can become very severe.  This is unusual though.
  8. As you have had a general anaesthetic, you may feel more tired than usual for about 48 hours after surgery.  You may also feel sick, dizzy or faint, have a headache or sore throat. Very occasionally patients can feel nauseated up to 24 hours after an operation under general anaesthetic.
  9. You will receive an appointment through the post at two weeks after surgery for follow up and removal of your stitches.

WHAT TO DO:

  1. Mr Jacobs would advise you to take regular painkillers at home until the pain settles down.
  2. You may eat and drink normally if you feel like doing so.  Do not worry if you do not feel hungry.  If you vomit or feel sick then continue with bed rest and drink clear fluids only.
  3. The dressing of the wounds on the shoulder should be kept clean and dry and left in place for 48 hours.  You should try not to get the wounds and/or dressing wet.  If they do get wet by accident then all dressings should be removed and the wounds should be re-dressed after being dried with a hair drier on low to medium heat setting.  Under no circumstances should wet dressings be left applied to the wound for any length of time.
  4. You will be sent an appointment for follow up and removal of your stitches.  This is usually two weeks after the operation.
  5. Mr Jacobs will decide when he sees you for removal of your stitches whether you will need physiotherapy.  This is usually arranged at Highfield Hospital if it is required.  The number of sessions you will require will be decided by the physiotherapist themselves and will depend on your progress.
  6. Your return to work depends on the type of work you do.  If this is sedentary or office-based work then you can return to work as soon as you are able to use your shoulder for everyday activities probably after your sutures are removed at two weeks.  If this is heavy manual work then you will not be able to work for at least six weeks.  However, Mr Jacobs would emphasise that using your shoulder as soon as possible and as normally as possible would ensure the quickest road to recovery.  All that has been undertaken with the decompression of your shoulder is to increase the space available to the tendons of the rotator cuff so that they can move more freely and unimpeded.
  7. Mr Jacobs would advise that you can drive your car as soon as the pain has settled in the shoulder and you are able to grip the steering wheel.  If in doubt, ring either his secretary or contact your General Practitioner.

WHAT TO DO ABOUT PROBLEMS:

  1. If the shoulder becomes very painful, swollen, throbbing or inflamed; the wound could be infected and you should seek advice from the ward at Highfield Hospital with regards to this.
  2. If you find that the local anaesthetic pump leaks where it is inserted into the skin or anywhere else please contact the ward at Highfield Hospital.
  3. If anything else unexpected occurs please seek help.
  4. If you are worried in any way with regards to the surgical wound, please contact either Highfield Hospital (01706 655 121), my secretary (0161 448 2928) or your General Practitioner.  You can also use my email address: pennineshoulder@aol.com

Availability

Mr Jacobs is in Clinic on Monday mornings and Friday afternoons. In order to book an appointment please contact us.