Total Shoulder Replacement
WHAT TO EXPECT:
- This operation is performed under general anaesthesia. It is not possible, in Mr Jacobs's opinion to undertake this surgery under local anaesthesia. However, your anaesthetist will insert a needle at the base of your neck in order to a local anaesthetic block into the nerves that provide sensation to the upper limb (the brachial plexus). This is to give you post-operative pain relief. This is usually undertaken once you are asleep under the anaesthetic.
- 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.
- The operation is undertaken through an incision in what is called 'the bra strap area' at the front of the shoulder and is usually between 8 and 10 cm long.
- After the operation your arm will be in a sling that you that should be retained for approximately 6 weeks. A physiotherapist will see you pre-operatively to give you instructions as to what exercises to do after your operation. This will relate to keeping your elbow, hand and wrist mobile whilst you are wearing a sling. You will also be allowed to undertake some exercises of your shoulder and you will also receive instruction with regards to this.
- Immediately following your operation, your arm should be pain-free for between 12 and 36 hours. However you should be aware that if you feel any slight niggle of pain in your shoulder, start taking analgesics or ask the nursing staff for these as soon as you feel this as the local anaesthetic block can wear off very quickly leaving you in severe pain.
- It is possible that in the first 24 hours after the operation you may experience very severe pain which will be controlled for you. It is this that will prevent you from going home. Most patients are discharged between three and five days after this kind of surgery.
- 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.
- You will receive an appointment through the post at two weeks after surgery for follow up and removal of your stitches.
WHAT TO DO:
- Mr Jacobs would advise you to take regular painkillers at home until the pain settles down.
- 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.
- 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.
- You will be sent an appointment for follow up and removal of your stitches. This is usually two weeks after the operation.
- Physiotherapy will be arranged for you at Highfield Hospital at a time that is convenient. The number of sessions you will require will be decided by the physiotherapist themselves and will depend on your progress.
- Mr Jacobs would advise that you can drive your car after about six weeks when you can remove your sling, as at this point the tendon that has been taken down to allow insertion of the total shoulder replacement will have healed sufficiently to allow you to start using your shoulder actively.
- You will probably require long-term follow-up after your shoulder replacement operation. If your health insurance does not cover this, arrangements can be made for this to be undertaken as an NHS patient. This might require you to request your General Practitioner to refer you to Mr Jacobs at Royal Oldham Hospital for this follow-up.
WHAT TO DO ABOUT PROBLEMS:
- 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.
- If anything else unexpected occurs please seek help.
- 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.
