Shoulder Anatomy

Bursa - is a small sac filled with fluid that cushions the tendon from the bone.
Labrum - is a rim of cartilage that helps to stabilize the joint.
Capsule - is an envelope filled with fluid that assists in joint stability.

The shoulder is classified as a ball and socket joint. It is the most mobile joint in your body.

There are four common problems a person may have with his/her shoulder.

1. Impingement caused by inflammation of the rotator cuff and bursa. Pain occurs when raising the patient's arm above his/her head.
2. Recurrent Dislocation caused by a tear in the labrum or excess laxity in the joint's capsule may result in a disability.
3. Painful Instability occurs when a shoulder is forced beyond the joint's normal range of motion causing the ball to move abnormally in the socket.
4. Arthritis may be caused by long-term wear and tear, infections, injuries or a variety of other diseases. It is characterized by roughened joint surfaces with worn cartilage. Fragmentation of bone and cartilage is also known as loose bodies.

1. Arthroscopy: allows the surgeon to look inside the shoulder joint using small incisions and identify the problems. The surgeon may often be able to correct the problem using this procedure by removing loose unwanted tissue from the joint, with less disturbance to the joint. Recovery time is usually short.

2. Bankart procedure: an operation that tightens ligaments and repairs torn capsular detachments, restoring shoulder stability. It is often performed for athletes involved in throwing sports who suffer from recurrent dislocations and subluxations. It allows the patient to return to contact sports such as baseball, football, wrestling, and ice hockey because the muscles and tendons are returned to their anatomic locations.

3. Rotator cuff repair: a procedure that is performed to repair the tear, therefore, relieving the patient's pain and improving function of muscles and tendons that move the joint. The surgery is commonly performed on older patients who complain of pain and weakness in the deltoid region that occurs with normal daily activities as well as work and sport. The pain is often worse at night.

4. Prosthetic shoulder replacement: a procedure involving replacement of the head of the humerus or "ball" (hemiarthroplasty) or in some cases the resurfacing of the "socket" or glenoid as well (total shoulder replacement). This surgery is sometimes performed for patients with arthritis in the shoulder joint because it provides pain relief, which is the major indication for the procedure. Improvement of function may result but is less predictable.

Day of Surgery

• Arrive at the hospital at the designated time for surgery
• Bring comfortable clothes, preferably shirts that are very loose fitting or those that button up the front to wear home
• Leave valuables at home
• Remove rings from operative hand
• You will go to the operating room on a cart with your gown on
• An IV will be started in the holding area or in the operating room

On the Orthopaedic Floor

• You will be asked to cough and breathe deeply. This is important for prevention of pneumonia and also helps clear your lungs of anesthesia.
• The nurses will ask you to move your fingers, check the color, temperature, pulses and the sensation to your operative side.
• Pain medication may be administered through your IV or may be given every 3-4 hours in a shot form as needed for pain.
• You will begin walking the same evening of surgery or the next day as this is important in the prevention of blood clots.
• Your IV will stay in during surgery and until oral intake is adequate.
• You may have a drain in your shoulder to prevent excess fluid collection in the incisional area.

Therapy may begin as early as the first day after surgery or you may remain with your shoulder joint immobile for a length of time.

Some of the exercises include pendulum, weights and pulleys. Even if the shoulder joint is not to be exercised it is important to exercise your fingers, hands and elbows to prevent stiffness.

Do not lift objects with your injured arm because this may strain the healing muscles.

It is important to perform your exercises as instructed on a regular basis for the return of a strong functional shoulder and arm. Our goal is to help you achieve the best use of your shoulder, but you are the one who has to do your exercises.

Immobilization Devices
One of these will be applied in the operating room.

• Sling
• Immobilizer
• Splint or airplane cast

Cleanse with soap and water. Sprinkle an absorbent powder (ie. Gold Bond_®) on an ABD pad, clean dry washcloth or handkerchief and place in armpit.

Pain Medications
These will be prescribed when you go home. It is important to take as prescribed and use especially prior to physical therapy and before performing exercises at home.

Incision and Dressing Changes
The incisional area will be swollen and bruised following surgery. Ice may be applied to the shoulder to relieve pain and prevent further swelling for 20 minutes after exercising.

Keep the incision line clean and dry. Most often the incision line has steri-strips holding the edges together and this is covered with a clear waterproof dressing called Tegaderm. If a bulky dressing is covering the surgical site do not remove unless instructed.

You may bathe after leaving the hospital but do not get the dressing wet. You may shower if a waterproof dressing covers the incision. Do not stand with the shoulder under the direct spray of water.

Call your doctor with the following:

• Signs of infection such as increase in warmth, redness or pain from incision line, new drainage, increase or change in drainage from clear to thick greenish-yellow or foul smelling, chills or fever.
• Change in sensation such as tingling, numbness in your fingers/arm.
• Decreased motion to injured/surgical arm not relieved with rest, repositioning, sling, or elevation.