The shoulder is a complex ball and socket joint with more range of movement than any other joint in the body. It is therefore very susceptible to injury, particularly in sports or movements involving overhead, repetitive shoulder movements, or trauma.
Shoulder surgery is often indicated for more complex injuries, those related to acute or sudden trauma like falling on the shoulder, or those that don’t respond to non-surgical management strategies. These non-surgical strategies can include Physiotherapy, manual therapy, exercises, pain medications, anti-inflammatories or injections.
The rotator cuff is a group of four muscles (supraspinatus, infraspinatus, subscapularis, teres minor) around the shoulder that act to provide support for and allow shoulder movement, strength and function. Injuries (partial or complete tears) to any or some of these muscles (for example repetitice overuse injuries or direct trauma through sport or car accidents) can impact on shoulder movement, strength and function.
Rotator cuff repairs are a common procedure performed to repair one or some of the injured rotator cuff muscles. The procedure can be performed through arthroscopy (keyhole or small incision) or open surgery. This is often performed by suturing the tear or re-anchoring the tendons to the bone, thus aiming to fix the structural issue.
Shoulder arthroscopy involves the use of a camera guided through the shoulder joint through small incisions (often keyhole) in the skin. This allows the surgeon to look inside the shoulder joint and so they can more accurately and visibly determine any structural damage. They can then continue with the procedure to fix the structural issue without causing too much trauma to surrounding structures and areas.
This procedure is often conducted when radiological investigations (such as MRI or ultrasound) do not suggest any significant findings, or the symptoms do not correlate to the investigative findings.
This type of shoulder surgery involves the replacement of damaged parts of the shoulder with artificial components. It often refers to the bone and thus can either replace the head of humerus (ball) or the glenoid (socket), or both.
A full shoulder replacement is only indicated once other treatment options have been exhausted, or if pain or stiffness is affecting function. It is often performed for osteoarthritis, rheumatoid arthritis, or severe trauma or fractures.
The decision to undergo shoulder surgery is often determined in collaboration with your General Practitioner and Orthopaedic Surgeon, and is based on your levels of pain, movement restrictions and loss of function.
Following surgery, you will be provided with a directed protocol from your surgeon. A sling may be used for some weeks. Advice is often to rest as appropriate, and then over time to gradually rebuild range of motion and then strength through the shoulder. This is often conducted in collaboration with and guidance of your Physiotherapist.
Rehabilitation will take weeks to months. This is often determined by the type of surgery you had, the structural injury of the shoulder and length of time of symptoms prior to surgery, as well as other factors including pain tolerance, age and general health status, which can all play a role in healing time and recovery.
Physiotherapy can post-operatively assist in rehabilitation to improve shoulder mobility, strength and function through the prescription of an individualised treatment plan often consisting of prescription and progression of home exercises to regain mobility and strength through the shoulder, reduce pain and work towards regaining your functional goals. The personalised exercise programme can be done at home or in a supervised setting. This has been shown to be beneficial in maintaining function and preventing the need for another surgery. Physiotherapist’s initially then Exercise Physiologists later in the rehabilitation phase can provide this.
It will be important to follow the guidance of your General Practitioner and Orthopaedic Surgeon regarding their reocmmendations for the provision of further medical assistance such as pain medication or anti-inflammatory prescription as required. Shoulder surgery can be very painful, and medication could assist in your recovery. Ensure you discuss this along with any other medications you are taking with your medical practitioner.
Finally, if you are considering or planning on undergoing shoulder surgery, ensure open discussion with your treating health care professionals including General Practitioner, Orthopaedic Surgeon and Physiotherapist involved in your care
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