Shoulder pain is a common problem for obvious reasons. As the most flexible joint in the body, the shoulder joint allows for the placement and rotation of the arm in many positions in front and behind the body, as well as above and to the side. This flexibility makes the shoulder quite susceptible to instability, injury and various degrees of shoulder pain. Treatment depends on the nature of your shoulder pain problem, but often, nonsurgical methods of treatment to shoulder pain are recommended before surgery. However, in some instances, delaying the surgical repair of a shoulder can increase the likelihood that the shoulder pain problem will be more difficult to treat. Early, correct diagnosis and treatment of shoulder pain can make a significant difference in the long run.
Surgical vs. non surgical treatment of shoulder injury
Not all shoulder injuries require surgical treatment. In fact, up to 40% of all referrals to shoulder specialists are non-surgical. To provide more options for non-surgical patients with shoulder injuries Canadian Surgery Solutions has partnered with LifeMark Health to create a non-surgical shoulder care program at LifeMark Health’s facility at the Max Bell Arena. To learn more about this program call LifeMark Health at 403.569.8812.
Shoulder Care Centre
Collaborative, Multi-Disciplinary Treatment Planning for Patients with Shoulder Disorders
The Shoulder Care Centre (SCC) provides an innovative service to improve access and management of patients with shoulder disorders through a multidisciplinary, team-oriented model of care involving Orthopedic Surgeons, Sports Medicine Physicians and Physiotherapists.
The specialized team at the Shoulder Care Centre will streamline the assessment and treatment of shoulder disorders and ensure that patients are receiving the most appropriate care. Our multidisciplinary approach fosters communication and collaboration between the patient and all care providers in an efficient manner.
Each individual referral is reviewed to determine which professional is most appropriate for initial consultation. Referrals from family physicians, sports medicine physicians, physiotherapists, chiropractors, and any other health care professional will be accepted. In addition, patients may access the clinic directly.
Based on the findings of the initial consult, the Shoulder Care Centre team will develop and implement an individualized conservative treatment plan, which may include: a customized exercise program, education, bracing, physiotherapy services, cortisone or PRP injection, massage therapy, pain management planning, and traditional and non-traditional medicine.
- If appropriate, further diagnostics and/or a surgical consultation will be coordinated immediately.
- The outcome of the consultation, treatment plan and any changes in treatment planning will be communicated to the patient’s family physician.
- An assessment fee of $175 encompasses costs associated with uninsured services provided in this multidisciplinary, comprehensive spectrum of care.
Common shoulder injuries for surgical repair include rotator cuff tears, acromioplasty and shoulder stabilization to address shoulder dislocation(s).
- Rotator cuff repair: usually performed arthroscopically but sometimes done using ‘mini-open’ technique with the goal to reattach tendons in the shoulder to bone.
- Acromioplasty: an arthroscopy procedure to widen the space between the upper arm and the shoulder blade so that the rotator cuff tendons do not get stuck between them.
- Shoulder stabilization: the objective of the procedure is to tighten and repair the static stabilizers in the shoulder joint to prevent future dislocation. This means that physiotherapy after the procedure is often necessary to help regain flexibility and strength while the shoulder is healing.
Shoulder Surgery Recovery
HOW MUCH PAIN WILL I HAVE?
Following surgery most patients will experience a variable amount of shoulder pain. This is dependent on what type of surgery you have had and how your body reacts to surgery. Your doctor will give you a prescription for pain medication following surgery to control your shoulder pain. You may also apply intermittent ice packs to the shoulder to relieve pain. This is most helpful in the first 72 hours. Never apply ice directly over the skin. Wrap it in a towel or cloth. You may apply ice for 15-20 minutes per hour. A cryotherapy unit and cuff may be recommended by your surgeon.
HOW MUCH SWELLING AND BRUISING WILL THERE BE?
Following shoulder arthroscopy there will be a significant amount of swelling in the shoulder. This is mostly due to the arthroscopy fluid which is used to expand the joint. It is not uncommon for the swelling and bruising to travel down the arm, into the forearm and hand and also into the chest and thorax. To help with the swelling you should perform simple hand, wrist, and elbow exercises several times a day. If you feel you are having an extraordinary amount of swelling or bruising following surgery, please contact your doctor.
HOW MANY INCISIONS WILL I HAVE?
Shoulder arthroscopy is performed through small puncture (lcm) incisions through the skin. Depending on what procedure you have performed you may have anywhere from 2-10 small incisions. Most patients have 3-6 small puncture incisions.
WHEN CAN I TAKE A BATH OR SHOWER
Generally, you should not take a bath (i.e. soak the wound) until the wound is completely healed which may take up to three weeks. However, you may shower or sponge bath 24 hours after surgery. You may take your arm out of the sling when taking a shower and support the arm and its weight using the opposite arm. For the first five days the wound must be kept dry using a garbage bag or taping saran wrap over the shoulder. After five days you can shower by gently and briefly letting the water run over the shoulder. Do not scrub the area. Only allow water over the wounds if the wounds are dry. After taking a shower pat the wounds dry with a clean towel. It is important to keep the axilla (i.e. armpit) of the operated shoulder clean and dry. To clean the axilla, don’t try to lift the arm away from the body suing the muscles of the shoulder. Instead it is easier to lean towards the operated side and let the arm gently dangle away from the body supporting the arm. You can then wash and dry the axilla.
HOW OFTEN DO I NEED TO WEAR THE SLING
This depends on what type of surgery you have had. In general, if you have had a repair (e.g. rotator cuff repair, labral repair, instability repair) then the sling is worn for 3-6 weeks. During that time you should wear your sling 100% of the time, including sleeping unless you are doing your exercises or taking a shower. If you have had only a decompression type procedure (e.g. subacromial decompression, acromioplasty, distal clavicle excision) or a procedure to gain motion (e.g. capsular release for frozen shoulder) then your sling is for comfort only. You may take your sling off as soon as possible and begin moving your shoulder. If you are having trouble wearing your sling please contact your doctor.
CAN I USE MY ARM TO EAT OR WRITE?
You can gently use your operated arm to eat. It is easiest to slip your arm out of the sling and use your hand to feed yourself by bending at the elbow. Keep your elbow at you side and do not reach or do anything away from your body (e.g. picking up a plate, cutting tough meat) or lift anything heavy (i.e. no more than a cup of coffee). Similarly, you can write using your operated arm by keeping the elbow at your side. If you have had a procedure on the biceps tendon, talk to your doctor.
HOW CAN I GET TO SLEEP COMFORTABLY?
Some patients have difficulty finding a comfortable position to sleep. When you sleep on your back it may help to place a small pillow behind the elbow or shoulder to help support the weight of the shoulder. If you sleep on your side (the operated side up) then it may help to place a pillow between your arms. You can also sleep in a reclining chair or propped up with a pillow in bed. When you are getting in and out of a bed or chair, DO NOT use your operated arm to push down.
WHEN SHOULD I RETURN TO WORK?
This usually depends on the type of work you do, how much pain you are in and what type of shoulder surgery you have had. In general, most patients do not work until they are seen back in the clinic about 7-10 days alter surgery. After this most patients are able to tolerate either single-handed work like answering the phone, or light deskwork duties only.
Your surgeon will provide you with specific post surgical instructions relevant to your needs to ensure a safe progression back to your regular duties.