I will see you 2-4 days after the surgery. A clear, plastic dressing will be applied on that visit so that you can shower. A physical therapy visit 2-4 days post operative is desirable. The sling is usually removed at that time and is rarely recommended for more than 3 weeks.
You will be instructed before the surgery and after the surgery on appropriate rehabilitative exercises. Physical therapy is for you to regain your motion and to strengthen the muscles about the shoulder. Some of you will need more supervised physical therapy than others. It takes about 2-3 months to regain most of your motion and strength.
Time out of school will vary from 3-4 days to 7 days. Work activities involving full strength and motion will require about 3 months. I ask all patients to stay out of athletic activities for six (6) months after surgery. We have found that the recurrence rate after surgery is much higher if you return to athletics at less than six months.
What you can expect from the surgery is to significantly reduce the likelihood of redislocation or resubluxation. Without surgery, the chances of recurrence are at least 90 to 100%. With surgery, the chances of recurrence for all patients overall are about 5%. As a group, football players have a slightly higher recurrence, but this is generally less than 10%. Because of the nature of the sport of football, some recurrences after surgery may have occurred with a normal shoulder.
As far as complications are concerned, recurrence of dislocation and subluxation is the most common. Fortunately, that is rare. Another complication which can occur is significant loss of motion, but can be avoided with diligent attention to rehab and exercise. Small degrees of loss of motion are not uncommon and usually not a problem. Loss of motion can be a problem in the dominant shoulder with pitchers or other athletes involved in overhead throwing or racquet sports. I will discuss this matter individually with those of you in those categories.
Surgical complications such as blood clots, and infection, can occur but are extremely rare in my experience. Infection, if it occurs, can be very serious and can result in loss of motion and arthritis. None of my patients have had an infection following this type of surgery. Important nerves and blood vessels are close to the surgical area, and there have been reports of injury to these structures. This obviously is a very serious complication. If it happens, it could result in serious impairment to the arm or even loss of the extremity. This has not occurred in my experience. Small skin nerves are, however, cut in the process of making the incisions, either the incision to reconstruct the shoulder or to do the arthroscopy. This will result in some numbness around the surgical site which should not be a problem other than a minor annoyance that cannot be avoided.
Anesthetic complications can occur and will be discussed with you by the anesthesiologist on the day of your operation. You will either have a general anesthetic or have some local anesthetic injected in the base of your neck to numb the arm and shoulder. In that case, you would remain awake but sedated during the procedure. The decision as to the type of anesthesia will be up to you and the anesthesiologist.
Some of you will probably have some questions about a pure arthroscopic repair or reconstruction. At the time of this writing, the results of arthroscopic reconstructions are good but not as good as open reconstructions and repairs. Reported recurrence rate after arthroscopic reconstruction ranges from 8% to as high as 30%. These results are from the hands of accomplished, select arthroscopic surgeons. The only advantage of arthroscopic reconstruction is a smaller incision and less pain immediately after the surgery.
In general, the length of immobilization/rehabilitation is longer with arthroscopic reconstructions than with open or conventional surgery described above. There are a few patients that I think are suitable candidates for an arthroscopic reconstruction, and I will discuss that with you if you are in that category. As time passes and our experience grows with this technique, I feel that the results will improve and arthroscopic reconstruction will be recommended more often.
*The information contained in this patient education packet is intended to help you and your families/ caretakers better understand a particular diagnosis and/or the treatment options available. If you have any questions after reading this, please don’t hesitate to contact Dr. Longobardi’s office at 201.343.1717 for a further explanation.
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