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Shoulder (resurfacing) replacement

Introduction

Osteoarthritis (OA) of the shoulder is a painful condition that can cause a significant loss of function over time. The condition is usually characterised by a loss of the normal smooth surface of the ball and socket joint, which make up the shoulder. The cartilage that usually provides this smooth surface cannot be restored once arthritis has become established, thus the result is a loss of comfort and function of the shoulder, which is difficult to regain.

What to expect from your surgery

Joint surface replacement surgery can help to improve the mechanics of the shoulder by providing a smooth surface, which is often less painful. It cannot however, make the joint as good as it was prior to the arthritis. The effectiveness of your surgery depends on your level of motivation, the condition of the shoulder, your age, your surgeon and your Physiotherapist. The aim of a surface replacement is primarily pain reduction; however, other benefits may include improved stability and function. These are however, very much dependent on your rehabilitation with your Physiotherapist, and the quality of the deep muscles around your shoulder.

The procedure

This is usually performed under a general anaesthetic, with a small incision being made on the front of your shoulder. The surface replacement is a small metal cup like device that is attached onto the top your arm bone (Humeral ball). For the majority of patients' the socket (Glenoid) part of your shoulder is not replaced, but may be refashioned to create a smooth surface.

During the procedure some of the muscles around the shoulder are released to enable the surgeon to get into the joint. These muscles are reattached towards the end of the procedure.

Your recovery

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When you awake from your surgery, your arm will have been placed in a sling by the surgeon. It is usual for patients to continue wearing the sling for up to 4 weeks. It is fine to use your hand and elbow out of the sling during the day, with your arm close to your body. However when in the sling, you will probably need help with activities such as dressing, or washing your hair. It is usual for the sling to remain on at night for 4 weeks.

Pain control

During your stay your postoperative pain will be controlled by prescription medication on the ward. On leaving the ward you will be given a 5 - day prescription, after this time you may be able to downgrade to over the counter analgesics, or you may need to visit your GP to continue with the prescription drugs. Ice can be used at home as a useful adjunct or alternative.

Your recovery

A surface replacement is a big undertaking with regards to the rehabilitation. The first stages of recovery are covered in this information sheet and during the first 4-6 weeks, form the basis of your physiotherapy programme. You will need to see your physiotherapist once / twice a week during this initial stage (depending on how well your shoulder moves) and to prevent stiffness. Following this, physiotherapy becomes less frequent as you continue your exercises independently and move through the subsequent stages of rehabilitation, namely the return to functional activities and finally to hobbies and interests. This can often take up to 9 months.

Recovery Milestones

Sling up to 4 weeks
Return to driving 4-6 weeks
Regain passive range of movement. This can take up to 6 weeks, although it is unlikely full movement will be achieved.
Regain active range of movement. This can take up to 12 weeks, although it is unlikely full movement will be achieved.
Lifting: Avoid Heavy Lifting for 4 months

The early goals of rehabilitation:

Allow tissue healing
Keep pain controlled
Prevent stiffness/ restore passive movement
Keep expectations realistic.

Early Phase Shoulder Exercises - Copeland Shoulder Replacement (weeks 1-2)

Shoulder pendular exercises
Position: Arm in sling leaning your body forward. Support your body weight resting the un-operated arm on a table.
Action: Gently swing arm in sling back and forth, using a pendular motion. Try this also rocking side to side across body, whilst in sling.
Reps: Repeat x6-10 x 3 per day

Fist squeeze
Position: Arm in sling.
Action: Make a fist clenching tightly, to perform a static contraction of your shoulder muscles.
Reps: Repeat x6-10 x 3 per day

Passive flexion
Position: Lying on your back.
Action: Hold your operated arm around the wrist using your unoperated arm. Raise both arms up towards your head using your unoperated arm to raise your arm up.
Reps: Repeat x6-10 reps x3 per day

You may wish to try this initially with your arms cradled over your chest, then progress to arms straight as able.

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For further information and advice:
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info@shoulder-and-bone.co.uk
 

Alternatively, please call Michele Murphy:
T: 02392 352 206

 
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