The tip of the shoulder blade (scapula) forms the roof of the shoulder joint, also called the acromion. Normally, the shoulder tendons (the rotator cuff) and a fluid-filled bursa have plenty of room under the acromion. They slide freely in this space and allow full freedom of movement. Overuse of the shoulder can damage the tissues below the acromial process. Tendons and bursa can thicken and then press against the bone and/or coracoacromial ligament, causing irritation and pain. This is known as "impact syndrome".
Athletes and workers who play sports or perform overhead work are at risk for this shoulder problem. People whose work involves repetitive shoulder movements or frequent overhead movements are also prone to shoulder impingement.
Some patients have an anatomical variation of the acromion (a protruding tip) and are more prone to this problem. Impingement can also occur where this bone meets the collarbone (clavicle) at the acromioclavicular or AC joint. Occasionally there are distinct spurs at the AC joint, and the spurs "pinch" the cuff like a hooked acromion. The AC joint can also become arthritic, injured (as in a shoulder separation), or worn down or cystic from repetitive movements such as lifting weights (a condition known as osteolysis of the clavicle). It can also be a source of pain.
Limited use of the arm, pain with activity, difficulty sleeping or waking from sleep are common problems with this condition, and pain is often associated with activities of daily living (fetching milk from the fridge, washing hair, or putting on a coat). Patients look for presence. Complete inability to sleep through the night can get worse and require treatment.
treatment: If the problem does not improve with nonsurgical methods and if the problem is related to a protruding acromion, calcified acromialclavicular ligaments, or a thickened bursa, arthroscopic surgery may help. Through the arthroscope, Dr. Reznik can remove damaged tissue, enlarge the subacromial space, and clean the inflamed bursa. This procedure is called “acromioplasty” and is performed on an outpatient basis. If the AC joint is the source of pain, spurs, arthritic surfaces, cysts, and softened bone can also be removed arthroscopically. This is known as the "Mumford procedure" (distal clavicular resection). The choice of procedure depends on your problem, and in some cases both are needed to relieve persistent shoulder pain symptoms.
Mumford Acromioplasty/Recovery Plan (Post-Op Tips for a Better Recovery)
Diet: You can resume your normal diet when you return home. Most patients start with tea or broth with the addition of crackers or toast, and then a non-spicy sandwich. If you're nauseous, check to see if any of your medications are upsetting your stomach, most narcotics can. If your stomach is upset, try Tums, Zantac, or Pepcid AC to calm it down, and drink some clear liquid.
Lunge: After the operation, it is recommended to breathe deeply and cough frequently (at least 3-4 times a day). This reduces mucus build-up in your lungs and reduces the risk of developing post-anaesthetic pneumonia.
pain control: Take the one from Dr. reznik. Please call our practice if you have any questions about your medication.
Sling: It is recommended that patients wear the sling when leaving the hospital within the next 3 weeks. This helps others avoid the affected arm during this healing period.
Drive: The patient cannot drive until he is off all pain medication, completely out of the belt, and can easily place his hands on the steering wheel at the 12:00 position and move them freely from the 5:00 position. 9:00 a.m. to 3:00 a.m.
go back to work: Most patients who are sedentary or have a light activity are able to return to work within 7 to 10 days. They still have limitations in lifting (typically 5 pounds), repetitive use, and overloading. Patients doing moderate work that may require heavy lifting may return in about 3 to 4 weeks. Patients in high-demand occupations with less repetitive arm use require at least 6-8 weeks. Heavy workers, or those doing frequently repetitive or general jobs (e.g., manufacturing or construction), require at least 3-4 months and then a job conditioning program before they can return to work.
Note: Most patients show an 80% improvement within 4 months, the rest within the first year after surgery.
Scheduled Flights: Patients can fly on short flights (up to 2 hours) 2-3 weeks after surgery, but generally have to wait 6-8 weeks for longer flights. You have to get up and walk often to avoid blood clots and take aspirin (unless you are allergic)
Patients at high risk of blood clots include:
- Those with long journeys by car or train.
- You may be overweight.
- have a history of cancer
- women on birth control pills
- men over 40
- History of a clot
These patients should take 1 aspirin daily for 6 weeks after surgery unless they are allergic to aspirin. Patients with more than two risk factors or a history of clotting should ask their GP if they need a blood thinner.
Call your doctor or go to the emergency room if:
- You have excessive, persistent nausea or vomiting.
- have a fever over 101
- Develop any type of rash
- Do you have calf pain?
A gradual program of exercises and activities to increase muscle strength and movement is critical to regaining good shoulder function. On the day of the operation you will start with simple exercises. Your physiotherapy will start 3-4 days after the operation. The physical therapist will guide you through your shoulder rehabilitation program. It is very important that you start therapy when it is recommended to you.
To avoid complications, postoperative follow-up appointments with your doctor are also necessary to monitor your progress. Blood clots are rare after shoulder surgery. Patients should get up and move around as soon as they feel comfortable. Moving the legs and feet several times a day is recommended and should be done daily for the first 3 to 6 weeks after surgery to maintain blood flow and prevent blood clots.
Postoperative instructions for shoulder arthroscopy
Tag 1: On the day of the operation: In the recovery room you will start with arm movements and simple exercises. If you are at home, leave the bandage on. You can add 4×4 bandages for drainage through the dressing if needed. Apply an ice pack for 20 minutes throughout the day. Be careful to avoid ice for a long time or directly on the skin. Prolonged ice on the skin can cause frostbite.
Move your fingers and wrist frequently. Expect swelling. If your arm or hand changes color or the feeling changes, let your doctor know. Tonight, start with the pendulum and wall running exercises (see list).
** All patients find it most comfortable to sleep semi-upright in the first few weeks after shoulder surgery. A recliner is generally more comfortable, sleeping with pillows on a sofa helps when a recliner isn't available.
Tag 2: The day after the operation (same as day 1)
Tag 3-4: (48 hours after surgery) Resume the same activities as on the day of surgery: Use ice for 20 minutes. periods as needed. Continue gripping exercises, making sure to move your wrist and fingers frequently. Take off the bandage and shower today. In the bathroom; Hold the affected arm with the other hand. In the bathroom; Start bending and straightening your elbow. When showering, you must move your arm freely. You can wash under your arm, but don't use too much soap. Too much soap can dry out the skin and cause rashes. After showering, dry the shoulder thoroughly and place bandages over the incisions. Physiotherapy usually begins on the 3rd-4th day of the week. Day. It is an important part of your post-operative care. Continue with the therapy program, each week will be added to your home program based on your individual progress.
**Now only use the arm sling for comfort, only wear it when necessary and when you are in a crowded place (this will alert people to avoid your injured area). Do elbow, wrist and hand exercises at least 3 times a day - 15 repetitions.
Tag 4 – 10: Change strips daily or as needed. Keep using the sling to get comfortable. Continue with the exercises as described. Add bicep curls and increase your circle size as you do the pendulum exercises. Depending on the type of surgery you had and your own recovery rate, physical therapy will begin 3 to 4 days after surgery.
Tag 7 – 10: Keep your visit to the doctor. The doctor. Reznik will monitor your movements and incisions, review surgical findings, and provide further guidance on how to continue your rehabilitation and recovery.
Exercises: do three of each
Shaking hands or gripping: Squeeze your hand with a small soft rubber ball or soft sponge. In the shower you can use a sponge filled with water. Do this for 3-5 sets of 10-20 repetitions per day. If that is too easy for you, you can use a grip booster later in the rehabilitation course.
range of motion of the wrist: After each round of grip exercises, wiggle your wrist in a circle for 30 seconds.
range of motion of the elbow: Turn your palm inwards towards your stomach, bend and straighten your elbow as comfortably as possible. This abdominal rubbing motion relieves pain and prevents elbow stiffness.
pendulum exercise: Hold onto the edge of a table with your good arm, bend forward at the waist and allow your affected arm to fall. Swing your arm back and forth like a pendulum. Then rotate in small circles and slowly increase. Do this for a minute or two at a time, rest and repeat for a total of 5 minutes, 3 times a day.
bicep thread: bend arm up and down 12 times; rest for a minute and repeat for a total of 3 sets of 12. Once you're comfortable try holding a very small can to start with, over a few days you can increase the size of the can like this as you are comfortable. This exercise should not be painful. When reducing or eliminating weight is painful.
walk on the wall: Stand facing a blank wall with your feet about 12 inches apart. "Walk" the fingers of the affected hand as high as you feel comfortable along the wall. Mark the spot and try to go higher next time. Do at least 10 repetitions, 3 times a day. When you are more comfortable and stronger (no sooner than three weeks), do these exercises on your side, with the affected side facing the wall. Don't let your hand fall off the wall, move your fingers up and down. Dropping the arm forces repair and is painful. If you feel weak, feel free to use your other arm to help.