This is a multifactorial decision which is specific to you. It is my aim to guide you through your condition and its natural history, your prognosis with either non operative or operative management and how this applies to you and your lifestyle specifically.
This will hopefully enable you to make a fully informed decision regarding the treatment of you condition that suits you best at that time.
There are general and specific risks associated with any operation. These will be explained to you if you decide to embark on surgical intervention for your condition.
For an overview of the general benefits and risks of surgery please see consent pages:
This will depend upon the operation that you have been listed for and its complexity. You will be given a clearer idea of this during the consent process.
Please see conditions pages:
Please see consent pages for more specific information:
For keyhole shoulder surgery and hand surgery, I typically use non-absorbable stitches. These require removal at around 2 weeks following surgery.
For open surgical procedures (Those with a larger cut in the skin), I generally favour dissolvable stitches combined with skin glue and paper stitches. Although they will dissolve within the wound, I leave ‘tails’ of suture outside the skin. These ‘tails’ require trimming flush to the skin at around 2 weeks following surgery.
The type of anaesthetic you will be offered will depend upon the surgery that you are having.
I perform some hand procedures under a local anaesthetic, where you are awake during the surgery. These include carpal tunnel release and trigger finger release. The local anaesthetic that I use takes effect after a few minutes and may last up to 24 hours. You will feel pressure during the surgery, but not pain.
It is important to take pain relief immediately after the surgery, even if it doesn’t hurt, as the effects of local anaesthetic can wear off very quickly once the process begins.
The majority of procedures that I perform are conducted under a general anaesthetic where you go to sleep.
In some cases a local anaesthetic ‘block’ may be used in conjunction with a general anaesthetic. These are performed by one of my anaesthetic colleagues just before the operation. They aim to provide pain relief during and immediately after the operation, the result being that you require less general anaesthetic to keep you asleep, meaning you recover from the anaesthetic more quickly and have less pain when you wake up. They are not suitable for all patients and do have risks associated with their administration. The anaesthetist will discuss this with you prior to your surgery.
You can shower the day after your surgery provided the dressings remain intact. You should not remove them before washing. If the seal around the dressing is compromised a fresh one should be applied. Once the dressings are formally removed at 2 weeks and the wound(s) have healed, there will be no further restrictions.
The vast majority of the procedures that I offer are performed as day case operations. In some cases patients may stay overnight in hospital if they are last on the operating list and take some time to recover from the general anaesthetic.
This will depend upon the procedure that you have had. For some procedures very little therapy is required. For others, physiotherapy constitutes an equally important part of your treatment to the surgery and will continue for several months. (See Recovery and rehabilitation section).
The physiotherapy team will see you on the day of your surgery and teach you how to use your sling safely for dressing, sleeping and washing. They also provide you with some basic exercises to do after your surgery.
Most people will require some form of pain relief for the first few days after surgery. The key to good pain relief is taking it regularly even if it doesn’t hurt at that time. After a week or so, most patients find they can comfortably begin to wean themselves off their pain medications.
Slings are there to support and protect you as well as warning other people that you have had an operation or injury. You will be given a timescale for how long you need to wear it by myself or the physiotherapist. Sometimes a strap will be fitted around your waist, this is to restrict certain movements and protect repaired structures.
Slings are generally worn for the majority of the time, including sleeping, but can be removed for periods during the day for eating, dressing, washing, physiotherapy and comfort.
You will be taught how to safely put on and remove your sling by the physio team on the day of your surgery.
For some operations, a sling is only for comfort and can be taken off when you are comfortable.
Durations of slings are shown below for more common procedures.
- Subacromial decompression or AC joint excision: 2 weeks, but you can mobilise as pain allows
- Rotator cuff repair: 4 weeks. May be longer in larger repairs, a body strap may be applied for some tears.
- Labral repair or stabilisation surgery (Soft tissue socket repair): 4 weeks, usually with a body strap around the waist in addition.
- Carpal tunnel release: 1-2 weeks.
- Cubital tunnel release: 2-4 weeks
This of course will depend upon the nature of your job. This is only a guide to safely returning to work. You should consider discussing your return to work with your occupational health department or employer. A fit note or supporting information can be supplied on request. (More detailed reports may incur further charges).
See Recovery and rehabilitation section for more details.
You should not drive if you cannot fully control your vehicle on account of pain or restriction from your upper limb surgery and/or rehabilitation. Typically this is at least 4 weeks after repair surgery, sooner if no repairs have been performed.
Again this will depend on what you like to do. If no repairs have been performed, you can return to you sports and hobbies as pain allows, however I would always recommend a gradual return to activity over a period of a few weeks.
Cardiovascular activity such as using a spin bike can be done very soon after surgery but the restrictions with the sling and movement remain. Bearing weight through the arms to the handlebars should be avoided in the early stages following surgery, particularly if repairs have been performed.
Racquet sports or golf should be avoided for around 12 weeks if structures have been repaired.
Contact sports and those involving heavy weight are not to recommended to start until at least 12 weeks if structures have been repaired. Normally this would start with gentle training and then building up from there at 12 weeks. In reality return to playing may be between 4-6 months depending on progression with physiotherapy and range of movement.