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This leaflet will provide you with some information and exercises for you to follow after your shoulder surgery. This leaflet is for rehabilitation following shoulder surgeries that involve immobilisation which means your arm will be in a sling for 4 – 6 weeks.  

Your surgery may be planned weeks in advance (Elective) or done at short notice due to trauma.

• Elective Surgeries – surgeries that are planned in advance and may include repairs of the shoulder joint structures such as rotator cuff or joint replacement.
• Trauma Surgerie – surgeries that are undertaken at short notice due to fall or accident which has caused damage to the shoulder bone or soft tissues.

Your surgery maybe keyhole (arthroscopy); this involves the surgeon making small incisions around your shoulder and using a tiny camera to look inside your shoulder joint. Some surgeries require larger incisions but your surgeon will inform you prior to your surgery which approach they will take.

They will look for any areas of possible damage and undertake any treatment. Scans and x-rays allow your surgeon to plan surgery but sometimes the treatment required can be more or less than anticipated prior to surgery.

You will have a general anaesthetic which means you will be asleep. In some cases, we may use a nerve block to numb the area. You will have little or no movement of your full arm or hand initially after your surgery. This should return within 24 hours of surgery. The anaesthetist will speak to your before surgery about these.

Most patients go home on the day of their surgery or the day after. Your arm will be in a sling after your surgery.

A physiotherapist and/or Occupational Therapist will see you on the ward after your surgery to provide advice, sling education and complete exercises with you. They will refer you for further physiotherapy as an outpatient. You will be contacted with an appointment by telephone or letter with your outpatient appointment.

Pain

There will be some pain and discomfort after your surgery. You should take painkillers as prescribed, do not wait for your pain to worsen prior to taking pain relief. Ensure your sling is in correct position; your arm should rest in it across your stomach with your elbow at 90 degrees. Your arm should feel fully supported by the sling.

Swelling and bruising

It is normal to have some swelling/ bruising around your shoulder and down your arm or chest. Often this is worse following trauma or more complicated surgeries. Bruising can be more common if you are medication to thin your blood.  You can reduce swelling in your hand and elbow by ensuring you complete the exercises provided and ensuring your sling is applied correctly. If your sling is too loose your arm will hang downwards allowing swelling to gather in your fingers and hand.

If you have swelling around your shoulder you can apply an ice pack to help reduce swelling and ease pain. This should be wrapped in a towel and applied for 15 minutes at a time, monitor your skin to ensure you are not getting ice burns.

Wound

You will go home from the ward with a dressing over your wound. The nursing staff will give you dressings to use at home and tell you about when and where to get your stitches out. This is usually about ten days after your surgery.

Sleeping

We advise you to sleep in any comfortable position. However, sleeping on your operated shoulder will probably increase your pain. Your sling will need to remain on during the night.

Washing and dressing

Avoid getting your wound dressing very wet.

If showering you can remove your arm from your sling and let it hang by your side. Do not lift your arm to assist with washing. To clean under your operated arm, lean to that side so there is a gap between your body and arm, do not lift your operated arm.

When dressing your upper body place your operated arm into your clothes first for comfort. When undressing remove your operated arm last.

The physiotherapist will have shown you how to remove and apply your sling on the ward but below is a link if you need some assistance.

Your sling should only be removed for washing, dressing and completing your exercises. 

Very occasionally, some people are advised to wear their sling under clothes to avoid excess movement. We will advise you if this applies to you.  

 You should not drive will your arm is in a sling. Do not drive until you have regained full control and movement of your arm.

Before driving sit in your car and try using all of your controls to make sure you are able to do so comfortably. When you return to driving, start with a short journey to ensure you are comfortable and in control.

We also recommend that you speak with your insurance company before you start to drive. The law states you should be in complete control of a car to drive.

This depends on your occupation, most people can return to work around 6 -12 weeks after their surgery. If your job does not involve use of your operated arm you may be able to return sooner.

Please discuss this with your surgeon, doctor or physiotherapist.

Your physiotherapist will guide your return to heavy activities and sport.

This will depend on your pain, shoulder movement and strength as your rehabilitation progresses. Pain would be a sign that you are not ready to return to a specific activity.

You will be referred for physiotherapy by the ward physiotherapist or from fracture clinic when they are happy for you to start rehabilitation following surgery for trauma. You will need to attend physiotherapy to regain movement and strength of your arm.

Rehabilitation will not start until after your period of immobilisation around 4-6weeks after your surgery. 

While your shoulder is immobilised it is important to maintain the other joints of your arm such as your elbow to stop these from stiffening up. The exercises included in this booklet are safe to start once you have the feeling back in your arm, normally the same day or the day after your surgery. 

Hand and fingers

• Make a fist (thumb over fingers). Straighten your fingers and bring them apart.
• Repeat 10 times 3 x daily

Wrist movement

• Bend and straighten your wrist keeping your fingers straight throughout the exercise.
• Repeat 10 times 3 x daily

Elbow Rotation

• With your arm in your sling across your stomach , turn your palm up and down rotating your forearm.
• Or with your arm out of sling across your stomach with your elbow bent at 90 degrees, turn your palm up and down rotating your forearm.
• Repeat 10 times 3 x daily

Elbow bend and straighten

• Stand with your arm out of your sling, your elbow bent at 90degrees and forearm across your stomach.
• Bend your elbow and then straighten your elbow.
• Repeat 10 times 3 x daily

Shoulder blades

• Stand, pinch shoulder blades together as shown.

• Repeat 10 times 3 daily

All patients will attend follow up appointment but trauma and elective patients will be seen at different clinic types and at different timescales post-operatively.

You will be given your first return appointment by the nursing staff prior to discharge from the ward.

If you have any concerns following surgery please contact your follow up clinic, your GP or physiotherapist for advice.

If you have any urgent concerns please call NHS 24 on 111.

A wrist fracture is a break in the radius bone, close to the wrist joint. In medical terms this is called a “distal radius fracture”. Occasionally a small chip or fracture can occur in the ulna.

Fractures happen when a force is applied to a bone that is greater than the strength of the bone. The angle at which the force is applied and how the strong the force is can affect the type of fracture that happens. Fractures can happen with a fall, while playing sport or exercising, through a work injury or road traffic accident for example.

The aim of surgery is to realign and stabilise the bone while it is healing. This aims to prevent stiffness, weakness and pain. Some wrist fractures can be treated in a plaster if the bone is not displaced, you accept the displacement or surgery would be too risky.

Surgery involves the bone being held with either pins that go through the skin (k-wires) or by a plate and screws that sit under the skin and muscle on the bone. The type of surgery carried out depends on what is needed to safely fix your fracture. It is carried out with either a general anaesthetic (were you are asleep) or a regional anaesthetic (were you are awake but can’t feel your arm). Surgery usually takes 30-60 minutes.

You will be seen back at the fracture clinic 2 weeks after your surgery. This should have been arranged with you before you were discharged from the hospital.

Closed Reduction and K-Wire Fixation Surgery

You will be seen by the fracture clinic staff, they will remove your cast, check your wounds, hand function, sensation and blood supply. They will then send you to get an x-ray of your wrist and this will be reviewed by one of the surgeons. If there are no concerns then you will be given a new cast. You will then be given a further appointment for 3 weeks later. At this appointment the cast will be removed and you will be given a removable splint to wear for 1 week. The wires will be removed in the clinic. This is safe and is usually not painful.

Open Reduction and Internal Fixation Surgery

You will be seen by the fracture clinic staff, they will remove your dressings or cast, check your wounds, hand function, sensation and blood supply. They will then send you to get an x-ray of your wrist and this will be reviewed by one of the surgeons. If there are no concerns then you will be given new cast, removable splint or no splint depending on your injury. You will then be given a further appointment for 4 weeks later. At this appointment the splint/cast will be removed.

Before you are discharged from hospital you will be given advice on problems to watch out for and advice on hand and wrist exercises. You will be given this patient information sheet. You should read through this leaflet closely as it will tell you about what you should expect for your recovery and exercises to carry out. It will also tell you how to get arrange a further appointment should you have any problems.

Once you have finished at your final appointment, if you develop a problem related to your wrist fracture or surgery, you can contact the clinic and arrange a new appointment yourself. You do not need to contact your GP to do this.

Some problems patients can develop after surgery are infection, poor bone healing, arthritis, tendon irritation, complex regional pain syndrome and carpal tunnel syndrome. These problems can cause you to feel unwell, develop pain, stiffness, swelling, pins and needles or weakness.

• Infection – You might feel unwell or feverish with increased pain, swelling or stiffness in the wrist. Sometimes the wound can start to leak. If you develop any of these problems contact the clinic using the contact details below. If it is out-with clinic hours and you feel unwell then go to your local Emergency Department.
• Pain – This can be caused by many problems. If your pain is getting worse at any time after surgery, or you still have moderate or severe pain 12 weeks after surgery then contact the clinic using the details below.
• Stiffness – If you are having problems with wrist stiffness that is affecting your ability to do things at 12 weeks after surgery you should arrange physiotherapy using the details below.
• Swelling – If you have new or worse swelling after you have been to your final clinic appointment then contact the clinic using the details below.
• Tendon Irritation – If you are getting pain or a grating/cracking sensation when you are trying to move one of your fingers or thumb then allow it to rest for 1-2 weeks. If the pain doesn’t go away or gets worse then contact the clinic using the details below.
• Carpal Tunnel Syndrome – If you develop pins and needles, or numbness in any of your fingers that doesn’t go away after an hour, contact the clinic using the details below. If it is severe and the hand becomes numb and it is out-with the clinic hours, attend your local emergency department.

If you have a problem related to your wrist fracture or surgery that is not listed here but you would like to see someone about it then please contact the clinic using the details below.

Queen Elizabeth University Hospital Fracture Clinic

• Call: 0141 452 3210 (Monday – Friday, 9.00am – 4.00pm)

Victoria ACH Fracture Clinic

• Call: 0141 347 8754 (Monday – Friday, 9.00am – 4.00pm)

This depends on the demands of your job. It is likely that you will require 2-3 weeks off to recover from the surgery and allow the discomfort to settle. If you have an office job, returning to work after this for light duties should be possible, but you should avoid anything which makes your wrist uncomfortable, such as prolonged typing.

For manual work requiring lifting, you will need at least 6 weeks off, which may be longer depending on the extent of your injury.

You should not drive while you are needing to wear a cast or splint. After this you can drive when you are able to control your vehicle without distraction. This is your decision, you can discuss this with your doctor or physiotherapist if you are unsure. You must be safe and in control of the vehicle.

The law is very clear that you have to be able to prove to the police that you are ‘safe’ to drive, so it is entirely your own responsibility and we cannot give you permission to drive.

You should only return to contact sport 12 weeks after your injury. Other sport may be earlier but you should take the advice of your doctor or physiotherapist who will guide you.

Most patients don’t need physiotherapy. If you carry out the hand and wrist exercises in this leaflet your movement will probably return to normal. If you are having problems with stiffness and this is affecting what you can do 12 weeks or more after surgery, please self refer to your local physiotherapy department or arrange this with your GP.

Below is a rough guide of what most patients will be able to do after wrist fracture surgery. Everyone is different and some people may take longer or shorter to be able to do these things. If you are unsure please discuss them with your nurse or surgeon.

Weeks 0 to 2

• You will be in a cast, splint or bulky bandage depending on your injury
• Use the sling for the first few days if the arm is painful.
• Move your fingers often.
• Carry out stage 1 exercises

Weeks 2 to 6

• You can use the arm for simple tasks as pain permits.
• Depending on your injury and if you are comfortable the nurse in clinic may remove your cast, splint or bulky bandage.
• Continue stage 1 exercises
• Return to desk based work if required and comfortable.

Weeks 6 to 12

• The fracture is united (healed)
• You can begin to resume normal activity but be guided by any pain you are experiencing.
• Carry out day to day activities.
• Carry out stage 2 exercises
• Heavy tasks, heavy lifting or sport may cause some initial discomfort.

Weeks 12+

• Return to manual work, sport and heavy activities.
• You are still experiencing significant pain and swelling then please contact the Fracture Care Team for advice.

Finger exercises

• Keep your fingers moving whilst you are in the splint.

Elbow Bend to Straighten and Forearm Rotations

Elbow Bend to Straighten

• Bend and straighten your elbow as far as you can without pain. You should not feel more than a mild to moderate stretch.
• You can use your other arm to assist if necessary. Repeat 10 – 15 times if there is no increase in pain.

Forearm Rotations

• Begin this exercise with your elbow at your side and bent to 90 degrees. Slowly turn your palm up and down as far as you can go without pain.
• You should not feel more than a mild to moderate stretch. You can use your other arm to assist if necessary. Repeat 10 – 15 times if there is no increase in pain.

Finger and wrist flexion and extension

• Open and close your hand as shown 10-15 times. Then move your wrist up and down 10-15 times.
• After a few days, hold a soft ball / ball of socks. Squeeze the ball as hard as possible without pain.
• Hold for 5 seconds and repeat 10 times.

Contact Details

• Queen Elizabeth University Hospital main switchboard – 0141 211 1100
• Queen Elizabeth University Hospital Fracture Clinic – 0141 452 3210 (Monday – Friday, 9.00am – 4.00pm)
• Victoria ACH Fracture Clinic – 0141 347 8754 (Monday – Friday, 9.00am – 4.00pm)
• Appointments booking office – 0141 347 8347 (Monday – Friday, 8.00am – 8.00pm)
• Physiotherapy – 0141 452 3713 (Monday – Friday 8.30am – 4.00pm)

Other Resources

• MSK Physiotherapy Self Refer
• Further information is available on the NHS UK website.

A fracture is a break or crack in a bone. The Tibia is the ”shin bone” in the lower leg, between the knee and ankle. The top of the tibia is the bottom half of the knee. The bottom of the tibia is the top half of the ankle. The fibula is a smaller bone that sits on the outside of the tibia. A tibial fracture is a break or crack in the tibia. It happens when a force is applied to the bone that is stronger than the bone can withstand.

This sometimes happens after a fall, playing sport, a road traffic accident or a fall from height. Occasionally the skin will be damaged at the same place as the fracture which is then called an ”open fracture”. Sometimes the fracture goes into the knee or ankle joint, which is then called an “intra-articular fracture”.

The aim of surgery is to realign and stabilise the bone while it is healing. This is to try and prevent permanent stiffness, weakness and pain. Some tibial fractures can be treated in a plaster or splint if the bone is not displaced and stable, you accept the displacement or surgery would be too risky for you.

Surgery usually involves the bone being realigned either through pulling the leg straight or with a clamp through small cuts in the skin. The bone is then held together with a metal rod that is put within the bone. This rod goes from just below the knee to just above the ankle. Screws lock the rod in place at the top and bottom. There are other ways that tibial fractures can be fixed surgically but your surgeon will discuss them with you if that is necessary. Usually the other methods are if you have an open or intra-articular fracture.

You will usually have a small cut (wound) at the front of the knee, two small stab wounds just below this and another 2 small stab wounds just above the ankle. If another wound is needed to realign the fracture with a clamp you may have another wound at the level of your fracture.

There are always risks of surgery, these will be explained to you before surgery takes place by your surgeon. Surgery will either involve a general anaesthetic (going to sleep) or a spinal anaesthetic (numbing your leg so you don’t feel the surgery). This will be decided between you and your anaesthetist. The surgery usually takes between 1-2 hours.

You will usually be discharged from hospital within a day or two after surgery unless you have problems with your mobility. Before you go home a doctor or nurse will discuss with you whether you need to take any blood thinning medication. You will usually have follow up at 2 weeks and 12 weeks after surgery. These appointments will should be given to you before you leave hospital.

Walking Boot : You will usually go home wearing a walking boot that you can put as much weight through as you are able. You should wear this for 2 weeks after surgery (you can wear this for up to 6 weeks if you find it helpful). You can take it off when you are sitting down, in bed, or doing your exercises.

Physiotherapy : You will also see a physiotherapist before you go home that will show you how to do some knee and ankle exercises. These are also shown in this information sheet. If they think you might need some extra help they will arrange an appointment for you to see them once you have gone home.

At around 2 weeks after your surgery, you will be seen by one of the fracture clinic nurses. They will examine your wounds and leg. They will look at your wound, remove the clips. They will then make sure you have another appointment booked for week 12 with the fracture clinic. If they are concerned they may ask you to come back later that day or the next day to see a surgeon.

At around 12 weeks after your surgery, you will come back to hospital for an X-ray and to see a surgeon. Most people will be discharged after this appointment to patient initiated return but some may need more appointments or a physiotherapy referral.

If your bone has not healed back together yet, some bloods will be taken at this clinic and you might be referred onto a specialist. They will then phone you at around 6 months after surgery to find out how you are doing and to review your tests. If your bone hasn’t healed you might be offered further surgery at around 1 year following your original operation. This is only required for around 1 in 20 patients.

Some problems patients can develop after surgery are infection, blood clots in the leg, poor bone healing, arthritis, knee pain, nerve damage, irritating or prominent metalwork, , knee or ankle stiffness, walking difficulties or poor balance. If you are suffering from any of the list below, it may mean you have one of these problems from your surgery.

• Infection – You might feel unwell or feverish with increased pain, swelling or stiffness in the knee or ankle. Sometimes the wound can become red, painful or start to leak. If you develop any of these problems contact the clinic using the contact details below. If it is out-with clinic hours and you feel unwell then go to your local Emergency Department.
• Pain – This can be caused by many problems. If your pain is getting worse or you still have moderate or severe pain more than 12 weeks after surgery and it hasn’t been discussed with your surgeon, then contact the clinic using the details below.
• Stiffness – If you are having problems with knee or ankle stiffness that is affecting your ability to do things at 12 weeks after surgery you should arrange physiotherapy using the details below.
• Swelling – If you have new or worse swelling after you have been to your final clinic appointment then contact the clinic using the details below.
• Breathing problems – For around 1 in 100 patients, a blood clot can form in the veins of the leg after surgery. This might cause pain and swelling in the leg. Very rarely a clot can travel to the lung through the bloodstream. This can give people chest pain or breathing difficulties. If you think you have one of these problems phone an ambulance or NHS24 immediately.

Walking difficulties or balance problems – There are different reasons why patients can have problems with walking or balance after surgery. If these problems continue for more than 12 weeks after surgery you may benefit from speaking to a healthcare professional. You may also have stiffness or pain that affects your ability to walk. If your problem is mainly caused by pain, you should contact the clinic. If it is mainly caused by stiffness, or you have balance problems, you should arrange to see a physiotherapist. It is ok to call the clinic to discuss this first if you are not sure.

Irritating or prominent metalwork – If you can feel a prominent lump around one of your scars, it might be that one of the screws has become loose. If this happens you should contact the fracture clinic.

If you have a problem related to your fracture or surgery that is not listed here but you would like to see someone about it then please contact the clinic using the details below.

Queen Elizabeth University Hospital Fracture Clinic

• Call: 0141 452 3210 (Monday – Friday, 9.00am – 4.00pm)

Victoria ACH Fracture Clinic

• Call: 0141 347 8754 (Monday – Friday, 9.00am – 4.00pm)

This depends on your injury and the surgery you have. Your surgeon will advise you about this after your surgery. Most patients will be allowed to walk as their pain allows them immediately after surgery.

You will need to wear a walking boot while you are walking for the first 2 weeks after surgery but you can wear it for up to 6 weeks if this is helpful. You can take it off when you are sitting down, sleeping or doing your exercises. Sometimes people need to use crutches for some of this period. This will be assessed by a physiotherapist before you go home and sometimes at their clinics.

This depends on the demands of your job. It is likely that you will require 2-3 weeks off to recover from the surgery and allow the discomfort to settle. If you have an office job, returning to work after this for light duties might be possible, but you should avoid anything which makes your ankle uncomfortable, such as prolonged standing or walking.

For manual work requiring lifting, you will need at between 6-12 weeks off, and this may be longer depending of the extent of your injury. If your job involves driving you will be off work for at least 6 weeks. Once you can do the activities required by your job without significant pain, you can go back to work.

You should not drive while you are in a cast or walking boot. You cannot drive for at least 6 weeks after surgery. After this you can drive when you are able to control your vehicle and safely perform an emergency stop. This is your decision. You can discuss this with your doctor or physiotherapist if you are unsure.

You must be safe and in control of the vehicle. The law is very clear that you have to be able to prove to the police that you are ‘safe’ to drive, so it is entirely your own responsibility and we cannot give you permission to drive.

You should only return to contact sport at least 12 weeks after your injury. Other sport may be possible earlier but you should take the advice of your doctor or physiotherapist who will guide you.

Before you are discharged you will be seen by a physiotherapist and they will go over the exercises in this book with you. If they feel that you might need extra help they may arrange an appointment at their clinic for you.

If you are having problems with stiffness and this is affecting what you can do discuss this at your clinic appointment and you may need a physiotherapy referral. If you have been discharged from Orthopaedic clinic, please contact the physiotherapy department below or arrange this with your GP.

Below is a rough guide of what most patients will be able to do after surgery for a tibial fracture. Everyone is different and some people may take longer or shorter to be able to do these things. If you are unsure please discuss them with your nurse or surgeon.

Weeks 0 to 2

• You will be in a walking boot for 2 weeks (up to 6 weeks if you find if helpful).
• Keep foot elevated when you are not walking to reduce swelling.
• You can weight bear as your pain allows.
• You can remove this when you are sitting down, in bed or doing your exercises.
• You can begin the knee and ankle exercises.

Weeks 2 to 6

• Continue knee and ankle exercises
• Return to desk based work if required and comfortable.

Weeks 6 to 12

• The fracture is still healing.
• You can begin to resume normal activity but be guided by any pain you are experiencing.
• Carry out day to day activities.
• Continue knee and ankle exercises.
• If you no longer require to wear a walking boot you may wish to consider driving provided you can safely operate a car.
• Heavy tasks, heavy lifting or sport may cause some initial discomfort.

Week 12+

• The fracture is still healing for most people. It is usually healed by around week 14.
• Return to manual work, sport and heavy activities may be possible.
• If you are still experiencing significant pain or swelling that has come on after your week 12 clinic appointment then please contact the fracture clinic for advice.

Daily exercise programme

Aim to complete this exercise program every day, five times daily. You should spend around 2 minutes per exercise.

Bed Exercise

1. Straight leg raise

• Sit in bed with your legs straight and your back supported
• Point your toes up to the ceiling, tighten your thigh muscles of your operated leg and press the back of your knee down into the bed.
• Keep the knee straight and lift your leg up off the bed (clearing approx 30cm)
• Hold for five seconds and then relax for five seconds.
• Repeat 10 times

2. Ankle Movement

• Sit in bed with your legs straight and your back supported.
• Write out the alphabet with your foot, allowing your ankle to move through the movements of all the letters A to Z. All the movements should come from your ankle joint

3. Active assisted toe up with towel

• Sit in bed with your legs straight and your back supported.
• Loop a long towel/cloth around the front of your foot.
• Hold the two ends with your hands.
• Keeping you knee straight, try to bring your toes up towards your face. Assist the movement by pulling the ends of the towel/cloth.
• Hold this position for 30 seconds and then release and relax.
• Repeat 10 times

Chair Exercises

1.Knee bending

• Sit upright in a chair, with both feet flat on the floor.
• With the operated leg, slide your foot underneath the chair, keeping your toes on the floor, trying to bend your knee as much as possible, within your pain limits.
• Hold this bent position for 10 seconds and then slowly return your leg to a comfortable position.
• Relax between repetitions.
• Complete this exercise 10 times.

2. Knee extension

• Sit in a chair, with your knees at 90 degrees, and with both feet on the floor.
• With the operated leg, tighten the muscles in your thigh, lift your toes and straighten your leg as much as possible.
• Hold this straight position for five seconds and then slowly lower back down to the floor.
• Relax between repetitions.
• Repeat 10 times.

At the end of your final appointment you will usually be discharged from further follow up. This information sheet has advice on problems to watch out for and advice on exercises you should carry out. You should read through this leaflet closely as they will tell you about what you should expect for your recovery. They will also tell you how to get arrange a further appointment should you have any problems.

Once you have finished at your final appointment, if you develop a problem related to your tibial fracture or surgery, you can contact the clinic and arrange a new appointment yourself. You do not need to contact your GP to do this.

Contact Details

• Queen Elizabeth University Hospital main switchboard – 0141 211 1100
• Queen Elizabeth University Hospital Fracture Clinic – 0141 452 3210 (Monday – Friday, 9.00am – 4.00pm)
• Victoria ACH Fracture Clinic – 0141 347 8754 (Monday – Friday, 9.00am – 4.00pm)
• Appointments booking office – 0141 347 8347 (Monday – Friday, 8.00am – 8.00pm)
• Physiotherapy – 0141 452 3713 (Monday – Friday 8.30am – 4.00pm)
• MSK Physiotherapy Self Referral

Other Resources

• Further information is available on the NHS UK website

Your keyhole surgery (arthroscopy) involves the surgeon making small incisions around your shoulder and using a tiny camera to look inside your shoulder joint. They will look for any areas of possible damage and undertake any necessary treatment. Sometimes the treatment required can be more or less than anticipated prior to surgery. 

You will have a general anaesthetic which means you will be asleep. In some cases, we may use a nerve block to numb the area.

After surgery your arm may be in a sling. This is for initial support, as after your procedure there will be little to no movement in the arm and hand. This should not last for longer than 24 hours.  Once you have regained full sensation and movement of your arm it is safe to take the sling off and discard it. You will probably get home on the day of your surgery or on the day after. 

The ward physiotherapist will see you on the ward after your surgery to provide advice and complete exercises with you. They will refer you for further physiotherapy as an outpatient. You will be contacted with an appointment by telephone or letter with your outpatient physiotherapy appointment.

Pain

There will be some pain and discomfort after your surgery. You should take painkillers as prescribed, do not wait for your pain to worsen prior to taking pain relief.

Wound

You will go home from the ward with a dressing over your wound. The nursing staff will give you dressings to use at home and tell you about when and where to get your stitches out. This is usually about ten days after your surgery. However, you will be left with small scars around the shoulder

Sleeping

We advise you to sleep in any comfortable position. However, sleeping on your operated shoulder will probably increase your pain.

Washing and dressing

Avoid getting your wound dressing very wet.

When dressing your upper body place your operated arm into your clothes first for comfort. When undressing remove your operated arm last.

Are there things I should avoid after my surgery?

There are no movements of the shoulder that you need to avoid unless we tell you otherwise. You can expect your arm to be uncomfortable when moving. Do not be frightened to start moving your arm and start the exercises.

We recommend you start light activities when you feel able this should be in the days following surgery. Do not lift anything heavy with your operated arm for at least 6 weeks.

If your arm is painful on certain movements then it is best not to force or push these movements and speak with your physiotherapist.

You should not drive for 2 weeks after your surgery. Do not drive until you have regained full control and movement of your arm. Before driving sit in your car and try using all of your controls to make sure you are able to do so comfortably. When you return to driving, start with a short journey to ensure you are comfortable and in control.

We also recommend that you speak with your insurance company before you start to drive. The law states you should be in complete control of a car to drive.

This depends on your occupation, most people can return to work within 6 weeks of their surgery. If your job involves only small movements of your operated arm you may be able to return to work within 1 week.

Please discuss this with your surgeon, doctor or physiotherapist.

This depends on your pain, shoulder movement and strength. Pain would be a sign that you are not ready to return to a specific activity.

Your physiotherapist will guide your return to heavy activities and sport. We normally recommend that you avoid specific sporting activities that involve the operated arm, such as golf and racquet sports for 3 months.

The exercises included below are safe to start once you have the feeling back in your arm, normally the same day or the day after your surgery. It is important that you attempt to do these exercises as instructed to regain the movement and strength of your shoulder.

You will be referred for physiotherapy by the ward physiotherapist – this will usually be within a few weeks of your surgery. You will need to attend physiotherapy to continue your rehabilitation.

It is normal to feel aching, discomfort or stretching sensations when doing your exercises. We recommend that you do each exercise 15 – 20 times and repeat this three times per day with at least 2 – 3 hours in between.

• Pendular: Allow your operated arm to hang by your side and allow it to swing gently forward and backward.

• Posture: It is important not to slump or have round shoulder posture after your operation. You should practise correct posture regularly.

• Shoulder Raising: Hold a stick in both hands and slowly raise this upwards, your non-operated arm should help assist movement of your operated arm.

• Shoulder Side Movements: Hold a stick in both arms at waist level. Gently push your operated arm up and outwards, using your operated arm to assist the movement.

• Shoulder Rotation: Hold a stick in both hands with your elbows at waist height. Push your operated arm out to the side using your non operated arm to help. You should keep your elbows at your waist, only your hand should move out.

•  Wall slide: Place your hand flat on wall in front of you at waist or chest height, which ever you are comfortable with. Slide your operated arm up the wall. As your arm raises you may need to step closer to the wall.

• Table Flexion: place your hands onto flat surface or table. Slowly step backwards keeping your hands on the table bringing your head and shoulders forward into flexion.

All patients will attend follow up appointment but trauma and elective patients will be seen at different clinic types and at different timescales post-operatively.

You will be given your first return appointment by the nursing staff prior to discharge from the ward.

If you have any concerns following surgery please contact your follow up clinic, your GP or physiotherapist for advice.

If you have any urgent concerns please call NHS 24 on 111.

Illzarov is a circular frame used to hold bones in place; this is a type of external fixation. The frame holds broken bones in place to allow healing through the use of rings and wires. The metal rings will go fully or partly round your leg with the metal wires going through your bone and attaching to the rings. The tension between the rings and wires hold the bones to allow healing, this can take some time and your frame can be on for 6 months to 2 years.

Frames are used for:

• Bone breaks
• Correcting deformities
• Leg lengthening
• Infection of metalwork
• Non-union of bone internal fixation

Rehabilitation is a large part of your recovery once your frame is applied. The physiotherapists and occupational therapists will work with you on the ward from the first day after your surgery until you are fit for discharge home; this will include mobility and other daily tasks such as washing and dressing. It is very important that you work with the physiotherapist and occupational therapists; this is your recovery and your progression relies upon your willingness and co-operation to work with the team looking after you.

If your frame is on the lower half of your leg you will be provided with footwear to fit below the frame and a band will be fitted around the shoe and to your frame to help maintain your ankle movement. See picture below.

Once your frame has been applied, you will be expected to learn and perform exercises that will be explained to you by your physiotherapist. It is important to exercise the joints and muscles around the frame to prevent any other problems that would slow your recovery and to promote new bone formation. The main aim of these exercises is to maintain muscle length and strength. Try to repeat these exercises 3 times per day.

Toe exercises

• Bend and straighten your toes. Repeat 10 times.
• If you find this is difficult and your toes remain in a bent position try to gently straighten them out with your hands – hold this stretch for 30 seconds and repeat 3-5 times.

Ankle exercises

• Lying on your back or sitting. Bend and straighten your ankles briskly. If you keep your knees straight during the exercise you will stretch your calf muscles.
• You can do this against the elastic band that is attached to your frame to make this exercise more difficult.

• A towel looped around the bottom of your foot can help pull your foot into a stretch – you should feel this up the back of your calf. Hold for 30 seconds and repeat 3-5 times.

Knee exercises

1. Knee bend

• Either sitting or lying on your back. Bend and straighten your hip and knee by sliding your foot up and down.
•  Repeat this 10 times.
• If you are struggling with this then you can use a towel to assist with this as shown.

2. Knee Strength:

• Lying on your back with legs straight. Bend your ankles up and push your knees down firmly against the bed. Hold 5 seconds then relax. Repeat 10 times. 

• Inner range Quads: Place a roll underneath your knee. Point your toes to the ceiling, rest the back of the knee against the roll and lift your heel off the bed while straightening your knee. Hold for 3-5 seconds then relax. Repeat 10 times.

• Straight leg raise: Lying on your back with one leg straight and the other leg bent. Exercise your straight leg by pulling the toes up, straightening the knee and lifting the leg 20 cm off the bed. Hold approx 5 secs. – slowly relax. Repeat 10 times.

Knee Stretch:

In sitting or lying. Rest your ankle on a stool or a rolled up towel. Stay in this position for 5-10 minutes to stretch the back of your knee.

Hip strength:

• Lying on your front. Squeeze buttocks firmly together. Hold approx. 5 secs. Relax. Repeat 10 times

•  Sidelying on your non frame side. Keep the leg on the bed bent and the upper leg straight. Lift the upper leg straight up with ankle flexed and the heel leading the movement. Repeat 10 times.

•  Sidelying on your non frame side. Keep the leg on the bed bent and the upper leg straight. Lift the upper leg up 10cm then keeping the ankle flexed and the heel leading the movement take the leg behind you and back. Repeat 10 times.

Hip Strength in Standing

• Hip Extension: While standing, hold onto a steady object (e.g. the back of a chair). Keep your trunk still in an upright position and bring your leg backwards. Hold for 3-5 seconds then relax (you can hold for longer as the exercise gets easier). Repeat 10 times.
• Hip Abduction: While standing, hold onto a steady object (e.g. the back of a chair). Keep your trunk still in an upright position and lift your leg out to the side. Hold for 3-5 seconds then relax (you can hold for longer as the exercise gets easier) Repeat 10 times.

After frame application you can fully weight bear on your leg, you will receive pain killers from nursing staff at regular intervals in the day to allow you to participate in your rehabilitation.

Your physiotherapist will provide walking aids to allow you to mobilise from the first day after your operation, the aid used will vary depending how much support you require. It is advisable that you have pain relief prior to therapy input as this will allow you to get the most out of your time with the therapist.

Walking with a frame

• Place walking frame out in front.
• Step your frame leg first then weight bear down through your arms and step your non-operated leg in to meet it then repeat.
• With therapy input you should move to walking one foot past the other, this encourages heel contact and weight bearing on your frame leg which is important.

Walking with elbow crutches

• You will be progressed to elbow crutches if able
• Place both elbow crutches out in front
• Step your frame leg first followed by your non operated leg.
• When able start to walk one foot past the other again to encourage heel contact and weight bearing on frame leg.

If a handrail is available then always use it as well as one crutch. Your physiotherapist will teach you how to carry your other crutch up and down the stairs as you will need it when you get to the top/bottom. 

Going up stairs

Instructions for climbing upstairs are:

• Place your un-operated leg up onto the step
• Bring your frame leg up to the same step
• Bring the crutch up onto the same step

Going down stairs

Instructions for climbing downstairs are:

• Place your crutch down onto the step below
• Step down with your frame leg
• Bring your un-operated leg down to the same step

Your Occupational Therapist and Physiotherapist will likely ask you to demonstrate your ‘transfers’, i.e. how you move from one surface to another. This includes getting in/out of your bed, and on/off your toilet and chair. You will need to demonstrate that you can safely do these transfers before going home. Your rehab team will offer you advice on techniques, and may recommend specialist equipment to help. Some general tips for transfers are as follows:

Bed

• Sit-down high up the bed to minimise the need to adjust your position later.
• Shifting your weight over each hip in turn can help you shuffle further on/off the bed.
• Lift your leg high to avoid catching your frame or ripping your sheets/mattress. You may have to change which side you sleep on depending on which leg you find easiest to lead with.
• The frame can be very heavy, so your Occupational Therapist may provide equipment to make getting in and out of bed easier.

Toilet

• Your Occupational Therapist will assess your ability to sit down and stand up from the toilet based on information provided about your home
• Do not sit down until the backs of both knees are touching the toilet.
• To sit/stand, stick your affected leg out in front, and bending forward at the hips to put your weight through your unaffected leg.
• To control your movement, your Occupational Therapist may provide you with equipment which gives a sturdy hand-hold, or you can place your hands on the toilet bowl itself for support.      

Chair/sofa

• It is important to choose a chair that is high enough for you to get off easily. Your occupational therapist may provide equipment to raise your chair heights if required.
• A chair with armrests on both sides can be useful to push up from.
• You may wish to elevate your leg for comfort on a stool. Be careful with recliner footrests as your pins may get caught.

Dressing

You will find wearing loose fit trousers, shorts, dresses, skirts or t-shirts ideal for getting on/off over your frame. You may find wearing a bigger size of clothing helps when dressing. When taking clothes on / off over your Ilizarov frame you will be required to be careful of the wires and pin sites You may even wish to cut trousers/ leggings / t-shirt arms above the external fixator. During your hospital stay, your Occupational Therapist will look at you getting dressed to provide further information and equipment to make getting dressed easier if required.

Personal care

You will be advised to try keeping your frame and pin sites dry. It is recommended in between pin site cleans to have a strip wash while sitting on a chair being careful to avoid your pin sites. On the day you are completing pin site clean you can shower beforehand.

Sleeping

When sleeping, you may find it more comfortable sleeping on your back. The metalwork around the frame may cause ripping to your bed sheets, to limit this wrap a pillow case around the External Fixation to protect your bed sheets. Do not place pillows under your frame, this can cause your knee to bend and over time this can limit your ability to fully straighten your knee.

You will be involved in your own discharge planning throughout your rehabilitation including any ongoing needs you may have such as rehabilitation and care package.

Depending on your level of mobility and mobility aid, there are lots of things you will still be able to do for yourself. However, for the more robust activities, it is important to plan, and consider what support you have available to assist you.

Housework

You may still be able to complete basic tasks, for example washing & drying the dishes. In order to make this task easier, consider storing your frequently used dishes and utensils in an easily accessible place at waist height, for example, on the work top, or, an easily reachable cupboard at eye level.

For more robust tasks such as hoovering or changing the bedding, you may want to arrange help. Speak to friends and family about this, or if you are able, privately arrange a cleaner.

Shopping

Your ability to go to the shops will depend on your level of mobility. Being able to attend the shop for groceries should be a goal of yours if you were able to do this before. Initially for convenience, you may wish to speak to friends or family about arranging assistance.

If you have access to the internet, you can also arrange a delivery with a local grocer or supermarket.

Kitchen activity and meal prep

There are many ways you can retain your independence in the kitchen. Your Occupational Therapist will discuss these with you during your assessment.

If there is an able bodied person at home with you, they may be asked to assist you with your meal preparation, and carrying items.

If you live alone, your Occupational Therapist will discuss your kitchen environment, how you will safely transfer items, and may assess you with appropriate equipment depending on your level of mobility at discharge.

Exercises and Mobility

Try not to sit for long periods when at home, go for short walks regularly and keep using your walking aid(s) as instructed by your physiotherapist. Build up your walking distance gradually from short distances around the house to getting out and about.

Continue with your exercises at home 3 times a day.

You will be referred to your local physiotherapy department for ongoing progression of exercises and mobility; they will contact you with appointment once you are at home.

If you are of a working age, and currently in employment, either the Doctor on your ward, or your own GP, can provide you with a sick line as required.

When returning to work, you should speak to your employer’s Occupational Health department. If your employer does not have an Occupational Health department, speak to your GP.

Either your GP or your Occupational Health department can provide advice and guidance with regard to a phased return to work.

You cannot drive with an ilizarov frame. If you drive you must wait until your frame is removed before returning to driving.

Having an External frame fitted can require a big adjustment to you (and your families) life. Following the application of your External Fixation you may find you have emotional ‘ups and downs’. Some frame users have described feelings of:

• Fearfulness
• Loss of identity
• Feeling useless
• Feeling like a burden
• Fear for the future
• Concern regarding pain/infection/your own ability

Prior to surgery you may find it beneficial to think of ways of coping and identifying people whom you could speak to when you feel frustrated and low. Your GP, consultant, nurse and AHP staff are also there to support you, providing advice and/or referring you onto other relevant services in your local area. Very often challenges can be overcome by finding ways to adapt to, or overcome, the situation.

You may also benefit from speaking with other frame wearers at the weekly clinic to share experiences and advice. It is important to remember that every frame-wearer will have a different experience, and it is impossible to predict how you will feel, or what challenges you may come across. 

Useful resources

• Samaritans – 116 123 (freephone)
• Breathing Space – 0800 83 85 87 (freephone)

1. Ankle pumps: Repeat 10 times 3 times per day

2. Ankle strength: start this exercise when exercise 1 becomes too easy.

• Repeat 10 times 3 times per day

3. Knee stretch: hold position for 10mins repeat every 1-2hours

4. Knee flexion: Repeat 10 times 3 times per day

5. Inner Range Quads: Repeat 10 times 3 times per day

6. Straight Leg Raise: lift and hold for 10seconds.

• Repeat 10 times 3 times per day

7. Hip Abduction in lying: Repeat 10 times 3 times per day

8. Hip Extension in lying: Repeat 10 times 3 times per day

9. Hip Extension Standing: can be done as alternative to exercise 8.

• Repeat 10 times 3 times per day

10. Hip Abduction: can be done as alternative to exercise 7.

• Repeat 10 times 3 times per day