Upper Limb Procedures

Shoulder Replacement Surgery

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What’s involved in shoulder replacement surgery?

Each shoulder is made up of three joints. These joints work together to help the shoulder move. The largest of these joints is a ball and socket joint. The “ball” is formed by the top of the upper arm bone, which glides around on a “socket”, which is part of the shoulder blade.

During shoulder surgery, a metal ball on a stem is inserted into the upper arm bone and a plastic surface is fitted onto the socket.

Shoulder surgery is usually done under general anaesthesia, which means that you will be asleep during the procedure. However, for some patients, regional anaesthesia is preferable. This blocks the feeling in your shoulder and arm but you stay awake. Your surgeon and anaesthetist will discuss with you which type of anaesthesia is most suitable in your case.

You will need to stay in hospital for two to five days.

An artificial joint will usually last for at least ten years, after which it may need to be replaced.

Your surgeon will explain the benefits and risks of having a shoulder replacement surgery, and will also discuss the alternatives to the procedure.

About the shoulder replacement operation

A single cut, usually around 10 to 20cm long, is made along the upper arm and shoulder. When the joint has been replaced, your surgeon closes the cut with stitches or clips. The operation usually takes up to two hours.

Afterwards, a physiotherapist will visit you every day in hospital to guide you through exercises to help you recover. You will be encouraged to move your new shoulder from the first day.

After surgery, your shoulder area is likely to be sore for several weeks. You may also feel temporary pain and swelling in the upper arm.

Having a shoulder replacement is generally a safe procedure. However, all surgery carries an element of risk.

Some of the complications specific to shoulder replacement are listed here:

  • infection of the wound or joint. Antibiotics are given during surgery to help prevent this.
  • for up to six weeks after the operation, it is possible to develop a blood clot (DVT) in the veins in the leg. This clot can break off and cause a blockage in the lungs. In most cases this is treatable, but it can be a life-threatening condition. Compression stockings and blood-thinning injections are used to help prevent DVT.
  • occasionally, small cracks in the bone result in a fracture of one of the shoulder bones during the operation. This can be treated but may slow down your recovery.
  • damage to the nerves or blood vessels controlling the arm and hand. This is usually mild and temporary.
  • the new joint may dislocate. This is most likely to happen immediately after the operation and you may need further surgery to treat this.

The chance of complications depends on the exact type of operation you are having and other factors such as your general health. Ask your surgeon to explain how these risks apply to you

Shoulder Arthroscopy

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What's involved in a shoulder arthroscopy operation?

Shoulder arthroscopy is a “keyhole” operation that is used to look inside and treat the shoulder joint.

During the procedure a tube-like telescope called an arthroscope, which is about the thickness of a pencil, is inserted into the shoulder joint. The joint can be viewed either directly through the arthroscope, or at pictures it sends to a video screen, If necessary, other instruments can be inserted to repair any damage or remove material that may be interfering with movement or causing pain in the shoulder.

The operation usually takes 30 to 60 minutes and is routinely performed as a day-case, although some people stay in hospital for one night.

Rotator Cuff Repair

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About rotator cuff repair

There are four tendons that are involved in movement of the shoulder. These tendons are collectively called the rotator cuff. They are attached to the shoulder blade at one end and to the top of the humerus (upper arm) at the other end. They pass through a narrow space just before attaching to the top of the humerus. This space can become increasingly narrow over time due to either formation of a bony spike of bone or thickening of a ligament. This causes increased pressure on the rotator cuff tendons, initially the tendons become inflamed and painful, but if the pressure is not relieved the tendons can become damaged and ultimately they can tear. Normally the uppermost tendon, supraspinatus, tears first and if the tear gets worse the next tendon, infraspinatus, may also tear. The treatment will depend upon the size of the tear.

Generally an MRI scan is done before performing surgery. At the time of surgery a subacromial decompression is performed first to help relieve the pain associated with the tear. The subacromial area is the space between the top of your upper arm bone (humerus) and the small bone attached to the top of your shoulder blade (acromion). Subacromial decompression opens up this space and reduces the pressure on the muscle by cutting the ligament and shaving away the bone spur on the acromion bone, which allows the muscle to heal.

Small tears can be treated by arthroscopic repair, repair through a small incision or if very small can be left untreated. This can be done with an overnight stay in hospital.

Larger tears generally need to be repaired and both arthroscopic and open techniques are used depending on the size and location of your tear. Arthroscopic repairs will involve the use of suture anchors (dissolvable plastic pegs with strong sutures attached) which are placed into the bone and the tendon is then sutured down to the anatomic insertion site. Typically there will be between three and five small incisions to allow this surgery to be performed

For open surgery 4-8cm incision is made on the side of the shoulder and the torn tendon reattached to bone with sutures. This requires a stay in hospital of 1-2 nights. Post-operatively your arm will be placed in a sling, which you will be required to wear for up to six weeks during the healing process.

After surgery

Typically the first three weeks are spent with your arm in a sling with minimal movement. The aim of this phase is to allow the repair to heal strongly. Between three and six weeks physiotherapy may then be started to regain movement in the shoulder, which will be quite stiff by this time. You should typically be able to restart driving after about two months. The final phase is between 8-16 weeks. Strengthening exercises are started as the repair is now strong enough.

If it is deemed appropriate after four months some sports can be restarted, but heavy lifting and contact sports should be avoided until six months after surgery.

Carpal Tunnel Syndrome

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What is carpal tunnel syndrome?

Carpal tunnel syndrome is a fairly common condition that occurs when there is too much pressure on a nerve in the wrist.

The nerve enters the wrist through a narrow channel made of bones and a ligament, called the carpal tunnel. Because there isn’t much room in the tunnel, any swelling of the tissue in or around the carpal tunnel can compress the nerve, causing tingling, numbness or pain in your hand, wrist and forearm. 

Surgery is needed if medicines or wrist splints have failed to relieve pain, or if your symptoms continue to get worse. 

The operation is usually done under a local anaesthetic, which means that your wrist and hand will be completely numb but you stay awake. 

The procedure is routinely performed as a day-case, with no overnight stay. Your surgeon will explain the benefits and risks of having carpal tunnel surgery, and will also discuss the alternatives to the procedure. 

About the operation 

There are two main types of surgery - open and keyhole. Your surgeon will discuss which technique is appropriate for you. 

Open surgery 

A single cut (about 5cm long) is made in the front of the wrist at the base of your palm. Your surgeon opens the carpal tunnel and cuts the ligament to relieve the pressure on your nerve. 

Keyhole surgery 

A small cut (about 2cm long) is made in your forearm just above the wrist or in the palm of your hand. A thin flexible telescope (endoscope) is passed into the cut to help see inside the wrist either by looking directly through this, or at pictures it sends to a video screen. Using a special instrument attached to the endoscope the ligament is cut. 

After surgery, the skin cut is usually closed with dissolvable stitches. The operation can take 10 to 20 minutes. 

The operation to relieve carpal tunnel syndrome is a commonly performed and generally safe procedure. However, all operations carry risks as well as benefits. 

Complications specific to carpal tunnel surgery include a small risk of injury to other nerves, blood vessels or tendons in the hand. 

Most people have little or no pain and numbness in their hand after surgery, but for some people it can take several months for discomfort to disappear. 

In some cases, the symptoms of carpal tunnel syndrome can return, or you may experience a temporary loss of strength when pinching or gripping objects. 

The chance of complications depends on the exact type of operation you are having and other factors such as your general health. Ask your surgeon to explain in more detail how any risks apply to you.

Ganglion Removal Operation

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What is a ganglion on the hand or wrist?

A ganglion cyst is a swelling filled with jelly-like fluid, that sticks out from the lining of a joint or tendon. It most often occurs around the wrist or ankle, or at the base of the palm of the hand. Surgery to remove it is needed if the ganglion is painful or when attempts to treat it, including draining the fluid, have not worked.

The operation to remove a ganglion is routinely performed as a day-case procedure, with no overnight stay. Your surgeon will explain the benefits and risks of having the ganglion removed, and will also discuss the alternatives to the procedure. 

About the ganglion removal operation 

If you are having the operation under local anaesthesia, your surgeon will usually need to wait at least 20 minutes for the anaesthetic to take effect before starting the operation. 

Once the anaesthetic has taken effect, a cut is made over the ganglion. It is removed from the joint or tendon lining without disturbing the surrounding structures. Where a ganglion is tricky to remove, the cut will be larger than the size of the lump. At the end of the operation, the cut is closed with stitches. The operation usually lasts about 30 minutes. 

Removing a ganglion is a commonly performed and generally safe operation. For most people, the benefits are greater than the disadvantages. However, all surgery carries an element of risk. 

Complications specific to removal of a ganglion are rare. They include excessive swelling, delayed healing and damage to surrounding skin nerves. Occasionally, a ganglion reappears in the same place, but this is not common. 

The chance of complications depends on the exact type of operation you are having and other factors such as your general health. Ask your surgeon to explain in more detail how any risks apply to you.