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Subacromial Decompression

Many thanks to "Iceman" for this contribution:

I injured my shoulder 2 years ago by carrying a very heavy bag up an awful lot of stairs. It didn't get better so after 15 months I had physiotherapy (PT). This made it much worse. I went to the doctor and he referred me for chiropractic treatment, which made it worse still.

I then went to see an orthopaedic surgeon, which is what I should have done in the first place. He gave me a cortisone injection and soon sent me off for PT. The PT made it worse again. Another injection was given, with no more PT. That undid a lot of the PT damage but didn't fix the problem.

8 days ago, I had an arthroscopic (keyhole surgery) subacromial decompression under general anaesthetic in the UK. The purpose of this post is to tell what it was like.

I arrived at hospital at 0700 hours, having already filled in all the admission forms. The anaesthetist visited to say hello and then the surgeon came in. He asked me to sign the consent forms and drew with marker pen on the area to be operated.

As early as 0815, nurses arrived and wheeled me to the pre-op room. Something was painlessly put into the back of my right hand. It had 2 openings where small tubes could be inserted. I think that it was an intravenous access point to put in fluids as needed. The anaesthetist then said he was going to put something in there and that it might hurt a bit. Initially it didn't hurt at all, but then it quickly hurt a lot. This pain lasted only a few seconds because the next thing that I knew was that the ceiling lights were becoming unstable and fuzzy, in my perception, and I went to sleep from whatever had been given to me.

I was woken by nurses telling to wake up and that I had had my operation. They asked me to roll slightly, put a board under me and put me on my bed, which they then wheeled back to my room. I felt very cold and was shivering. I found that my arm was in a sling, resting on my chest. It was completely numb. They had used a nerve block ( Interscalene Block ) to deaden the arm completely. That was quite disturbing because it had not been explained to me. There was no feeling in the arm and I could not move it at all, not even the fingers. I thought that the op had gone wrong and that I had lost the use of my shoulder, arm and hand. I lifted the numb arm with the good hand and accidentally dropped it about an inch and a half on to my chest. It was really heavy as it landed. The nurse and the surgeon later explained that it was completely normal for there to be no feeling in the arm.

Feeling returned gradually, from the fingers first, ending with the top of the shoulder. This took about 12 hours in my case. It was only then that I felt any pain, for the first time since the operation. I was given Tramadol pain killers. No-one told me about their side effects, which I experienced when on my own. In my case, it was sudden barely controllable shaking, dizziness, sweating and nausea on Day 2. This occurred only after the second time that I was given Tramadol. The nurses advised that I drink a lot of water to flush out the Tramadol. The Tramadol took about an hour to combat the pain in the first place, which was considerable but not unbearable. Ask for painkillers as and when you need them. I held back a bit, thinking that I had to put up with the pain. You don't have to put up with pain, at least not much. I was very surprised by how much water I drank after the operation on Day 1. It was nearly all retained by the body. The nurse explained that a great deal of fluid is lost during the op. I felt very tired most of the time and slept a lot.

The surgeon visited early the next morning (0815) to find out how I was. He said that I would be discharged at around 10 am. I told him that I was still feeling dizzy. He said to wait until that stopped. In the meantime, the nurse came in to look at my bandages.

After surgery, a huge padded dressing is put on the shoulder. In my case, there was a lot of dried blood on it but the nurse said not to worry and that it was normal and that the incision was not bleeding. He changed the dressing for 2 waterproof dressings. He said that they would withstand a week or more of showering, but not to have any baths until they came off. They have lasted as he said. They were removed on Day 8 when I went back for review.

Still on Day 2, the physiotherapist came in to give me exercises to do immediately. She explained that if I did not do them, I would then not be able to do them and would end up with a frozen shoulder . Some of these exercises are on this excellent website, but I would do only what the physiotherapist tells you. I found them really hard and painful. I immediately saw that I really would get a frozen solid shoulder if I didn't do them. After a few gingerly made attempts, they got easier and I was able to do more. The idea is to go as far as you can without too much pain, I think. It's important to do what you can, but not to try and do more than you can, or so I have been told. You may be told something different for your condition. Doing the exercises at home is a chore, but it helped me that I knew that they were for my benefit to get a full range of painless movement back.

I wore the sling in the taxi home and then wore it only at night for 3 nights. I slept on my back with a pillow placed down alongside the injured arm to stop me rolling on to it. With 400 mg of Ibuprofen at bedtime, I slept reasonably well. During the day, for the first 5 days, I needed another 400 mg at around 3 pm to deal with the pain, which it did. The surgeon advised me that I should not leave hospital until the dizziness went away. It did go away by late morning and I had a shower, without the sling, and got dressed. I was able to do all this unassisted and unsupervised.  The surgeon also said that I should discard the sling as soon as I felt physically comfortable without it. He said that prolonged wearing of the sling was not good for it. I managed at home without it during the day on Day 2. That means that I could use a knife and fork, but there was not much power in the use of the knife as it was painful to press down. In hospital, I could not use the hand of the damaged arm to cut up food. On subsequent days, there was noticeable improvement every day.

Each day, I could do a little bit more. On Day 2, the arm and hand movements were incredibly slow. This improved. On Days 2, 3 and 4, I was quite tired and still slept a lot. Extreme and sudden tiredness would just happen unexpectedly and I would have to sit or lie down. The surgeon says that this is the continuing effect of the general anaesthetic and could last for up to a month.

I have been to see the surgeon today (Day 8) and he says that I can drive from tomorrow. I have power steering, but I am sure that I could manage any car. I have been advised not to do any heavy lifting for 3 to 4 weeks. He has given me several pages of exercises to do. Some of them are here at /article/503 . Your surgeon will tell you what's best for you. He also told me that it usually takes about 6 weeks before the patient says that the operation was worthwhile. He showed me photographs of the inside of my shoulder, before and after, and explained what was done. You can ask your surgeon to do the same.

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