Glenohumeral arthritis: Recovery

Follow-up appointments

You will usually be invited to attend an outpatient clinic about two weeks after your operation, where the wound will be examined and your stitches removed. After about three months you will be asked to return so that Mr. Cole can check on your progress. You may discuss any concerns you have during these appointments. Alternatively, should you have a concern, you may telephone Mr. Cole's clinic at any time following your operation.

The wound

You will need to keep the wound dry until it has healed. This normally takes 10 to 14 days. You can wash or shower and use ice packs, but protect the wounds with a waterproof dressing. These will be given to you on your discharge from hospital. Avoid using spray deodorant, talcum powder or perfumes near or on the scar. The dressing and stitches will normally be removed at your first follow-up appointment.

The sling

You will be given a sling to wear immediately following the operation. This is for your comfort. You can take the sling on and off as you wish, although you might find it more comfortable to wear your sling at night. You will not need to wear the sling strapped to your body and you will gradually wear it less over a period of four to six weeks following your operation.

Sleeping

Sleeping may be uncomfortable for a while. It's best to avoid sleeping on the side of your operation. If you choose to lie on the other side, you can rest your arm on pillows placed in front of you. A pillow placed behind your back can help prevent you from rolling onto your operated shoulder during the night. If you are lying on your back to sleep you may find placing a thin pillow or small rolled towel under your upper arm or elbow will enhance your comfort.

Your recovery

Different people recover at different rates. However, you will need to avoid certain movements for the six to eight weeks following your operation. For example, you should avoid moving your arm out to the side and twisting it backwards (in the way you would to put on a shirt or a seatbelt). The trick is to put your operated arm into the shirt first, so that it does not need to reach up behind your back. You should also avoid leaning with your body weight on your arm as you might when getting out of a chair, for example. However, you should not be frightened of moving your arm as much as you can. Gradually these movements will become less painful.

Your recovery can be divided into four phases:

Phase 1
Immediately following your operation, until you are discharged
You will start to move the shoulder with the help of your physiotherapist. However, you will find that most of your post-operative activities will be completed one-handed and you may need some help.

When you are discharged from hospital, you will find it more difficult to complete day-to-day activities such as dressing, bathing, hair care, shopping and preparing meals. An occupational therapist will discuss this with you and show you how to be as independent as possible during this time.

Before you are discharged from hospital, the staff will help you plan for how you will manage when you leave. Please discuss any worries with them. We may be able to organise or suggest ways of getting help for when you are home.

Phase 2
After you have been discharged and for up to six weeks after your operation
The pain in your shoulder will gradually begin to reduce and you will become more confident. Wean yourself out of the sling slowly over this time, using it only when you feel necessary. Do not be frightened to try and use your arm at waist level for light tasks. You will be seeing a physiotherapist and doing regular exercises at home to get the joint moving and to start regaining muscle control. If you feel unsure about what you can or cannot do, please discuss this with the physiotherapist. Lifting your arm in front of you may still be difficult at this stage.

Phase 3
Between six and 12 weeks following your operation
The pain should be lessening. The exercises are now designed to improve the movement available and get the muscles to work, taking your arm up in the air or away from your body when you are sitting or standing. Overall, you will have an increasing ability to use your arm for daily tasks.

Phase 4
From twelve weeks after your operation
You can progress to more vigorous stretches if this is necessary for the activities that you want to do. If the muscles are weak because before the operation the shoulder pain stopped you being able to use them, you should find that you will regain the strength in them with regular exercise. Strength can continue to improve for many months, even up to a year or more. However, unfortunately sometimes the muscles are badly damaged and then you may find it is difficult to regain movement even though you are trying very hard. Even if the muscles will not work properly, the pain in the shoulder joint should still be much less than before your operation and often you can find small "trick" movements that enable you to do what you want to do. Most improvement will be felt in the first six months, but strength and movement can continue to improve for 18 months to two years.

Driving

You may begin driving six to eight weeks after your operation or when you feel comfortable. Check you can manage all the controls and it is advisable to start with short journeys. The seat belt may be uncomfortable to begin with, but your shoulder will not be harmed by it.

In addition, it is a good idea to check your insurance policy. Many insurers will require you to inform them of your operation.

Returning to work

The best time for you to return to work depends on which arm has been operated on, if you need to drive and on the type of work you do. If your job is largely sedentary and uses your non-operated arm, or requires minimal arm movements close to your body, you may be able to return to work between six and eight weeks after your operation. However, if you have a heavy lifting job or one with sustained overhead arm movements you won't be able to work for three to four months. It is best to discuss this with Mr. Cole and with your physiotherapy team.

Returning to sport and leisure activities

Your ability to start these activities will be dependent on pain, range of movement and strength that you have in your shoulder. It is best to start with short sessions involving little effort and then gradually increase the effort or time for the activity. Your physiotherapy team will be able to give advice tailored to you and your situation. As general guidance, however, you can expect to have to wait this long for these sports:

• Gentle swimming: after six weeks
• Gardening (light tasks such as weeding – do not try to do any digging): six to eight weeks
• Bowls: three to four months
  
• Golf, tennis, badminton, squash: four to six months
  

Physiotherapy

You will be shown exercises by the physiotherapist and you will need to continue with the exercises once you go home. They aim to stop your shoulder getting stiff and to strengthen the muscles around your shoulder. We have outlined these early exercises here. Your physiotherapy team will also devise a longer term programme tailored for you and your situation. Use pain-killers, ice packs or both to reduce any pain before you begin exercise, if necessary. It is better to do short frequent sessions of physiotherapy several times a day, rather than one long session. Aim to exercise for five to ten minutes, four times a day.

It is normal for you to feel aching, discomfort or stretching sensations when doing these exercises. However, intense or lasting pain (such as pain that lasts for more than 30 minutes) is an indication to change the exercise by doing it less forcefully or less often.