Shoulder Treatment Surgery

	Procedure Summary Estimated time of arrival 2 Days prior to surgery Duration of hospital stay 1 Days Estimated length of stay in Cape Town Minimum 1 Week Where to stay

Rotator Cuff Repair

Shoulder surgery for rotator cuff repair can be described as such: the rotator cuff is a group of four muscles that are responsible for most movement of the shoulder. These muscles come together to form a tendon which inserts on the head of the humerus (the 'ball' of the shoulder joint). Tears of the rotator cuff occur due to various reasons such as general 'wear and tear' resulting in degenerative tears, impingement by the overlying bone, or trauma (such as a fall) causing a traumatic tear.

The diagnosis of a rotator cuff tear involves both the evaluation of clinical symptoms and radiological tests. Clinically, you will experience pain in the shoulder and down the outer aspect of the upper arm. This pain is usually worse at night. On lifting your arm, you may feel more pain and some weakness and your arm may 'hook' on the way down again. A diagnosis is confirmed with either ultrasound or MRI scanning, as a normal x-ray does not usually help, as arthritis will only show after a long period of symptoms. Your surgeon in Cape Town will need to evaluate you prior to the operation.

A rotator cuff tear can be treated conservatively (cortisone injections and physiotherapy) or surgically. With conservative treatment, the pain is likely to subside but strength will never return to normal. After any surgical repair, it is very predictable that the outcome will be good.

A rotator cuff repair is performed arthroscopically (‘keyhole surgery’). Four tiny 3mm holes will be made around the shoulder, allowing for passage of the instruments and camera. The bone is roughened at the site where the tendon is to be reattached, tiny anchors are drilled into the bone and finally the rotator cuff tendon is tied down to the bone using the sutures on the anchor. Healing of the tendon to the bone takes about six weeks and final healing can take up to six months.

You will normally only need to stay in hospital for one day after your orthopeadic surgery. When you wake up, you may have a sling on your arm which (depending on the severity of the tear) you will wear for up to six weeks. The sling is there to protect the repaired shoulder and prevent active movement of the arm. You will be visited by a physiotherapist in the ward who will instruct you in the passive exercise program that you need to follow. There will be some pain after surgery that will last from a few days to possibly a few weeks. You will be provided with pain medication. You are free to return home after your surgeon has performed a follow-up examination after your surgery. You will be able to continue your rehabilitation with physiotherapy back home. If you wish to stay on in Cape Town for a visit, a physiotherapist will be organised to treat you at your hotel.

When you are planning your surgery, bear in mind that most of your "everyday" activities will be impacted as your arm will be immobilised in the sling. You will need someone to help with dressing, grooming, etc. We therefore recommend that a loved one accompany you on your trip to help you. Also remember that once back home, driving may be difficult if your car does not have power-steering. Your surgeon will also advise you on your return date to work, which will depend on the nature of the physical demands of your work.

The surgical team who will be performing your operation are well-respected internationally and are a training centre for orthopaedic surgeons from all over the world. They have done over 900 such shoulder treatments and through their follow-ups have found that 90% of patients have excellent or good outcomes.

	Procedure Summary Estimated time of arrival 2 days prior to surgery Duration of hospital stay 3 Days Estimated length of stay in Cape Town Minimum 1 Week Where to stay

Shoulder Replacement Surgery

Many hospitals in South Africa are fully capable of performing successful shoulder replacement surgery. Our shoulder is one of the most mobile joints in our body, consisting of a 'ball' (humeral head) and 'socket' (glenoid) and like any other joint, it can become osteoarthritic. Pain is experienced in the shoulder joint when the two bones begin to grind against each other, due to the wearing away of the cartilage. This can become very unpleasant as the pain increases and the mobility of the joint decreases. This can become so intense that the pain keeps you up at night. An audible 'grating' may be heard in the joint and it may feel as if it is 'catching' or 'slipping' as the rough surfaces move over each other.

Your doctor will make the diagnosis of osteoarthritis based on your clinical symptoms (the pain, decreased range of movement and possible 'grinding') as well as on your x-rays. These will show a narrowing of the joint space and the growth of bony spurs around the joint. A CT-scan may also be useful to see the extent to which the glenoid ('socket') has been worn away.

In the early stages of osteoarthritis of the shoulder joint, conservative management is appropriate. This may include anti-inflammatory and pain medication, physiotherapy and cortisone injections. Later in the process, arthroscopy of the joint may be performed to 'clean' it out. It is also possible to 'resurface' the glenoid using an 'interpositional graft' (this procedure is only done in specific cases, for specific patients and by experienced surgeons).

Shoulder replacement surgery is performed once the pain and stiffness have become severely limiting. It is also important not to wait too long for surgery as the 'bone stock' of the glenoid needs to be sufficient and stronger muscles will result in faster recovery.

A hemi-replacement is simply the replacement of the humeral head (the 'ball' of the shoulder) with a metal prosthesis, while a total replacement also involves the replacement of the glenoid (the 'socket') with a plastic prosthesis. Your surgical facilitators will decide which procedure to perform depending on your age, diagnosis, quality and quantity of your bone, as well as your physical activity level.

The total replacement is especially successful in older patients. They are generally less active and have less muscle strength resulting in less force on the prosthesis. The prosthesis thus lasts much longer in older patients than in younger patients who are strong and very active. This prosthesis has been used for many years with great success.

You will need to see the surgeon for an evaluation prior to your operation. You will be admitted to hospital the night before to give the anaesthetist time to evaluate your medical condition.

When you wake up after surgery, your arm will be in a sling for a couple of days to aid pain relief. You should however not have any post-op pains as the anaesthetist will have performed a nerve-block to keep the arm numb and pain-free for a few hours. Early mobilisation of the arm is encouraged, and you should be discharged within two days, probably without the sling as well. You will be encouraged to use the arm for everyday activities such as grooming, eating and dressing as this is a natural and gentle rehabilitation.

You will find that the pain and discomfort will gradually decrease and your activity level will increase as pain allows. You should be able to return to clerical type activities after about four weeks and total recovery will take about two to three months. The surgeon will need to see you for a post-operative examination and thereafter you are free to return home after surgery.

It's important to bear in mind that the purpose of the surgery is not to return you to strenuous work activities such as heavy lifting and contact sports. Rather you will return to less strenuous activities such as gardening and playing golf! Should your aspirations include more strenuous activities; the surgeon will discuss your options with you.

In very specific cases where older people have arthritis as well as 'disappearance' of the rotator cuff muscles due to chronic degeneration, it is possible to implant a reverse prosthesis, which enables lifting of the arm by use of the deltoid muscle. This option will be discussed with you should it be appropriate.

An initial consultation with an orthopaedic surgeon is necessary, in order for the appropriate x-rays and MRI images to be obtained. Surgical Bliss will then initiate the process with the surgeon and surgery in South Africa. The orthopaedic shoulder surgeon that will treat you is one of the best shoulder surgeons worldwide and the hospital that you will facilitate your shoulder surgery is a sophisticated, first-world facility.

At Surgical Bliss, you can get the best shoulder treatment and surgery abroad and overseas.