Surgery for Broken Bones of the Shoulder
Surgery to repair the broken bones of the shoulder is done to help align the bones properly so that they heal in a good position. If surgery is not performed, usually the body is able to heal the broken bones but they will heal out of alignment. This will decrease the person’s chance of having good range-of-motion and good function. Another term for repairing the broken bones is an “open reduction and internal fixation”, or ORIF. See Broken bones of the shoulder.
A fractured bone is the same as a broken bone. When the upper part of the arm bone breaks it is called a shoulder fracture (see picture). When the bone breaks and the pieces are out of alignment then surgery is often needed to restore the alignment back to normal. This will improve the chances of the person having good use of their shoulder.
What Happens During Surgery?
Surgery takes between 45 minutes to 1 hour. It is done with general anesthesia meaning the person is asleep. Most of the time the person will have a nerve block in their neck which makes their shoulder and arm numb for 6 to 48 hours. During surgery a 4 inch incision is made over the front of the shoulder. The broken pieces of bone are pushed back into place and a metal plate with screws are used to secure the pieces in good position.
For very damaged broken bones, sometimes a shoulder replacement surgery is performed.
Immediately after Surgery
When the person wakes up from surgery they are usually in the recovery room. The person may notice that they cannot feel or move their arm and hand and fingers. This is because of the nerve block and is normal.
After spending 1 to 3 hours in the recovery room then the person will be moved up to their room. In their room there may be a bed with a special range-of-motion machine (CPM). If indicated, the nurse will hook the person up to the machine and teach the person how to use the machine. This machine should be used as often as possible.
A person may have questions following your surgery. Many of these frequently asked questions about surgery can be answered here.
What to Expect After Surgery: Week 0 through Week 6 (Phase One)
- Pain: It is normal for a person to experience moderate to severe pain for the first few days after surgery. A person will be given pain pills to take for the first 5 days after surgery. After that, only Tylenol is recommended (only if the person’s primary doctor says it is safe for them). Pain from the surgery should decrease by half, with each passing day. Pain usually improves with the stretches that are taught. If a person wakes up with pain in the middle of the night, they should do their stretching exercises, as stretching usually makes the pain better.
- Therapy: After waking up from surgery and being brought up to their room, a therapist will visit the person to teach them a therapy program, which involves stretching the shoulder that had the surgery with the help of the other arm. This initial therapy programs are Pendulum Exercises and the 0/90 therapy program. Later the person will be advanced to the 40/140 therapy program. These therapy programs involves stretching the shoulder that had the surgery with the help of the other arm. The person will be taught 2 stretches. Each stretch must be done 5 times in a row. Each set must be done 5 times a day. This means that the person must do a minimum of 50 stretches per day.
- If a person’s shoulder is too sore to be stretched, it’s very important that they communicate this to their doctor and/or therapist. Every day that passes that a person does not achieve their range-of-motion goals, makes it extra difficult to get back on track.
- Precautions: For the first 6 weeks after surgery, a person may do Passive Range-of-Motion only. It is extremely important that the person not actively uses their arm (Active Range-of-Motion), and keep it completely relaxed for the first 6 weeks after surgery. The reason for this is that the repair needs time to heal. If a person actively uses their shoulder before this repair is fully healed, the surgical repair could pull apart, and the person may need another surgery.
- Although a person will not be permitted to move their arm/shoulder away from their body, they will still be able to move their elbows and wrists. This means they can still do easy things like type, write, cut their food, feed themselves, wash their face, etc.
- The only form of exercise that a person should do at this point, is: 1) walk uphill on a paved, even road with their arm in a sling or 2) ride a stationary bike with their arm in a sling and not holding on to the handle bar
- Work: Nothing should get in the way of the shoulder stretches after surgery. If a person wants to go back to work right away then they must find the time while at work to do the stretches. They also must follow the above mentioned precautions. If the person can afford not to go back to work right away then they will receive a doctor’s note for their employer.
What to Expect After Surgery: Week 6 through Week 12 (Phase Two)
- The plan given below starts when the shoulder has healed. Usually this is by 6 weeks.
- Pain: It is expected that there will be pain with movement of the shoulder. Pain should be much less than the first few weeks after surgery, and most people are comfortable if they are resting.
- Therapy: Starting on week 6, the previous stretches will be stopped. The person will begin 4 Quadrant Stretching. They will also begin the Early Strengthening Program.
- Precautions: When the bone has healed all precautions are lifted. The person may begin to use their arm. The level of activity will be guided by their pain. If the pain is tolerable then they can continue their activity. If the pain is too much then they should back off the activity.
The shoulder and arm will be weak at this point since the person has not used the arm for the last 6 weeks. As such the person should use common sense when returning to activities. For example, if the person wants to play golf then start out at the driving range first to see how the shoulder responds -don’t jump into 18 holes with their friends. Or, if the person wants to swim then start out in the shallow end to see how the arm will respond -not the deep end.
- Work: Work should not interfere with the therapy programs. If a person wants to return to work during this period they must find time to stretch and strengthen.
Most people who have jobs that require physical labor are not ready to return to work at the 6 week mark. Some may be ready to go back around week 8-10. It’s unlikely that a person who has a highly physical job will go back to full duty at this time.
What to expect After Surgery: week 12 through 1 year and beyond (Phase Three)
- Pain: The pain will continue to decrease over the year. It is normal to still have pain once in a while.
- Therapy: After week 12 most people will begin to decrease the number of stretches and strengthening exercises they do. They also begin to return to normal activities. Their function will gradually improve over the year.
- Precautions: Usually by the 12 week mark, a person is doing about 80% of the kind of activity and exercise they were doing prior to surgery. It is important to note, that people’s shoulder function will continue to improve for 1 to 1 1/2 years after their surgery.
- Work: Most people have returned to work.