Smoothing Procedure Surgery
The smoothing procedure, also called the Smooth and Move, is used to help people with very large or massive rotator cuff tears. This procedure is often an alternative to a reverse shoulder replacement.
What happens during Surgery?
Surgery takes between 45 minutes to 1 hour. It is done with general anesthesia, meaning the person is asleep. Also, 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 an arthroscope is placed into the joint. The joint is cleaned out and repairs are made. Usually a 1 inch incision is made over the top of the shoulder. Any repairable rotator cuff tendons are fixed. The biceps tendon is usually moved out of harm’s way. The rough painful bone is smoothed.
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 their arm and hand and fingers. Also, they cannot move their fingers and hand. This is because of the nerve block and is normal.
After spending 1 to 3 hours in the recovery room, the person will either be kept overnight in the hospital or allowed to go home. If the person goes home they must have a ride since they cannot drive or take public transportation.
If the person stays in the hospital, after recovery room they will be moved up to their room. In their room there is usually a bed with a special continuous range-of-motion machine (CPM) hooked up to the bed. 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 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 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 roughly half with each passing day. If done correctly and often, the stretching usually helps to decrease the pain. 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: If the person goes home they will have an appointment with the therapist the next day. If the person stays in the hospital then a therapist will visit the person multiple times during their stay to teach the person the 40/140 Therapy Program. This therapy program involves stretching the shoulder that had the surgery with the help of the other arm. The person will be taught 2 stretches. Each stretch should be done 5 times in a row. The stretching sessions be done 5 times a day. This means 50 stretches a day.
- Many people will be advanced to 4 Quadrant Stretching during the first 6 weeks.
If a person’s shoulder is too sore to stretch, it’s very important that they communicate this to their provider and 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: Some people who have the smoothing procedure will have no precautions and will be allowed to move and use their shoulder and arm right away.
- Others will be asked to do Passive Range-of-Motion only for the first 6 weeks. For these people 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. This gives the repaired tendons needed time to heal. If a person actively uses their shoulder before full healing, 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 light things like type, write, cut their food, feed themselves, and wash their face, etc. The only form of exercise 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)
- Pain: It is expected that there will be pain with movement of the shoulder. Pain should be much less than during the first few weeks after surgery. Most people are comfortable if they are resting.
- Therapy: Everyone is advanced to 4 Quadrant Stretching at this time. They will also begin the Early Strengthening Program.
- Precautions: For people who were given precautions, starting on week 6 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 most people will continue to improve for at least 1 to 1 1/2 years after surgery.
- Work: Most people have returned to work.