Flight risk?

With the Easter weekend coming up, I’ve had a few post-op patients asking if it’s safe for them to fly, and what precautions they should take.

Generally, flying post-op is safe if patients are aware of the risks and manage them. For my patients I normally advise at least a week after an operation to allow any side effects of general anaesthetic (if they have had this – many operations are now “awake” and don’t need a general anaesthetic) to wear off, for them to be comfortable in a sling and for pain to be at a manageable level.

There is a heightened risk of deep-vein thrombosis (DVT) after surgery which vary from patient to patient and should be discussed in with the patient’s operating surgeon or GP. Measures to help mitigate this risk include staying well hydrated on the day of and day after each flight, moving around the plane and performing small elbow, wrist and hand movements as shown by the post-op physical therapist and taking an Aspirin if recommended according to the patient’s medical history.

Generally the risk of DVT after shoulder and upper limb surgery is low (less than 1%*) but it’s important patients are aware of it.

In addition to this the general post-op precautions still apply – many patients forget that they are still recovering from an operation when they are in sunnier climes!

Wishing anyone travelling this weekend while recovering from an operation safe and happy holidays!

*Thromboembolic Phenomena After Arthroscopic Shoulder Surgery, Kuremsky et al. 2011

Venous thromboembolism incidence in upper limb orthopedic surgery: do these procedures increase venous thromboembolism risk?, Hastie et al. 2014

woman walking on pathway while strolling luggage
Photo by Oleksandr Pidvalnyi on Pexels.com

Keep it moving!

This picture shows skin changes in the hand post a rotator cuff repair. Although the hand is not directly affected the process of putting the arm in a sling and restrictions of movement post-operatively can have an effect on the whole affected arm. 

In this case, the patient was me (after my shoulder op)!

While understanding the theory behind why we keep the affected arm moving post-operatively I was surprised at how changes in the nervous system manifested in swelling and dryness of the hands, leading to this blistering and skin peeling. It resolved in a couple of weeks, once range of movement improved.

This is a great example of why we give active range of movement exercises from the day of the operation for the elbow, wrist and hand and why it’s important to work with a physical therapist post-op. Physical therapy:

  • reduces swelling by increasing venous return
  • keeps the shoulder from stiffening up
  • keeps the tendons healthy and the muscles active – tendons need gentle loading to maintain their health, and
  • By doing these small exercises it also helps the pain to settle

If you are seeing changes in your hand or the affected arm feels different it’s always worth having it checked by your surgeon.

Do you even lift, Bro?

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It’s not just bro’s that lift – I met a fascinating lady yesterday who lifts more than I could in just her warm up. She was suffering from ACJ osteolysis. She told me she had been told that she would “never get over the erosion of the ACJ” and was given the impression she would not be able to lift heavy or competitively. It was disappointing for me to hear that people are still wing given the impression that they should not be pushing weights or pursuing strength training.

Osteolysis means “the pathological destruction or disappearance of bone tissue”. This happens in the AC joint when the end of the clavicle rubs against the ACJ while loaded with heavy forces such as weightlifting, thereby giving it the name “weightlifter’s shoulder”.

Patients will usually be under the age of 40 and present with:

  • Pain over the AC Joint
  • Osteolysis on x-ray and
  • Positive scarf test

Treatment does not always have to involve surgery. The first course should include rest, NSAIDs, possibly an injection and physiotherapy. In this case and is most other cases where an injection is given this would be to allow something else to work – whether that something else is rest, activity modification or physical therapy (in my practice I would always counsel for physical therapy as patients who present with this are usually motivated to get back to the gym and need support to achieve this).

If surgery is indicated then the aim is to remove the eroded bone, and to provide a wide enough healthy space so that the clavicle and acromion don’t irritate each other, followed by good physical therapy.

My advice to my patient yesterday included an explanation that the shoulder joint is not like the knee, where treatment protocols are usually more straightforward. Of all the joints shoulders are pretty complex and I work closely with my physical therapy colleagues to help my patients make a full, and guided recovery.

With thanks for the 📷 to @katiepistello

The SLAP 👋 Tear

This video demonstrates what a SLAP tear looks like anatomically.

I find it’s helpful to visualise this and also to bear in mind that the shoulder is a ball and socket joint but a relatively unstable one (golf ball-golf tee rather than a true ball and socket). The tendons, ligaments and muscles around the shoulder help to keep the joint in place.

The Labrum sits as a circumferential rim around the glenoid. It serves to deepen the socket and therefore to stabilise the shoulder in joint. 

A SLAP (superior labral tear from anterior to posterior) tear occurs when there is damage to the superior (top) area of the labrum. It can be an acute or an overuse injury.

Symptoms include:

  • Deep, throbbing pain
  • Decreased range of motion, especially overhead
  • Instability in the shoulder
  • Loss of shoulder strength

Treatment for SLAP tears will normally start with conservative measures such as anti-inflammatories and physical therapy to balance the muscles in the shoulder and rebuild strength. If this fails, arthroscopic surgery combined with post-op physical therapy usually yields good results.

video: Visible Body