I spoke to a physio colleague the other day about a patient who hadn’t made much progress recently.
This patient hadn’t been very compliant with their physio exercises and was becoming frustrated that they were not feeling better. We discussed that it might be enough for this patient to first continue the exercises they had at the same level rather than looking for progress st every appointment.
I’ve had physio recently and this made me consider my own situation. One of the most frustrating aspects of rehab is doing the exercises. People look for excuses not to do them (I’m just as guilty):
💭 “I’m busy with work”
💭 “I’m too tired”
💭 “I can’t be bothered – it probably won’t work anyway”
💭 “I’ll do them at the weekend”
If you don’t do the work, you won’t get the results.
As healthcare professionals part of our job is coaching people through the plateaus they might hit and helping them to see the progress that lies on the other side.
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
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.