Your shoulder is the most mobile joint in your body. It is dependent on muscles, ligaments (including the joint capsule) and a rim of cartilage (called the labrum) to stabilise it during movement.

S.L.A.P lesions or tears of the superior labrum (superior labrum, anterior and posterior), can be caused by trauma e.g. a fall or as a result of degenerative changes. The tendon of the biceps muscle also attaches onto the labrum in this area and so can be affected by this injury.

In the operation the damaged area is repaired using small anchors. This is done via arthroscopy (keyhole surgery).

What are the benefits of having a SLAP Repair?

The purpose of a SLAP repair operation is to re-attach the damaged labrum (cartilage) to the socket of the shoulder joint to restore stability to your shoulder and reduce your symptoms.

What are the risks of having a SLAP Repair?

All operations involve an element of risk, these are very small but you need to be aware of them and can discuss them with your doctor at any time.

The risks are complications relating to the anaesthetic, infection, stiffness and or pain around the shoulder, damage to nerves or blood vessels around the shoulder, need to re-do the surgery e.g. if the repair fails and the shoulder becomes symptomatic again.

What can I do to aid the recovery process after my surgery?

Your shoulder is likely to be uncomfortable in the first few days post-surgery. This is normal but can be helped by;

Your sling is to support your arm and allow the surgical repair to heal. You will have to wear the sling for two – three weeks following your surgery. It can be removed for washing and dressing only – the Physiotherapist will advise you how to do this safely before you go home.

Using ice on your shoulder for 15 minutes, 2 times per day or after exercise and therapy. Gel packs, frozen peas or a plastic pack of ice can be used. These must be wrapped in a moist towel as direct contact with the skin can cause burns (cover your dressings with cling film or a plastic bag to prevent them getting wet).

Sleeping can be uncomfortable if you try and lie on your operated arm. We would recommend that initially you lie on your back or on the opposite side. You should sleep in your sling for the first two-three weeks. If you lie on your back support the operated arm with a folded pillow under your lower arm. Make sure that your elbow is above your shoulder. If you are on your side then a folded pillow supports your operated arm from your elbow to your wrist. You should also have a pillow between your knees.

Posture can make a significant difference to your pain post surgery. Avoid hitching your shoulder or holding it in an elevated position. Also try to avoid slumping or standing/sitting with round shoulders.

As you start to wear your sling less  you will find it helps to support your arm on pillows with your elbow in front of your shoulder and slightly out to the side when you are sitting down (see picture above right).

When will I be fit enough to return to work?

You can self-certify for the first seven days of sickness. Before you are discharged, a medical certificate (sick note) may be issued by your consultant to cover the expected time off you will need. The time that you can return to work will depend on the nature of your work. If you are in a relatively sedentary job you may be able to return as early as 4-6 weeks after surgery. If your job involves heavy lifting or sustained overhead positions it may take up to 12 weeks before you can return. Your consultant and physiotherapist will discuss this with you and advise you accordingly.

How long will it be before I can start to resume my normal activities?

Lifting and heavy manual work must be restricted for 2-3 months following surgery. It is also very important to avoid pulling large objects for up to 12 weeks as tension on the biceps muscles will put strain on the repair. For specific guidance regarding sport or DIY please speak to your physiotherapist.

If you feel comfortable and have good range of movement you can begin driving 4-6 weeks after your operation. It is advisable to check this with your consultant or physiotherapist if you are unsure. It is important to advise your insurance company that you have had shoulder surgery.

Will I need any follow up appointments?

You will be seen in outpatients clinic approximately 1 to 2 weeks after your surgery. This appointment will be made and given to you before you are discharged from hospital.

If you are continuing with your physiotherapy at Spire Liverpool Hospital an outpatient physiotherapy appointment will normally be arranged within the following week. The amount of physiotherapy you require will depend on your individual progress.

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An arthritic or injured shoulder greatly affects activities of daily living by causing pain and limiting motion. When shoulder replacement is necessary, the surgeon may perform either a total shoulder replacement or a hemi (partial) shoulder replacement.

There are two main bones involved in shoulder motion: the humeral head (rounded portion at the top of the upper arm bone) and the glenoid (cup-like bone in front of the shoulder blade). In a hemi (partial) shoulder replacement, the humeral head is replaced with a metal implant with the same rounded shape. The glenoid, in this case, is healthy and does not need to be replaced.

In the Copeland Shoulder Replacement a resurfacing component is used. This implant is designed to “cap” only the top of the humerus. During your operation your surgeon will use a tiny camera to look inside your shoulder for other areas of damage. It may be necessary to do an additional procedure at the same time. This might include sub-acromial decompression, acromio-clavicular joint excision, excision lateral end of clavicle or rotator Cuff Repair.

What are the risks of having a Copeland Resurfacing Shoulder Replacement?

All operations involve an element of risk, these are very small but you need to be aware of them and can discuss them with your doctor at any time.

The risks are complications relating to the anaesthetic, infection, stiffness and or pain around the shoulder, damage to nerves or blood vessels around the shoulder, tear of the rotator cuff muscles, instability.

What can I do to aid the recovery process after my surgery?

Your shoulder is likely to be uncomfortable in the first few days post-surgery. This is normal but can be helped by using ice on your shoulder for 15 minutes, 2 times per day or after exercise and therapy. Gel packs, frozen peas or a plastic pack of ice can be used. These must be wrapped in a moist towel as direct contact with the skin can cause burns (cover your dressings with cling film or a plastic bag to prevent them getting wet).

Sleeping can be uncomfortable if you try and lie on your operated arm. We would recommend that initially you lie on your back or on the opposite side. You should wear your sling in bed for the first 3 weeks. If you lie on your back support the operated arm with a folded pillow under your lower arm. Make sure that your elbow is above your shoulder. If you are on your side then a folded pillow supports your operated arm from your elbow to your wrist. You should also have a pillow between your knees.

Your sling is to support your arm and allow the soft tissues to heal. You will have to wear the sling for three weeks following your surgery. The sling can be removed for washing and dressing only – the Physiotherapist will advise you how to do this safely before you go home.

Posture can make a significant difference to your pain post surgery. Avoid hitching your shoulder or holding it in an elevated position. Also try to avoid slumping or standing/sitting with round shoulders.

As you start to wear your sling less you will find it helps to support your arm on pillows with your elbow in front of your shoulder and slightly out to the side when you are sitting down (see picture above right).

When will I be fit enough to return to work?

You can self-certify for the first seven days of sickness. Before you are discharged, a medical certificate (sick note) may be issued by your consultant to cover the expected time off you will need. The time that you can return to work will depend on the nature of your work. If you are in a relatively sedentary job you may be able to return as early as 2-4 weeks after surgery. If your job involves heavy lifting or sustained overhead positions it may take up to 8-12 weeks before you can return. Your consultant and physiotherapist will discuss this with you and advise you accordingly.

How long will it be before I can start to resume my normal activities?

For specific guidance regarding sport or DIY please speak to your physiotherapist. If you feel comfortable and have good range of movement you can begin driving 6 weeks after your operation. It is advisable to check this with your consultant or physiotherapist if you are unsure. It is important to advise your Insurance Company that you have had shoulder surgery.

Will I need any follow up appointments?

You will be seen in outpatients clinic 1 to 2 weeks after your surgery. This appointment will be made and given to you before you are discharged from hospital.

If you are continuing with your physiotherapy at Spire Liverpool Hospital an outpatient physiotherapy appointment will normally be arranged within the following week. The amount of physiotherapy you require will depend on your individual progress.

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My surgeon has prescribed injection therapy. What will this injection do?
An injection in to the appropriate area will suppresses inflammation in the tissue and will help to combat any musculo-skeletal pain you may have.  Many patients obtain lasting relief of symptoms from injection therapy.

What is in the injection?

The injection is comprised of 2 ingredients, these being a local anaesthetic called Marcaine which is used to aid the diagnosis and diminish pain, and a slow release steroid called Depo-Medrone which is an anti-inflammatory medication used to reduce swelling.

What should I do or expect after the injection?

The anti-inflammatory effect of your injection therapy will start 24 to 36 hours after treatment and will continue to work for up to 3 weeks giving long-lasting benefit.

You are advised not to undertake the sport or repetitive activity that caused your problem for 1 week after your injection.  You may require physiotherapy to prevent recurrence or your problem and you should seek advice if you are at all concerned

Will I need to attend any follow up appointments?

You will be seen in an Out Patient clinic approximately 6 weeks after your procedure.  This appointment will be made for you before you leave the hospital after your injection therapy. The amount of physiotherapy you require will be dependent on your progress.

I have been informed that there may be some side effects. What are they?

The most common side effects include what is known as a post injection flare. This means that you may experience a temporary worsening of pain and sometimes a little swelling and local heat.  This is quite a rare reaction resulting from the anti-inflammatory component of the injection.  The flare is temporary and will settle quickly if a non-steroidal anti-inflammatory drug such as Ibuprofen, or analgesia like Paracetamol is taken.  An ice pack over the area may also help. Some facial flushing or reddening of the face may very occasionally occur but this usually only lasts 24 to 48 hours and is not uncomfortable. Very rarely some women make experience an irregular period as a result of the steroid component. Skin changes such as a slight discoloration and thinning of the skin may also occasionally occur locally at the site of the injection.

You will need to be aware of a number of very rare side effects that can occur after injection therapy. If you are a diabetic you may experience a passing upset of your glucose control and it is important to monitor your sugar levels for up to 2 weeks after your injection. If the area becomes hot and swollen you may have picked up an infection and should contact your surgeon or GP as soon as you can. In very rare cases a tendon may rupture as a result of the injection. Again, if this occurs you must contact your surgeon or GP as a matter of urgency. Finally, in very rare circumstances you may have an allergic reaction to the injection. Such a reaction would occur within minutes of the injection being administered and in such circumstances the medical team would treat you immediately.

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The acromion and the end of the clavicle form a bony arch over the top of the humerus. The space under the acromion is called the subacromial space. The structures within the space include the bursa (a lubricating structure) and the tendons of the rotator cuff muscles. Subacromial impingement occurs when bony changes occur either on the under surface of the acromion or the acromioclavicular joint. There is also inflammation in the bursa, which often becomes thickened. There may be some involvement of the rotator cuff tendons.

The operation aims to smooth out the bone, effectively making the space larger and so decreasing pressure on the tendons. The surgeon does this via keyhole surgery and shaves away part of the acromion. During your operation your surgeon will use a tiny camera to look inside your shoulder for other areas of damage. It may be necessary to do an additional procedure at the same time. This might include a rotator cuff repair,or acromio-clavicular joint excision.

What are the risks of having a SAD?

All operations involve an element of risk, these are very small but you need to be aware of them and can discuss them with your doctor at any time.

The risks are complications relating to the anaesthetic, infection, stiffness and or pain around the shoulder, damage to nerves or blood vessels around the shoulder, need to re-do the surgery.

What can I do to aid the recovery process after my surgery?

Your shoulder is likely to be uncomfortable in the first few days post-surgery. This is normal but can be helped by using ice on your shoulder for 15 minutes, 2 times per day or after exercise and therapy. Gel packs, frozen peas or a plastic pack of ice can be used. These must be wrapped in a moist towel as direct contact with the skin can cause burns (cover your dressings with cling film or a plastic bag to prevent them getting wet).

Sleeping can be uncomfortable if you try and lie on your operated arm. We would recommend that initially you lie on your back or on the opposite side. If you lie on your back support the operated arm with a folded pillow under your lower arm. Make sure that your elbow is above your shoulder. If you are on your side then a folded pillow supports your operated arm from your elbow to your wrist. You should also have a pillow between your knees.

Your sling is for comfort only and you can start weaning yourself of it within the first 2-4 days. You may find it useful to continue to wear the sling at night for a little longer if the shoulder feels uncomfortable. It is generally recommended to wear the sling if you are going out to protect your arm.

Posture can make a significant difference to your pain post surgery. Avoid hitching your shoulder or holding it in an elevated position. Also try to avoid slumping or standing/sitting with round shoulders.

In the first few days after surgery you will find it helps to support your arm on pillows with your elbow in front of your shoulder and slightly out to the side when you are sitting down (see picture above right).

When will I be fit enough to return to work?

You can self-certify for the first seven days of sickness. Before you are discharged, a medical certificate (sick note) may be issued by your consultant to cover the expected time off you will need. The time that you can return to work will depend on the nature of your work. If you are in a relatively sedentary job you may be able to return as early as 1-2 weeks after surgery. If your job involves heavy lifting or sustained overhead positions it may take up to 6-8 weeks before you can return. Your consultant and physiotherapist will discuss this with you and advise you accordingly.

How long will it be before I can start to resume my normal activities?

You should avoid sustained repetitive overhead activities for up to 12 weeks. You can usually start swimming when your sutures are removed- breast-stroke is advisable initially. Patients generally return to activities such as golf at about 6 weeks. For specific guidance regarding sport or DIY please speak to your physiotherapist.

If you feel comfortable and have good range of movement you can begin driving 1-2 weeks after your operation. It is advisable to check this with your consultant or physiotherapist if you are unsure. It is important to advise your insurance company that you have had shoulder surgery.

Will I need any follow up appointments?

You will be seen in outpatients clinic approximately 1 to 2 weeks after your surgery. This appointment will be made and given to you before you are discharged from hospital.

If you are continuing with your physiotherapy at Spire Liverpool Hospital an outpatient physiotherapy appointment will normally be arranged within the following week. The amount of physiotherapy you require will depend on your individual progress.

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This picture shows the shoulder joint and the rotator cuff muscles.

This is a group of muscles which wrap closely around the shoulder joint, helping to keep the joint in the correct position and control shoulder movements. The muscles attach from the shoulder blade on to the top of the arm bone. They can be damaged through general wear and tear or after an accident /fall. This usually happens close to the muscles attachment in the tendon.

Damage to one or more of these muscles can therefore lead to a loss of shoulder movement and the shoulder becomes weak and painful.

The operation aims to repair the damage to the rotator cuff. The torn muscles are repaired with sutures or suture anchors depending on the site and size of damage. The operation can be done either arthroscopically (i.e. key-hole surgery) or through an open incision. Your surgeon will discuss this with you before surgery as the approach used will be determined by the size and nature of the tear.

What are the possible associated procedures?

During your operation your surgeon will use a tiny camera to look inside your shoulder for other areas of damage. It may be necessary to do an additional procedure at the same time. These include:-

Sub-acromial Decompression

Acromio-clavicular joint excision

Excision lateral end of clavicle

What are the risks of having a Rotator Cuff Repair?

All operations involve an element of risk, these are very small but you need to be aware of them and can discuss them with your doctor at any time.

The risks are complications relating to the anaesthetic, infection, stiffness and or pain around the shoulder, damage to nerves or blood vessels around the shoulder, re-tear of the rotator cuff

What can I do to aid the recovery process after my surgery?

Directly after surgery before you come round you will be fitted with a sling. In some circumstances you will find the sling has a small wedge under the elbow to keep your arm slightly out to the side. This reduces tension on the repaired tendon.

Your shoulder is likely to be uncomfortable in the first few days post-surgery. This is normal but can be helped by using ice on your shoulder for 15 minutes, 2 times per day or after exercise and therapy. Gel packs, frozen peas or a plastic pack of ice can be used. These must be wrapped in a moist towel as direct contact with the skin can cause burns (cover your dressings with cling film or a plastic bag to prevent them getting wet).

Sleeping can be uncomfortable if you try and lie on your operated arm. We would recommend that initially you lie on your back or on the opposite side. You should wear your sling in bed for the first 2- 6 weeks. If you lie on your back support the operated arm with a folded pillow under your lower arm. Make sure that your elbow is above your shoulder. If you are on your side then a folded pillow supports your operated arm from your elbow to your wrist.

Your sling is to support your arm and allow the surgical repair to heal. You will have to wear the sling for between two and six weeks following your surgery. The amount of time that you have to wear your sling for will depend on the size of the rotator cuff tear. This will be explained to you after your surgery. The sling can be removed for washing and dressing only – the Physiotherapist will advise you how to do this safely before you go home.

Posture can make a significant difference to your pain post surgery. Avoid hitching your shoulder or holding it in an elevated position. Also try to avoid slumping or standing/sitting with round shoulders.

In the first few days after surgery you will find it helps to support your arm on pillows with your elbow in front of your shoulder and slightly out to the side when you are sitting down (see picture above right).

When will I be fit enough to return to work?

You can self-certify for the first seven days of sickness. Before you are discharged, a medical certificate (sick note) may be issued by your hospital doctor to cover the expected time off you will need. The time that you can return to work will depend on the nature of your work. If you are in a relatively sedentary job you may be able to return as early as 1-2 weeks after surgery. If your job involves heavy lifting or sustained overhead positions it may take up to 8-12 weeks before you can return. Your doctor and physiotherapist will discuss this with you and advise you accordingly.

How long will it be before I can start to resume my normal activities?

This will depend on the size of the rotator cuff tear and the condition of the tendons. Your surgeon will discuss the operation findings with you. In the case of a large tear you will need to refrain from heavy work or lifting for at least 12 weeks.  For specific guidance regarding sport or DIY please speak to your physiotherapist.

Driving If you feel comfortable and have good range of movement you can begin driving 4 -6 weeks after your operation in the case of a small tear. In a large tear you will need to avoid driving for up to 8 weeks. It is advisable to check this with your doctor or physiotherapist if you are unsure. It is important to advise your insurance company that you have had shoulder surgery.

Will I need any follow up appointments?

You will be seen in outpatients clinic approximately 2 weeks after your surgery. This appointment will be made and given to you before you are discharged from hospital.

If you are continuing with your physiotherapy at Spire Liverpool Hospital as an outpatient, an appointment will normally be arranged within the following week.  The amount of physiotherapy you require will depend on your individual progress.

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