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Delta Shoulder

 

 

Please note that information on this site was NOT authored by Dr. Frederic A Matsen III and has not been proofread or intended for general public use.  Information was intended for internal use only and is a compilation for random notes and resources.

 

If you are looking for medical information about the treatment of shoulders, please visit shoulderarthritis.blogspot.com for an index of the many blog entries by Dr. Frederick A Matsen III.

 

 

Da Book

Standard Operating Procedures and Notes for the Shoulder Team

 

Nursing Guidelines

 

The following are notes for all of the wonderful nurses that take care of our patients.

 

CPM:

Patients that use are CPM bed include those that have just had one of the following procedures:

  1. Rotator Cuff Repair

  2. Smooth and Move

  3. Total Shoulder Arthroplasty (TSA)

  4. Hemiarthroplasty of the shoulder (Ream and Run)

 

Patients that DON'T NEED a CPM include:

  1. Patients with fracture repairs

  2. Delta Arthroplasty patients on the 1st post op day

  3. Bankart repairs

 

The CPM wrist splint needs to fit the patient's hand without decreasing circulation to the hand and be snug enough so that it doesn't come off when the CPM raises that patient's arm.  A common mistake is to put a large size wrist splint on a large woman with small hands.

 

The goal is for the CPM to slowly lift the patients are so that the elbow comes off the bed and is lowered back down on it.  It is important to note that when you raise and lower the patient's back in their bed, the geometry of the CPM is changed and what worked with the patient sitting up may be too much for the same patient laying flat.

 

Important - Please stop the CPM machine and remove the wrist splint for 2 hours after an hour of use and have the patient remove the wrist splint when not using the CPM.  This is important to decrease the possibility of developing nerve problems from excessive constriction of the the wrist splint.

 

 

Blocks:

These are great and they generally control surgical pain for about 8 hours following surgery.  After that, the block usually wears off and these patients feel a significant amount of discomfort.

 

We usually plan on giving a long acting narcotic at bedtime to buffer this transition from numbness to pain.  It is important for the nurse to recognize this transition early and be able to offer pain medications early on and when appropriate.  That said, pain control can be a difficult task for the night sift.

 

 

Out of Bed and Walking:

It is extremely important that we get our patients up and out of bed as soon as possible.  This decreases the chance of DVTs, PEs and bed sores.  Since our patients will still have anesthesia in their systems while in the hospital, they will need help from the nurses to walk around and avoid falls.

 

Please offer to help patients get out of bed at least three times a day.

 

 

Other DVT Prophylaxis

 TEDs and SCDs must be used until patients are able to get up and walk around without difficulties.

 

 

Incentive Spirometry

 It is really important to offer patients these, take them out of their wrappers, demonstrate/instruct how to use them and make sure the patients use them.

 

PURPOSE: An Incentive Spirometer was ordered to maintain and/or improve your lung function through controlled breathing exercises.

 

INSTRUCTIONS:

  1. Sit in an upright position.
  2. Hold or stand Incentive Spirometer in an upright position.
  3. Exhale normally. Place the mouthpiece in between your teeth with lips tightly sealed and inhale slowly.
  4. While inhaling slowly:
    1. Try to raise the white piston (column) in the chamber as high as you can. The top of the piston indicates volume obtained.
    2. The top of yellow air float should stay in the clear window. The float indicates proper inhalation.
  5. After taking the deep breath, hold the air in your lungs for three (3) seconds before exhaling normally.
  6. Repeat steps a and b for a total of twenty (20) times.
  7. Use your Incentive Spirometer at least every hour or as ordered by MD/PA.
  8. Stop and rest if you become lightheaded or dizzy.
  9. Inhale deeply and cough after you have completed the Incentive Spirometry Exercise.

 

 

Nice Things:

Please offer our patients a washcloth, toothbrush and menu.  They have gone through a rough surgery and many are too polite or too exhausted to ask for help.

 

It is particularly important to get each patient a menu for the following meals so that they have a say in their next meal.  They often get out of surgery late and miss being able to plan for the dinner or breakfast meal following their surgery.

 

 

Our Most Common Surgeries:

  1. Rotator Cuff Repair - we sew down a torn rotator cuff to the humerus.  This is an extremely painful surgery to have done.  Patients will be very limited in what they are allowed to do with their arm 6 weeks following their surgery.
  2. Smooth and Move - aka Subacromial Smoothing - we remove any scar tissue, inflamed bursa and bone protuberances in the place between the rotator cuff and deltoid muscle.  Patients are often put on a full motion program.
  3. Total Shoulder Arthroplasty - a complete replacement of the shoulder joint with a stainless steel humeral head and stem and a polyethylene glenoid surface for it to articulate on.
  4. Ream and Run - aka Hemi-arthroplasty of shoulder with glenoid reaming - we replace the top part of the humerus with a stainless steel head and stem and either ream out the glenoid so that it matches the new head.  In a plain Hemiarthroplasty (without the reaming), we leave the glenoid alone.
  5. Delta Reverse Shoulder Arthroplasty - this is an extremely difficult surgery for patients with rotator cuff tears that are so massive, their humerus rides high and becomes trapped whenever they try to lift them.  The geometry of the shoulder it reversed so that the glenoid becomes the ball and the humerus becomes the socket part of the joint.  Please patients are often older than our other patients, have gone through a very complicated surgery and may have other compounding health issues.  These are very special patients that need a little extra attention.
  6. Total Elbow Arthroplasty - generally for ladies with really bad rheumatoid arthritis - we replace the elbow joint with a stainless steel hinge.
  7. Bankart Repair - we sew down the anterior labrum to the anterior glenoid edge.  This is used to create an anterior bumper that should make the joint more stable and less likely to dislocate.
  8. AC Resection - we remove about an inch of the clavicle nearest the shoulder.  This prevents the clavicle from rubbing on the acromion and alleviates AC arthritic pain.