All operations carry risks.
Thankfully, in routine surgery on the shoulder and elbow, those risks are extremely rare. I do have to discuss them with you however, so that if you decide to have an operation you not only know the reasons why I am doing the procedure and the potential benefits of it, but also the possible downside. This is called ‘informed consent’. It can be a bit daunting to be told all the things that can go wrong just before you get taken down to theatre for your surgery and, although some people tell me they don’t want to know, I’m afraid to say that it is a legal requirement that you are informed.
Infection.
I think what patients worry about the most is the risk of infection especially with all the horror stories in the press about ‘superbugs’ and MRSA. The benefits of routine surgery and of that surgery being carried out in a private hospital, is that the risk of infection is negligible. As far as I am aware I have never had an infection in an arthroscopic (keyhole) procedure done on one of my patients. There have been a few superficial infections in the incisions but those are not serious and a few days of antibiotics will settle that down. Infections do occur in operations done through larger incisions and we take every precaution to keep that risk at an absolute minimum: clean rooms; sterile theatres and equipment and using modern antibiotics where indicated.
Deep Vein Thrombosis.
There is very small but genuine risk of Deep Vein Thrombosis or DVT. This is the clot in the calf that you may hear about especially in people flying long haul and it is an issue because part of the blood clot can break off and move through the blood vessels before getting clogged in the lung and causing sudden death – a Pulmonary Embolism. The way to minimise that risk is to find out if you have any pre-disposition to it or any factors in your life-style that could contribute to a DVT forming. We evaluate this in the medical pre-screening assessment and there are guidelines that we use to grade your risk and take suitable precautions. Virtually always you will wear compression stockings to stop the clot forming and if we consider your risk to be higher than normal then we may give you a shot of a blood thinner. Whilst you are on the operating table there are special pumps attached to your calves which keep the blood pumping round.
Frozen Shoulder.
The most common but, thankfully, least serious complication is getting a frozen shoulder. This is where the shoulder sort of over-reacts to the trauma of the operation and freezes up. It doesn’t happen instantly. Often everything seems to be going according to plan and it is only at about the 6 week mark when your progress halts and the shoulder becomes stiffer and more painful. It freezes up.
The important thing is to recognise and be aware of this as a potential problem because otherwise you and your therapist may continue banging away and pushing the shoulder even though you are aware things are no longer going as planned and it is getting more and more painful to move the shoulder less and less.
So just be aware of it. A great start and then a slow down and a stiffer shoulder? You might be freezing up. Come back and see me if you are worried and we can see if that is the problem.
Nerve damage and CRPS.
There are a couple of rare complications that you may have worries about.
There are reported cases of nerve damage after shoulder surgery either because the shoulder is suddenly moving a lot more so the nerve gets stretched or it gets bruised and bashed during the operation or it can be damaged by the Anaesthetist when inserting the needle to do the Inter Scalene Block (ISB).
The statistics are that about 1:5000 cases there will be temporary nerve damage – some weakness or some pins and needles – and 1:15000 times that can be permanent. To put that in perspective it is about the same risk as being killed in a car crash.
In 15 years of doing shoulder surgery 3 of my patients have had serious nerve injuries (2 from the ISB and 1 from the nerve being pulled during the release of a frozen shoulder). All 3 recovered but 2 did need surgery to get better. So this is a serious, but thankfully rare complication, and when it has occurred the patients have recovered.
The other rare complication is a condition called Chronic Regional Pain Syndrome. This is where the whole arm over-reacts to the trauma of the surgery and becomes chronically painful with swelling in the fingers and stiffness. This is a nightmare and I am typing this with fingers crossed because I don’t think I have ever had a patient who had this.
Please don’t worry.
What you must always remember is that virtually all the operations I do on shoulders and elbows are not essential. You may here me say that ‘you haven’t got cancer and your shoulder pain isn’t going to kill you but surgery could’. I know that sounds a bit drastic but it’s true and sometimes the risks of the complications do outweigh the benefits of successful surgery and we decide that an operation is not in your best interests. I am sure that in those circumstances both you and your loved ones would rather have you alive with a bad shoulder than dead with a good one!
But lets not panic. In many years of doing routine shoulder surgery none of my patients has died and, as far as I know, no keyhole operation had ever had an infection.
