Particularly after major surgery, sleep disturbances are commonplace. And, having trouble sleeping and reclaiming your favorite sleeping position after shoulder surgery is no different.
According to the British Journal of Anaesthesia, the body goes through a metabolic and hormonal response to the trauma of surgery referred to as the surgical stress response. This response, along with other post-surgery side effects, such as pain, fever, sore incision, anesthesia, insomnia, and medications, can inhibit many patients' normal ability to fall asleep and stay asleep after shoulder surgery.
The Anatomy of the Shoulder
The shoulder joint is made up of three main bones (the clavicle, the scapula, and the humerus); the shoulder bones work in tandem with muscles, ligaments, and tendons to give us movement. The upper part of the shoulder blade (scapula) protects the shoulder joint.
The articular bone is connected to the scapula by an acromioclavicular joint, often called the "AC joint". The inner part of the collarbone is attached to the sternum. A rotator cuff is a group of tendons and muscles that attach the arms to the shoulders, and this structure covers the shoulder joint.
Other Shoulder Muscles
When talking about the shoulder muscles, most people think of deltoids and trapeziuses. The shoulder, however, is made up of other less visible muscles, the development of which is essential for the health of the shoulder joints. These less visible muscles are the supraspinatus, infraspinatus, teres major, and teres minor - these last two are better known as the rotator cuff muscles. The following further describes these muscles:
This muscle originates from the top of the shoulder blade, and joins the humerus through an insert at the humerus's top. This muscle triggers and helps the deltoid when the shoulders are raised.
This muscle is fan-shaped, and originates in the middle of the scapula, covers almost all of the scapula, and joins the humerus at the middle facet on its greater tuberosity. It helps to raise the arm, and helps keep the head of the upper arm in the scapula's glenoid cavity.
This muscle originates from the lower inner part of the shoulder blade, and joins the humerus in the middle of its opposite side, just below the humeral head. It carries and rotates the arm across the body.
This tiny muscle originates from the lateral edge of the scapula, just above the teres major, and joins the humerus at the inferior facet on the greater tuberosity of the humerus. This small muscle rotates the arm laterally, and, like the infraspinatus, helps hold the humeral head in the glenoid cavity of the scapula.
Types of Shoulder Problems
There are a number of shoulder problems, each with its own likely cause and unique treatments. For example, bursitis or tendinitis often results from repetitive activities, such as painting, swimming, or weight lifting. Rotator cuff tears, whether partial or total, can be the result of a fall or heavy lifting. Either way, chronic inflammation is involved, and sometimes spurs form.
Fractures, including the collar bone or humerus, are other shoulder pain problems that may be treated with therapy, slings, or surgery. Rheumatoid arthritis and osteoarthritis can also impact the shoulder joint, especially as you age. While medications and physical therapy can help with these conditions, in some cases, you may need shoulder replacement surgery..
Tendonitis occurs with excessive use of repetitive activities, such as throwing and swimming. Activities like this lead to clamping and scraping of the rotator cuff under the AC joint. The rotator cuff and biceps become irritated, causing inflammation, which leads to biceps tendon tears and/or rotator cuff rupture. This condition is treated by limiting activity with the injured limb, but that is considered corrective treatment.
Contact a surgeon if you suspect you have this condition associated with isolated pain and injury to your biceps tendon. A medical surgeon may carry out a procedure called a "biceps tenodesis". This procedure alleviates symptoms, induces relief and healing, and prevents further damage, to list a few benefits.
Stroke syndrome develops when the joint bursa is inflamed, and the bone and tendons are irritated by being frequently rubbed against the lower surface of the acromion or AC joint. Orthopedic surgeons address this with an "arthroscopic subacromial decompression" procedure. In this procedure, the doctor removes part of the spurs, and the inflamed bursa, to provide more room for the shoulder structures, and accelerate healing.
Instability occurs when the head of the humerus is pushed out of the shoulder cavity. This is usually the result of a sudden injury, but it can also be the result of excessive loosening of the shoulder ligaments. The two forms of instability are subluxation and dislocation. Subluxation is essentially an incomplete dislocation.
During subluxation, the arm is partially out of the socket. Dislocation occurs when the bone of the head of the hand is completely pushed out of the socket, causing chronic joint instability. If there are recurrent dislocations, surgery is advised – whether arthroscopic or open surgery.
A frozen shoulder happens when the system of the shoulder joint becomes unmovable and loses tractability. This is due to damage or wear, or it can develop spontaneously without a definite cause.
A specialist orthopedist can treat a frozen shoulder in a variety of ways, including physiotherapy, anti-inflammatory drugs, injections, and in rare cases, manipulation under anesthesia or surgery to free up the tight structures, and provide relief and healing.
Fractured Collarbone and Acromioclavicular Joint Separation
Two common injuries in children and adolescents are collarbone fractures and acromioclavicular joint separation. Most of these injuries can be treated with splinting and bandaging, but fractures or severe separation often require open surgical repair.
Fractures of the Upper Humerus
If you fall with your arm outstretched, you can break your humerus and/or humeral head. This is common in the elderly suffering from osteoporosis. Open surgery is required if the fracture fragments, or is displaced. An orthopedist sometimes has to insert in the joint an artificial joint called a prosthesis.
Types of Shoulder Surgery
Open surgery and arthroscopy are the two main types of surgical procedures used in the treatment of shoulder problems. The type of shoulder surgery your physician recommends is largely dependent on the severity of your injury. Depending on the type of surgery you undergo, comfortably sleeping after shoulder surgery will be more or less of an issue.
With the advancements of technology and medicine, less invasive surgical procedures are being used in increasing frequency. One of these is arthroscopic shoulder surgery. Here, a small camera is used, and the medical surgeon makes a small incision around the injury region, and inserts the camera. Shoulder arthroscopy is commonly used for rotator cuff tears, torn tendons, and shoulder impingements.
Open Shoulder Surgery
As you might expect, open shoulder surgery is more invasive than arthroscopy surgery. It's used for correcting serious injuries or conditions, such as shoulder replacement surgery. Open surgery is also typically used to treat torn shoulder ligaments, lesions, or for people who experience recurrent shoulder dislocation. Rotator cuff surgery can be performed via open surgery.
Sleeping After Shoulder Surgery
It's quite common to have difficulty sleeping after shoulder surgery, particularly in the first few days. Some people find it especially difficult to get into a comfortable position, and are unable to lean on the arm that had the surgery.
Fortunately, there are a few things you can do to get more comfortable, so you can get the sleep you need for your shoulder to heal:
- Raise your upper body with pillows, says the National Institute of Health; refrain from lying flat on your back.
- Sleep in a reclined position (using a recliner), says physical therapist Dan Baumstark. As days pass after your surgery, you can lower your body over time until you eventually are horizontal. But Baumstark says this can take six weeks after surgery or longer, depending on your surgery.
- Avoid sleeping on your side or stomach, if possible. If you must sleep on your side, then sleep on the uninjured side, and place pillows behind your back, so you don’t roll over on your injured arm, according to the Orthopaedic Research Clinic Alaska. Contact your doctor for advice.
- Use pillows to support the elbow from behind. You don't want to let the elbow fall back onto the bed. Place pillows under the elbow and hand to allow for maximum blood flow to the shoulder tendons while you sleep as recommended by some rehab specialists.
Other Sleeping After Surgery Tips
- Make sure you have a mattress and head pillows that offer plenty of comfort and support. Natural latex mattresses are superb options for this. They remove a lot of pressure from "hot spots", or trigger points. They also possess many benefits for many patients suffering from shoulder pain.
- Take pain medications as prescribed by your doctor if shoulder pain is extremely bothersome, and prevents you from sleeping in a reclined position (using a recliner).
- Apply ice to the affected area before laying down to sleep. This reduces inflammation. Don't place ice on your shoulder without wrapping it in a thin napkin to prevent frostbite or irritation. You can use a bag of frozen vegetables, or fruit in place of ice.
- Wear a sling throughout the day for some weeks after surgery while sleeping in a reclined position. The sling helps reduce movement by supporting the affected shoulder in place, reducing postoperative shoulder pain, and causing you to fall asleep. It is also helpful to wear a sling for several weeks while sleeping at night to prevent joint movement.
The most important thing to realize about sleeping after shoulder surgery is that it will get better after some weeks. Just follow your doctor's orders, and in no time, you'll be back to sleeping in your normal sleeping pattern.
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