o We carry all our shoulder surgeries, whatever the method, arthroscopic or “opened”, under general anesthesia. We do not associate a regional anesthesia by interscalenic block.
o Immediate postoperative pain is completely controlled by analgesics. A pump can be used for morphine for more than the average algic patients. But in our experience, this is the immediate post-operative passive mobilization, in a combination with cryotherapy (ice packs are applied on the shoulder), which is the best postoperative pain reliever.
o Patients operated by arthroscopic method, but not those performed by the "opened method", can, in theory, return home the evening of the day of surgery, after, they did with the physiotherapist, their first session of passive mobilization of the operated shoulder. This is what is called outpatient surgery. But in practice, we prefer to keep the patient in hospital overnight or even for 2 to 3 days, in case of an elderly patient, or living alone. Two sessions of passive mobilization of the operated shoulder, morning and evening, are then performed with the physiotherapist in our shoulder unit, associated with passive motion exercises that the patient is doing alone, four times a day (see the "rehabilitation chapter"). Ice packs are applied to the operated shoulder, between therapy sessions.
o Patients operated by the conventional surgery "opened method" remain hospitalized in our shoulder unit, on average, four days after surgery of the instability for an athlete, and 7 days after implantation of total shoulder prosthesis. As after arthroscopic shoulder surgery, passive mobilization of the operated shoulder starts from the day of surgery with a physiotherapist, and continued two times a day with the physiotherapist, and 4 times a day by the patient alone for the duration of the hospitalization (see the "reeducation chapter"). Applying an ice pack on his shoulder, operated by the "opened method" is even more necessary after arthroscopic surgery to relieve post-operative pain, which is, in any case moderate, the day after intervention.
The surgical procedure can be made either through small skin incisions 2 to 5 mm with a control, on a television monitor, of the image provided by a micro camera introduced inside the shoulder (arthroscopic surgery), or by skin incision a few inches, and an opening in the muscle wall (opened surgery).
We perform arthroscopic shoulder surgery, learned during our stays in the USA since the 1990s ...
o We have operated all our patients by the opened method surgery from 1986 to 1992, before arthroscopic shoulder microsurgery becomes reliable and reproducible. The “opened" shoulder surgery still represents about 20% of our surgical practice.
We performed, with an “opened” procedure, what we call a triple locking of the shoulder (bony, muscular, ligamentous locking). The procedure can be called too “ Modified Bristow-Latarjet procedure”. This intervention, very carefully made, could return a direct sporting mobility, without any risk of subluxation or anterior dislocation.
Rehabilitation, postoperative recovery after each type of surgery, microsurgery performed arthroscopically or opened, are specified in the "reeducation chapter". Functional results after shoulder surgery are shown in the "Results chapter".