Background
Shoulder problems commonly occur as a result of gradual wear and tear of the joint structures. In some individuals, this may follow a previous injury such as a dislocation, fracture, or rotator cuff tear; however, in many cases, it develops without an identifiable cause. Degeneration or thinning of the cartilage that covers the joint surfaces can lead to exposure of the underlying bone, resulting in pain, stiffness, and reduced range of motion. Damage to the surrounding tendons, particularly the rotator cuff, or inflammation of the bursa may also contribute to shoulder pain and functional limitation, often interfering with daily activities such as reaching, lifting, or dressing.
What are the benefits of surgery?
Surgery for shoulder or elbow problems aims to reduce pain, improve movement, and restore function. In most cases, you should experience less discomfort and greater ease in performing everyday activities such as dressing, lifting, or reaching. Depending on the specific procedure—whether joint replacement, tendon repair, decompression, or stabilisation—you may also notice improved strength and stability, allowing a more natural and comfortable use of your arm.
In the days prior to surgery
In the week leading up to your shoulder or elbow operation:
- Do not shave or wax the area where the incision will be made.
- Have a bath or shower either the day before or on the day of your surgery to help reduce infection risk.
- Keep warm around the time of your operation and inform your healthcare team if you feel cold.
- If you are diabetic, keep your blood sugar levels well controlled to aid healing and reduce the risk of infection.
How do I prepare for my operation?
Getting yourself into the best possible health before surgery can significantly improve your recovery and long-term results.
Exercise:
Do as much gentle activity as your pain allows. Focus on the pre-surgery exercises provided by your physiotherapist or during your pre-operative assessment to maintain movement and muscle tone in your shoulder and elbow.
Stop smoking:
If you smoke, try to stop before surgery. A clear chest reduces anaesthetic risks and helps your wound heal faster.
Limit alcohol:
Keep alcohol consumption moderate in the weeks leading up to your operation.
Eat well:
Maintain a healthy, balanced diet with adequate protein, vitamins, and fluids to support healing.
Your inpatient pathway
There are 6 stages to your inpatient journey with us:
- Referral and decision: You are referred to Fife Orthopaedics by your GP. After assessment and discussion with your consultant, surgery is agreed as your best treatment option.
- Pre-operative assessment: You will attend a pre-operative assessment appointment to ensure you are fit and ready for surgery.
- Admission for surgery: You will be admitted to the National Treatment Centre (NTC) for your operation.
- Hospital stay: You will usually go home that day or be discharged the following day, during which our team will help you begin your early recovery and ensure your pain is well controlled.
- Recovery at home: Continue your rehabilitation at home, following the physiotherapy exercises and movement guidelines provided to help restore your shoulder or elbow function.
- Follow-up appointment: You will return for a review 6–12 weeks after surgery to check your progress and discuss your recovery plan moving forward.
Your operation
There are several types of shoulder and elbow surgery, and your surgeon will discuss the most appropriate option for your condition. Depending on the problem, this may involve joint replacement (arthroplasty), tendon or ligament repair, fracture fixation, nerve decompression, or arthroscopic (keyhole) procedures to remove scar tissue or bone spurs.
The operation typically takes between one and two hours. Your surgeon will make an incision (or several small ones if done arthroscopically) to access the joint. Any damaged tissue or bone will be repaired, reshaped, or replaced as required. If a joint replacement is performed, an artificial implant made of metal, plastic, or a combination of materials will be inserted and secured into the bone. The wound will then be closed with stitches or clips, and a sterile dressing will be applied.
Plan for aftercare:
You may need help at home for a short period after surgery, as your arm will be supported in a sling or brace while you recover
Risks and complications
Most patients recover well after shoulder or elbow surgery and experience significant improvement in pain and function. However, as with any major operation, complications can occur. Your surgeon will discuss these in more detail, but the following points outline the main risks.
General surgical risks
There are risks associated with all surgical procedures, including infection, bleeding, blood clots, and anaesthetic complications.
Specific risks associated with shoulder and elbow surgery
Nerve injury: Damage to nearby nerves may cause temporary or, rarely, permanent weakness, numbness, or tingling in the arm or hand.
Blood vessel injury: Although uncommon, damage to blood vessels can affect circulation and may require further surgery.
Joint stiffness: Some limitation in movement may persist, particularly if the joint was stiff before surgery.
Infection: Infection around the implant or wound site may require antibiotics or, in rare cases, additional surgery.
Implant wear or loosening: Over time, the artificial joint or repair may loosen or wear out, which could require revision surgery.
Dislocation or instability: In shoulder replacements, the ball and socket can occasionally dislocate, often requiring manipulation or revision surgery.
Fracture: The bone around the implant or surgical site can occasionally crack during or after surgery and may need fixation.
Persistent pain: Although uncommon, some patients may continue to experience discomfort even after healing.
After your surgery
After the procedure, you will be taken to the recovery area and then transferred to the ward. Your arm will usually be supported in a sling (for shoulder surgery) or a brace (for elbow surgery). You may also have an X-ray to check the position of your implant or repair.
Your physiotherapist will visit you soon after surgery, often the same day or the following morning to begin gentle exercises. Early movement is important to prevent stiffness and promote recovery.
For shoulder surgery:
You may need to keep your arm in a sling for several weeks but will begin guided exercises to maintain safe movement.
For elbow surgery:
The joint may be protected in a brace, and your physiotherapist will guide you through a gradual range-of-motion programme.
Wound care: Keep the wound clean and dry for 4–5 days. Use a waterproof dressing when bathing. Your healthcare team will advise whether your stitches or clips need to be removed.
Pain management
You will receive pain relief to help you move comfortably and start your exercises early. Your recovery team will provide a clear plan and follow-up schedule to monitor healing and ensure you regain strength and function as safely as possible.
Going home
We understand that most people prefer to recover in the comfort of their own home. You will be able to go home once your pain is well controlled, you can move safely and independently, and any care or support arrangements are in place. If you experience any concerns after discharge, please refer to our post-surgical issues page for advice on when and where to seek help.
You should carefully follow all the instructions given by your surgical and physiotherapy team.
After shoulder surgery
Your arm will usually be supported in a sling to protect the repair or implant.
After elbow surgery
You may have a splint or brace to limit movement while healing begins.
Your physiotherapist will guide you on how long to use these supports and when to begin your prescribed exercises. Early, controlled movement is essential for restoring function while avoiding stress on the surgical site. It is common to notice a small area of numbness or altered sensation around your scar. This is normal and tends to improve gradually as the nerves recover.
Before you leave hospital, you will be given a week’s supply of painkillers and your usual medications, with any changes clearly explained. All patients will receive a discharge letter, and a copy will also be sent to your GP to ensure continuity of care during your recovery.
