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Thread: Surgeon to reconstruct separated shoulder?

  1. #1

    Question Surgeon to reconstruct separated shoulder?

    Can anyone recommend an ortho surgeon who can reconstruct a separated shoulder? The most important thing is the level of functionality in the shoulder at the end. We would prefer someone located in eastern Massachusetts who accepts Mass Health insurance. Lahey Clinic would be easiest, but any of the Boston area hospitals would be fine also. Experience operating on a para with spinal cord injury would be a big plus. The patient-to-be is very concerned about how long he will be unable to use that arm. He would consider himself to be a "functional quad" until he can transfer using that arm.



  2. #2
    If surgery is indeed needed, I would recommend getting at least 2 opinions from orthopedists who specialize in shoulder surgery. Those who provide this service to local professional sports teams are often the best, and you can sometimes get this information from the team training staff.

    I would also recommend getting recommendations from the Boston area SCI center physiatrists, including Spaulding, New England Rehab (at BU), and even the VA SCI Center at West Roxbury (often the surgeons also have a private practice).

    If major surgery is needed, then a lot of specialized planning for post op care will be needed. At our center, the person is generally prevented from ddoing any weightbearing through the involved arm for at least 6 weeks. Active movement of the shoulder at all is limited for at least 5 weeks, with passive ROM by a therapist started at about week 3. We allow only mechanical lift transfers, power wheelchair only, and nurses perform all bowel/bladder care, ADLs, etc. for the patient for at least the first 4 weeks (but do the transfers still). At 6 weeks, a shoulder rehab program is begun in earnest with GRADUAL use of the shower over the next few weeks. Many of our members have found that they can qualify for an inpatient rehab stay for several weeks during this phase.


  3. #3
    Week 3: Passive Range of Motion begins
    Week 5: Active Movement of Shoulder begins
    Week 6: Shoulder Rehab begins in earnest.

    I understand thus far.
    Thank-you for giving me the beginning of
    an idea of the shape of the recovery over time.

    So let me extend this a little more.

    The para has shoulder surgery in a hospital, and typically
    stays in the hospital for some amount of time.
    Assuming no unexpected complications,
    how long is that, usually? Less than a week?

    For some amount of time after the hospital,
    the patient would typically stay in a rehab hospital,
    like Spaulding. Clearly the 6th week rehab you
    mentioned would make sense to start during that rehab
    stay. I don't know how long the para would stay
    in the rehab hospital after major shoulder surgery,
    typically, but I am guessing not more than 4 months,
    depending upon how they recover, maybe much less.

    So...after they are done with the rehab hospital,
    are they fit to live at home? Can they do transfers?
    Would they have a hoyer lift at home? I do not imagine
    what the next part of the sequence would be.



  4. #4
    Generally, depending on the exact surgery done, acute hospitalization is only required for 23-48 hours after this surgery. Then, if the person has sufficient full time assistance at home (and a lift, power chair, hospital bed, etc.) they would be discharged home for the 6 week period, with either home health or outpatient OT starting a 3-4 weeks. If the person does not have sufficient help at home, then a nursing home stay of 6 weeks would be generally required, then admission to a short (2-3 week) inpatient acute rehab stay, then home. At that time, if all goes well, transfers without a lift may be allowed, and use of a manual wheelchair, but that is up to the individual surgeon and the exact procedure done.

    I work in the VA and we have the luxury of allowing our patients to stay on the SCI unit for this entire process, but that is not the case in the private sector. Insurance companies would not allow that.


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