Patient pathway

It’s important to mention any acute or chronic illnesses, as well as the after-effects of previous illnesses, such as diabetes, allergies, hemophilia, epilepsy, chronic hepatitis, HIV, etc., that you are currently taking. And don’t forget to mention any medications you are currently taking, such as anticoagulants, aspirin, neuroleptics, antihypertensives, etc. If you have any doubts, don’t hesitate to contact your GP. If you are pregnant, inform the surgeon and nursing staff. If you have significant comorbidities, your doctor, surgeon or anaesthetist may ask you to undergo a pre-operative check-up.

Most shoulder operations can be performed under local or general anesthesia, depending on your state of health and wishes. A medical examination including a blood count, a biological examination and an ECG is not systematically required, but may be requested on a case-by-case basis.

Patients are requested to arrive at the clinic on time. On entering the clinic, the patient will be dressed in “surgical” patient clothing. The skin in the area to be operated on will be cleansed, and any hair in the incision area will be shaved. Once placed on the operating table and under anesthesia, the affected limb will be disinfected with specific solutions (please inform us of any allergies: iodine, mercury, antibiotics etc.), then sterile sheets will be placed around it to ensure sterility.

Monitoring vital parameters

During longer operations, particularly on the shoulder and elbow, several vital parameters are monitored: heart rate, blood pressure and oxygen saturation are measured continuously. The electrocardiogram is permanently displayed on a monitor. A perfusion is used to keep the venous access line working. An anaesthetist or qualified nurse is present throughout the procedure and in the phases preceding and following it, right up to the recovery room.

Good communication and information, as well as trust in your surgeon and care team, are important for making the perioperative phases more relaxing and optimizing the success of the operation.

After the operation, the dressing applied by the surgeon must be perfectly fitted and comfortable. It must compress the operated area without blocking blood circulation. The bandage must be comfortable. It is essential to elevate the operated limb and keep it as constantly as possible above heart level (i.e. shoulder level) to prevent edema and reduce pain. It is important to move the fingers, elbow and shoulder at least once an hour during the day to prevent swelling and stiffness by facilitating blood circulation. A first check-up is scheduled one week after the operation with the surgeon or a member of his team. A second check-up, during which the stitches or dressing (if only absorbable sutures) will generally be removed, is scheduled two weeks after the operation.

Relaxing in the clinic

After the operation, even if performed under local anaesthetic, you will be asked to remain in a chair for a while to monitor your pulse and blood pressure. The most intense post-operative pain usually lasts 1-3 days, so it is often necessary and effective to use all the painkillers prescribed by the doctor. Applying an ice pack to the hand or arm can help to combat the pain effectively. If necessary, even for outpatients, it is possible to spend a comfortable night at the clinic to avoid going home alone. What’s more, injections and infusions can be more easily organized here.

Who do I contact if I have a problem?

During the night following the operation, some pain is normal, but it should not be excessive. You can take the medication prescribed to relieve them. If the pain persists or is severe, don’t hesitate to contact the practice for advice or an emergency appointment. If the pain does not improve after taking these medications, contact the emergency number or your GP immediately. In the event of discomfort, contact the surgeon or attending physician, the cantonal hospital or the nearest hotline. If the surgeon who performed the operation is not immediately available, one of his or her colleagues at the center or an assistant will be there to help you and advise you on how to obtain rapid access to care.

Risks and problems

Every operation has its risks. The various tissues of our body (nerves, arteries, tendons, etc.) travel closely together, and anatomical variability can limit predictability in small spaces such as the upper limb. Wearing magnifying lenses, optimizing lighting equipment, improving blood drainage systems and optimizing vital parameters through anesthesia can reduce risks. In addition, the surgeon’s experience optimizes the choice of incision plan and size. Minimally invasive operations are preferred when they provide a real benefit to function and aesthetics.
Despite optimization, it is not possible to reduce risk to zero. Each area of operation may present specific risks not mentioned in this summary.