JOINT REPLACEMENT SURGEON IN INDORE WHAT IS JOINT REPLACEMENT? Joint replacement as the name suggests is the replacement of the torn or damaged joint in the body of an individual. The damaged joint in the body is replaced by artificial joint (prosthesis) made of metal, plastic or ceramic. Joint replacement is most commonly done to relive joint pain that can be caused die to various reasons. Some of these reasons are as follows: 1.osteoarthritis 2.rheumatoid arthritis 3.joint injuries The joint replace surgery helps restore the mobility of the patients and give him back the old quality of life where he doesn’t have to struggle with day to day activities due to joint related issues. The joint replacement surgery is mostly performed when the medicines and physiotherapy can’t seem to relieve the pain of the patient. Common Joints Replaced: 1.Knee (most common) 2.Hip 3.Shoulder 4.Elbow 5.Ankle TYPES OF JOINT REPLACEMENT 1. Knee Replacement Total Knee Replacement (TKR): Entire knee joint is replaced — both sides of the joint and the kneecap. Partial Knee Replacement (PKR): Only one part (inner, outer, or kneecap area) of the knee is replaced. Revision Knee Replacement: Done if the first knee implant wears out or fails. 2. Hip Replacement 3. ⁠Total Hip Replacement (THR): Both the ball (femoral head) and socket (acetabulum) are replaced. Partial Hip Replacement (Hemiarthroplasty): Only the ball of the hip joint is replaced. Hip Resurfacing: Bone is preserved by capping the ball instead of replacing it. Revision Hip Replacement: Second surgery if the first implant fails. 3. Shoulder Replacement Total Shoulder Replacement: Both the ball (humeral head) and socket (glenoid) are replaced. Partial Shoulder Replacement (Hemiarthroplasty): Only the ball part is replaced. Reverse Shoulder Replacement: Used in cases of rotator cuff damage or failed previous surgeries — ball and socket positions are reversed. 4. Elbow Replacement Replaces the damaged parts of the elbow joint with metal and plastic components. Mostly done for rheumatoid arthritis or complex fractures. 5. Ankle Replacement Less common than other joint replacements. Used in advanced arthritis or post-injury damage when movement is severely limited. SIGNS THAT ONE IS IN NEED OF JOINT REPLACEMENT: Joint replacement is usually considered when joint damage severely affects your daily life, and other treatments like medicines, physiotherapy, or injections no longer help. Here are the key signs that someone might need a joint replacement (knee, hip, shoulder, etc.): 1. Persistent Joint Pain Constant or severe pain that doesn’t go away, even with rest or medication. Pain that wakes you up at night or limits your ability to sit, stand, or sleep. 2. Stiffness and Limited Movement Difficulty in bending, straightening, or rotating the joint. Trouble doing everyday activities like climbing stairs, walking, or lifting your arm. 3. Swelling and Inflammation Chronic swelling that doesn’t improve with rest, ice, or medicines. Signs of joint inflammation that come and go, or stay constantly. 4. Joint Deformity Visible changes like bowed legs, uneven leg length, or misalignment of the joint. The joint may appear “sunken,” twisted, or bulged. 5. Dependence on Painkillers or Walking Aids Needing pain medicines daily just to function. Using a walker, cane, or crutches regularly due to pain or weakness. 6. X-ray or MRI Shows Severe Damage Imaging shows bone-on-bone contact, joint space narrowing, cartilage loss, or joint collapse. Bone spurs, cysts, or joint erosion. 7. Failed Conservative Treatments No long-term relief from: Physiotherapy Joint injections Weight loss and lifestyle changes 8. Declining Quality of Life You avoid walking, traveling, or socializing because of joint pain. Pain interferes with work, hobbies, or mental health. ADVANTAGES OF JOINT REPLACEMENT SURGERY: 1.Pain Relief Significantly reduces or completely eliminates chronic joint pain. 2.Improved Mobility and Function Restores movement, making walking, climbing stairs, or daily tasks easier. 3.Better Quality of Life Helps you return to normal activities, work, and hobbies with greater independence. 4. Long-Lasting Results Modern implants can last 15–20 years or more, giving years of active, pain-free living. For more details on total hip replacement/ DAA total hip replacement, please visit our dedicated website for hip joint issues created by Dr Vikas jain- www.hipreplacementindia.in https://hipreplacementindia.in/treatment/bikini-hip-replacement/

Best Knee replacement Surgeon in Indore WHAT IS ARTHRITIS? Knee replacement surgery is mostly performed in the cases of arthritis. It is a general term for various conditions which can cause pain, swelling and stiffness in the joints. It can affect one or multiple joints in the body sometimes leading to complete damage of cartilage which leads to making the movement severely painful. Symptoms of Arthritis: 1. Joint pain 2. Swelling and warmth 3. Stiffness (especially in the morning) 4. Redness 5. Limited movement 6. Cracking or grinding sounds. WHAT IS KNEE REPLACEMENT? Knee replacement, also known as knee arthroplasty, is a surgical procedure where a damaged or worn-out knee joint is replaced with an artificial joint (implant). This artificial joint can be made of metal, plastic, or ceramic. It is usually done to relieve severe knee pain and improve movement when other treatments like medicines or physiotherapy doesn’t seem to work or provide relief. TYPES OF KNEE REPLACEMENT There are 4 main types of knee replacement surgeries, each chosen on the basis of how damage the knee is and the patient's age, activity level, and overall health. 1. TOTAL KNEE REPLACEMENT SURGERY (TKR) As the name suggests total knee replacement surgery is the type of surgery which replaces the complete knee of the patient. In this surgery entire knee is replaced including both sides if the knee ( femur and tibia) and sometimes even the knee cap ( patella). This surgery is generally suitable for the people going through severe arthritis as it provides long term relief and generally the recovery of 2-3 months. Most people above 60 with arthritis are advised with Total knee replacement surgery. 2. PARTIAL KNEE REPLACEMENT SURGERY (PKR) As the name is self explanatory, partial knee replacement unlike total knee replacement replaces only one part of the knee. It can either be any of the two sides of the knee or the frontal part. It is recovered fast as compared to total knee surgery and is less invasive. It is usually done in early stages of arthritis. 3. BILATERAL KNEE REPLACEMENT In bilateral knee surgery both knees are replaced on the same day or in the single surgery. It is suitable if both knees are severely affected and you are medically unfit and in alarming need if both knee replacements. The recovery is intense as compared to the prior two surgeries as both the knees are replaced. REVISION KNEE REPLACEMENT A repeat surgery done when an old knee implant wears out, loosens, or gets infected. It is more complex than the first surgery. It is Usually needed after 15–20 years of the first replacement (or earlier if complications arise). SIGNS THAT YOU NEED KNEE REPLACEMENT: Knee replacement surgery is generally required when the non surgical treatment can’t seem to relieve the pain any longer. 1. Severe knee pain. 2. ⁠Advanced Arthritis 3. ⁠Joint Stiffness and limited range of motion 4. ⁠Swelling and inflammation doesn’t just go away 5. ⁠Failed non surgical treatments 6. ⁠Poor quality of life like difficulty in performing day to day activities like walking. 7. ⁠Deformity or structural instability. Knee visibly looks crooked. 8. ⁠post traumatic Arthritis. For more details on total knee replacement/ robotic total knee replacement, please visit our dedicated website for knee issues created by Dr Vikas jain- www.tkasurgery.com https://tkasurgery.com/robotic-total-knee-replacement-surgery/

A Total Knee Replacement surgery is one of the most common surgeries performed today in elderly in view of osteoarthritis and damage to the knee joint. The traditional knee replacement has 3 limitations- severe pain after surgery, restrictions such as not sitting on floor & unequal legs leading to abnormal walking. Though robotics knee replacement has advanced the process, but it involves high risks such as increased infection & intraoperative fracture risk due to multiple pins insertion making bones weaker. Introducing MIS Laser Precision High Performance Advance Total Knee Replacement Surgery, the most advance technique for Knee replacement which takes into account the advantages of robotic surgery but without the disadvantages & fracture risks. With Laser Precision Technology, we can get precise component placement for lasting durability as well as equal knee length ensuring no limping after the surgery. With High performance Advance Total Knee replacement, only the damaged part of knee is removed, ensuring saving maximum natural bone of the knee joint which helps in maintaining skeletal strength which is important for walking & quicker recovery. We mobilize our patients on day 1 walking & stairs on day 2. Patients can walk even WITHOUT walker within 3 days. Climb stairs & patients can now perform all activities including gymming, running, exercising & even sitting on floor without any restriction. For more details or Appointment, please call+91 7760547341. .

There are four different muscles that stabilize the ball and socket that make up the shoulder joint. These muscles are responsible for arm movement and shoulder stability. Through repeated heavy lifting, incorrect posture the tendons which attach muscles to bone may injure and tear. The muscles forming the part of the rotator cuff are Supraspinatus, Infraspinatus, Teres minor as well as Subscapularis, although the most common tear is of the tendon of Supraspinatus muscle. Torn Rotator Cuff Signs and symptoms include: • Pain and weakness with overhead movements • Pain with putting on and taking off clothes • Pain with reaching behind the back when showering • Pain with lying on the painful shoulder • Difficulty performing physical activity or even job duties It’s not uncommon for people with a rotator cuff tear to feel the following: • Increased pain in the shoulder with lifting or during overhead activities. • Inability to fully lift arm due to weakness of the shoulder muscles. • Pain in the shoulder at night, keeping them from sleeping • Pinching, catching, or popping sounds in the shoulder with movement • Restricted range of motion, especially with reaching behind the back or overhead Though most often rotator cuff tears are of traumatic origin, degenerative tears with increasing age are equally common and should be considered for repair too in symptomatic patients. Rotator cuff tendon tears are ultimately confirmed through Magnetic Resonance Imaging (MRI). A rotator cuff repair is a surgery to restore the muscle tendon attachment to the humeral head (the ball of the ball and socket shoulder joint). It is most often done today through an arthroscopic technique – small incisions around the shoulder. PRE-OPERATIVE STEPS Every effort is made to assess the patient prior to surgery in order to ensure safety of the patient for the elective procedure. 1. After admission, routine blood work-up will be done prior to surgery. Depending on the age of the patient and other premorbid conditions, other investigations such as Echocardiography may be performed in elderly patients. 2. All the investigations prior to surgery are performed in order to ensure that the surgical procedure can be safely tolerated by the patient, since shoulder arthroscopy is an elective procedure. If any risk is involved, the patient/ attendants will be informed so. 3. Blood transfusion though rarely required, may be done depending on the reports. 4. X-rays and MRI will be done ideally in order to guide the surgical plan and the prognosis. 5. Surgical consent will be explained to the patient detailing the procedure as well as the risks involved, if any. INTRA OPERATIVE STEPS 1. After anesthesia induction and patient positioning your surgeon will make two small incisions in the front and one small incision each in the back and the side of the shoulder joint. 2. The surgery is performed using a small fiberoptic camera (an arthroscope) and other small instruments inserted through the incisions. 3. The fatty tissue which is leading to symptoms of bursitis is removed along with a burr thinning of undersurface of the acromion bone is performed which is known to cause rotator cuff tears. 4. The remaining portion of the torn rotator cuff muscle tendon is mobilized after clear visualization through the arthroscope. 5. After mobilization, suture anchors are inserted into the underlying humerus bone. 6. The tendons are fixed to suture anchors with the help of a device known as Firstpass. 7. Once sufficient hold is obtained in the tendons, knots are applied in order to fix the tendon into the original insertion site on the bone. 8. Once the rotator cuff tendons are firmly in place, the incisions are then closed with small bandages and the surgery is complete. POST OPERATIVE STEPS After surgery, patients will take home a sling used to protect the arm and the newly repaired tendons. Patients need to wear the sling for the first 6 weeks even during sleep. Patients may take the sling off when bathing or performing physical therapy exercises. DON’Ts for the first 6 weeks: • Don’t lift your surgical arm overhead without help • Don’t reach behind your back • Don’t pick up any heavy objects with the surgical arm • Don’t push or pull any objects with the surgical arm • Don’t perform any chores or physical labor requiring the use of your surgical arm Pain Management after Shoulder Surgery Most patients with rotator cuff repair will have some level physical discomfort which is normal. The pain could be sharp when first attempting to move the arm. Most surgeons will prescribe medications which should be taken to reduce pain but the patient should continue with the rehabilitation program. Ice is helpful to reduce inflammation and improve pain in the initial recovery process. Place an ice pack or cold compress over the shoulder for up to 20 minutes several times a day especially when recovering the first few weeks. Some pain and inflammation are normal for routine healing. However, some things may be concerning and require further attention. Watch out for: • Active drainage or pus from the wound after 3 weeks, the incision sites should be closed by this point. • Swelling and stiffness in the hand/wrist/elbow – this may mean that you have some limited lymphatic drainage; try elevating the arm on some pillows when you sit and performing some hand/finger exercises • Severe unresolved pain in the shoulder joint after 6 weeks Rehabilitation after Rotator cuff repair Rotator Cuff Exercises for Weeks 1 – 6 Physical Therapy will be vital to facilitate recovery and provide the best guidance. For the first 6 weeks, patients need to refrain from any aggressive movement or weight lifting. Initial Physical Therapy sessions are very important for preventing injury and for gradual restoration of movement. In the first several sessions, the therapist will perform the arm movements for the patient (passive motion) so as not to strain any of the repaired muscles and tendons Pendulums • Brace against a supportive surface (like a kitchen counter or dining table) • Allow the surgical arm to hang down with just the weight of the arm • Move your body back by bending your knees until the arm begins to swing around passively • Go clockwise, then counterclockwise • Perform 2 sets of 20 repetitions Table Slides • Rest your hand and forearm on a towel placed in front of your dining table • Lean forward with your body and allow your arm to move forward until you feel a gentle stretch and hold at the end for 5 to 10 seconds • Keep your shoulders relaxed, do not shrug your shoulders • Perform 3 sets 10 reps Shoulder Flexion passive range of motion • Lie on your back • Using the strength of your non-surgical arm, bring your surgical arm overhead, hold at the end for 5 to 10 seconds • Keep your shoulders relaxed, do not shrug your shoulders • Perform 3 sets 10 reps Shoulder External Rotation passive range of motion • Lie on your back, with your surgical arm’s elbow by your side • Hold a lightweight stick with both hands • Using the strength of your non-surgical arm, rotate your surgical arm outwards into a gentle stretch • Hold at the end for 5 to 10 seconds • Keep your shoulders relaxed, and keep your elbow by your side • Perform 3 sets 10 reps Your physical therapist may also direct you to work on improving your wrist/elbow and grip strength. Rehab 6 to 12 weeks post-op Most patients will discontinue wearing the sling after week 4 to 6. This will also be the time in which patients will begin moving the arm, first with some help (therapists call this “active assisted” range of motion), then progressing independence with movement (“active”). Shoulder Exercise for Weeks 6 to 8 Active Assistive Exercises (Flexion, Abduction, External Rotation) The goal is to gradually get your surgical shoulder to move with support from your other arm. • With both hands, hold onto a stick • Using the help of the good arm, push your surgical hand: • Straight up and forward (flexion) • Up to the side (abduction) • With your elbow by your side, rotate the arm (external rotation) • When first starting, use your good arm to push most of the weight, then gradually do more with the surgical arm granted there is no pain • Perform 3 sets 10 reps holding for 5 seconds. Flexion with stick Abduction with Stick External Rotation with Stick Isometrics • With your elbow by your side, press a towel with your fist into the wall in each of these directions gradually until muscle activation is felt in the shoulder • Perform 3 sets 10 reps holding for 5 seconds Shoulder Exercises Week 8 to 12 Resisted Shoulder External and Internal Rotation External Rotation Shoulder Internal Rotation • Stand with your elbow to your side and hold onto a resistance band • External Rotation: take the resistance band and rotate the arm outwards • Internal Rotation: take the resistance band and rotate the arm towards your center • Gradually progress resistance, discontinue or decrease resistance if you feel shoulder irritation • Perform 3 sets 10 to 15 reps Other typical exercises performed during weeks 8-12 • Bicep curls • Triceps extension • Wrist flexor/extensor curls • Resisted shoulder extension • Resisted cable row pulls • Wall slides • Resisted internal/external rotation at 90 degrees of shoulder abduction Shoulder Rehab 12 weeks post-op About 3 months or 12 weeks after surgery, patients should be able to raise their arm on their own and be able to lift lightweight objects up to 5 pounds. Exercises past the 12 weeks should be gradually progressed with consideration of how the shoulder feels. Patients should still have routine follow-ups with a physical therapist to determine the intensity of the exercise. The strengthening program going forward should focus on movements for returning to job duties and previous active hobbies. Even if shoulder pain has mostly subsided, the tendons still need time to heal. Returning to Work After Rotator Cuff Repair Most rotator cuff repair patients will expect to be rested for several weeks. People who have a desk job may return to work sooner whereas a manual labor professional may be out for up to 3-6 months. Depending on the progression your surgeon may decide the appropriate time to return to work.

INTRODUCTION A revision knee replacement surgery is a procedure that is performed to replace a knee implant that is no longer functioning properly. Most knee replacements last several decades, some longer. However, there are also times when a knee replacement needs to be redone after years or even just months. Understanding why a knee replacement has worn out is critical to performing a successful revision knee replacement. The average knee replacement lasts more than two decades, and there are reports of implants lasting longer, and new materials and surgical techniques are hoped to provide even longer-lasting knee replacements. That said, there are times when knee replacements may last a very short time, even in otherwise healthy patients. A small percentage of patients (around 1-2%) end up requiring a knee replacement revised within a few years of their initial surgery. Revision replacements are performed for a number of reasons. Some of the more common include: Loosening of the implant Infection of the joint Instability of the knee Malalignment of the components Many people ultimately have a revision knee replacement because the problem is causing significant pain. While pain can be a problem in itself, a revision knee replacement surgery should not be performed without understanding why the pain is occurring. Performing this type of surgery for pain without an identified cause is unlikely to yield good results. Instead, the cause of the problem with the knee replacement needs to be precisely understood, and there needs to be a plan to address that problem with the implant. An operation without a clear plan to address the problem is unlikely to be helpful. Complexity in revision surgeries Revision replacement is difficult for several reasons. First, when someone has had surgery, scar tissue develops, and soft tissues become less identifiable. Performing the second surgery is always more difficult. Second, when performing a knee replacement, bone is removed. When performing a revision knee, often more bone has to be removed, and some may be lost as a result of the problem with the implant. Maintaining adequate bone to support the new implant can be a challenge. Finally, obtaining a knee that is flexible enough to allow for motion, yet stable enough to keep you steady, is also more difficult in revision situations. PRE-OPERATIVE PHASE Your surgeon will send you for routine blood tests to rule out infection, CT scan to look closer at the anatomy, and bone scans to help to determine if a component is loose. X-rays and/or MRI will be considered. Aspiration of the knee joint is occasionally done to diagnose or rule out infection Patient will be asked to undertake a general medical check-up with a physician Patient should have any other medical, surgical or dental problems attended to prior to the surgery in order to prevent a risk of infection. Cease aspirin or anti-inflammatory medications 10 days prior to surgery as they can cause bleeding. Any antiplatelet drugs / blood thinners such as clopidogrel, warfarin will be stopped 3-7 days prior to the date of surgery. Surgical consent will be explained to the patient detailing the procedure as well as the risks involved, if any. Blood transfusion, if required will be informed and done. Day of surgery You will meet the nurses and answer some questions for the hospital records You will meet your anesthetist, who will ask you a few questions and assess the risk factors for surgery. You will be given hospital clothes to change into and have a shower prior to surgery The operation site will be shaved and cleaned Approximately 45 minutes prior to surgery, you will be transferred to the operating room After explanation of the procedure, you will be asked to sign the consent for surgery. Occasionally, a high risk consent for surgery may be requested depending on the blood reports and clinical examination. SURGICAL PROCEDURE Each knee is individual and knee replacements take this into account by having different sizes for your knee. If there is more than the usual amount of bone loss, sometimes extra pieces of metal or bone are added. Surgery is performed under sterile conditions in the operating room under spinal or general anesthesia. You will be on your back and a tourniquet will be applied to your upper thigh to reduce blood loss. Surgery takes approximately two hours. The patient is positioned on the operating table and the leg prepped and draped. A tourniquet is applied to the upper thigh and the leg is prepared for the surgery with a sterilizing solution. An incision around 7cm is made to expose the knee joint. Old/ damaged components of the implants are removed. The bone ends of the femur and tibia are prepared using a saw or a burr to freshen the bone. Trial components are then inserted to make sure they fit properly. The real components (Femoral & Tibial) are then put into place with or without cement. The knee is then carefully closed and drains usually inserted, and the knee dressed and bandaged. POST- OPERATIVE MANAGEMENT When you wake up you will be in the recovery room with intravenous drips in your arm, a tube (catheter) in your bladder may be inserted, and a number of other monitors to check your vitals. Once stable, you will be taken to the ward. The postop protocol is surgeon dependent, but in general your drain will come out at 24 hours and you will sit out of bed and start moving your knee and walking on it within a day or two of surgery. The dressing will be reduced usually on the second postop day to make movement easier. Your rehabilitation and mobilization will be supervised by a physical therapist. To avoid lung congestion, it is important to breathe deeply and cough up any phlegm you may have. Your surgeon will use one or more measures to minimize blood clots in your legs, such as inflatable leg coverings, stockings, and injections to thin the blood clots or DVT’s. A lot of the long-term results of knee replacements depend on how much work you put into it following your operation. Usually you will be in hospital for 3-5 days and then either go home or to a rehabilitation facility depending on your needs. You will need physical therapy on your knee following surgery. You will be discharged on a walker or crutches and usually progress to a cane at six weeks. Your sutures will be removed at approximately 12-15 days. Bending your knee is variable, but by 6 weeks it should bend to 90 degrees. The goal is to get 110-115 degrees of movement. Once the wound is healed, you may shower. You can drive at about 6 weeks, once you have regained control of your leg. You should be walking reasonably comfortably by 6 weeks. More physical activities, such as sports may take 3 months to be able to do comfortably. You will usually have a 6-week checkup with your surgeon who will assess your progress. You should continue to see your surgeon for the rest of your life to check your knee and take X-rays. This is important as sometimes your knee can feel excellent but there can be a problem only recognized on X-ray. You are always at risk of infections especially with any dental work or other surgical procedures where germs (bacteria) can get into the blood stream and find their way to your knee. If you ever have any unexplained pain, swelling, redness or if you feel unwell you should see your doctor as soon as possible. A Revision Knee replacement is a complex procedure and requires a highly skilled surgeon with adequate expertise. Our Consultant in chief, Dr Vikas Jain is one of the few surgeons in the region who is trained from Europe and has adequate surgical experience in such complex revision procedures.

Shoulder Arthroscopy- Dislocation Bankarts Repair Surgery To better understand what shoulder dislocation is, an overview of the shoulder is needed. The humeral head (ball of the shoulder joint) is centered in the glenoid (the socket of the joint), which stabilizes the shoulder. If the shoulder becomes dislocated, it can tear the glenoid labrum and ligaments that help reinforce its structure. Bankarts repair surgery is a minimally invasive surgery to repair instability and restore function of dislocated shoulders. The goal of Bankart repair surgery is to re-attach the torn labrum and ligaments to the tip of glenoid from which they were detached. Symptoms of Bankart tear or lesions are: • Severe shoulder pain • Shoulder dislocation, single or multiple episode. • Repeated instances where the shoulders give out during activity • Sensation of the shoulder feeling loose, slipping out of the joint or “hanging there” PRE-OPERATIVE STEPS Every effort is made to assess the patient prior to surgery in order to ensure safety of the patient for the elective procedure. 1. After admission, routine blood work-up will be done prior to surgery. Depending on the age of the patient and other premorbid conditions, other investigations such as Echocardiography may be performed in elderly patients. 2. All the investigations prior to surgery are performed in order to ensure that the surgical procedure can be safely tolerated by the patient, since shoulder arthroscopy is an elective procedure. If any risk is involved, the patient/ attendants will be informed so. 3. Blood transfusion though rarely required, may be done depending on the reports. 4. X-rays and/or MRI may be done depending on the surgeon’s choice and the surgical indication. 5. Surgical consent will be explained to the patient detailing the procedure as well as the risks involved, if any. INTRA OPERATIVE STEPS 1. After anesthesia induction and patient positioning your surgeon will make two small incisions in the front and one small incision in the back of the shoulder. 2. The surgery is considered minimally invasive thanks to the small incisions resulting in less discomfort and shorter recovery time. 3. The surgery is performed using a small fiberoptic camera (an arthroscope) and other small instruments. 4. The labrum tissue which is attached due to fibrosis at abnormal position (after shoulder dislocation) is released from the underlying glenoid. 5. Small holes are drilled near the detached labrum, once it has been cleared of loose particles. 6. The surgeon will then attach sutures to the released labrum and pull them tightly across the anchors so the labrum can be reattached to the glenoid. 7. Once the ligaments are firmly in place, the incisions are then closed with small bandages and the surgery is complete. POST OPERATIVE STEPS The first few days following surgery may be painful, but is typically managed by minimal amounts of pain medication. Seven to 10 days after the surgery, patients should have a follow-up with their surgeon.. Physical therapy helps to improve physical strength, range of motion, and assists with normal activities of daily living. 1. After surgery the arm is placed in a sling immobilizer. The sling is worn for at least the first two weeks after the operation. It should be removed when bathing/showering, or to do exercises. The sling is worn to sleep, and when in big crowds for at least four weeks after surgery. 2. Physical therapy should begin 7 to 10 days after surgery. Your surgeon will guide you through the exercises required after the surgery. The exercises are necessary to strengthen the muscles around the shoulder joint. 3. 1-2 week: passive shoulder motion and passive/active elbow motion 4. 2-8 weeks: active-assisted range of motion 5. 8-12 weeks: isometric rotator cuff strengthening 6. 3-6 months: sports- and work-related exercises 7. Return to sport: conditioning at 12 weeks but full return to contact sports at 6 months For the first four to six weeks following surgery, the focus should be on rehabilitation and regaining as much range of motion as possible (keeping surgical repair in mind). Depending on the progress of the patient, the next four to six weeks the focus will be on increasing the strength of the shoulder. As the strength of the shoulder improves any pain should decrease. Patients should visit their physical therapist six-eight times over a period of 12 weeks. Depending on the recovery, a patient can return to normal activity within a short period.