The Procedure
Scapula resection, also called a scapulectomy, is a surgery involved removal of part or all of the shoulder blade. Partial removal of the scapula usually involves removing a section of the bone while leaving the glenoid intact. The procedure is typically performed due to tumours or severe injury, in order to preserve shoulder function.
The procedure is usually performed arthroscopically but can also be performed in an open technique. I typically book about two hours of theatre time for the surgery.
Complications
General risks of surgery include:
- Bruising & haematoma: this will vary for each patient. Bruising is a normal side effect of surgery and usually resolves in a short time.
- Infection: infection is a possible risk and is usually treated with antibiotics.
- DVT and PE: deep vein thrombosis and pulmonary embolism are blood clots that form in either the lower limbs or lungs. If left untreated, DVT and PE can have serious effects, however if treated promptly, the risks are significantly lowered. More information can be found here.
- Anaesthetic risks: general anaesthetic (GA) carries a number of risks, which will be discussed in detail with your anaesthetist prior to surgery. Fortunately, Australia is one of the safest places to undergo a GA. In Australia, the risk of mortality from GA is around 1 in 100,000. For context, the risk of death in a car accident in Queensland is around 1 in 10,000 per year.
- Wound issues: some superficial issues can develop in surgical wounds postoperatively, however most will require a small intervention to resolve the problem.
Specific risks of scapula resection include:
- Shoulder instability and dislocations
- Limited range of motion
- Ongoing pain
Pre Op
Whilst you wait for your surgery date, there are a few things to do:
- Speak to your health fund to confirm if the hospital fee for your surgery is covered on your policy
- Speak to your anaesthetist to confirm their fees
- Register your details with the hospital
- Read through, complete and return your paperwork to my office
- Plan your transport to and from the hospital. You won’t be able to drive yourself home after the surgery, so make sure you have a travel plan in place
- If required, arrange any recommended pre op physio appointments
- If required, get any pre op pathology tests (e.g., blood tests)
- Use benzoyl peroxide 5% wash on your shoulder for 5 applications: twice a day for two days, and then again on the morning of the surgery. This will help reduce your risk of infection from Cutibacterium acnes.
- Pack a bag for your hospital stay including regular medications in the original packaging, a loose button-up shirt to wear after surgery, nightwear, personal items including toiletries. If you have sleep apnoea, you must bring your CPAP machine.
- If you are on any blood thinners, ring my office and confirm when to stop taking them before the operation.
- If you are on any diabetic tablet medications, ring your anaesthetist and confirm whether you need to stop taking them before the operation.
- Confirm your admission details with my office one to two business days prior to surgery.
Though this can seem overwhelming, you will be provided with detailed instructions on what needs to be done so your surgery journey can be as smooth as possible.
Day of Surgery
Your admission details will be confirmed one to two business days prior to surgery. You will need to make note of your admission time and your fasting time. Your admission time may be as early as 6am. If you aren’t local to Brisbane, it is usually recommended that you stay the night before in case your admission is early.
When you arrive at the hospital, you will go through the admissions process and then be taken through to the surgical waiting area. Your anaesthetist will have a short consultation with you before you go into theatre and under general anaesthetic. I will say hi to you before the surgery in the anaesthetic bay of the operating theatre and mark your operation site with you.
Your hospital stay will usually be one night. You will be discharged usually around 10am. I will see you before your discharge. I will provide you with a folder containing a detailed postoperative pack including a letter telling you what I found at surgery and exactly what I did in your operation along with information about your rehabilitation and postoperative care. Remember to have someone available to take you home from the hospital.
Post Op Recovery & Healing
Following scapula resection surgery, the recovery can vary quite significantly, depending on the specifics of the procedure. If a minor resection has been performed, there is typically a return to normal activities with six weeks, whereas if a more complex surgery has been performed, recovery can take several months.
Time off work may be required, as well as assistance with some daily activities and limited driving.
Rehabilitation
Physiotherapy is a critical part of the recovery after scapula resection, with exercises focusing on restoring strength and function.
Physiotherapy Guidelines
Day 1 Physiotherapy Guidelines
The hospital physio will demonstrate how to fit your sling and how to eat, shower & dress whilst in your sling.
Goal: Promotion of gentle function and restoration of passive and active shoulder range of motion
Day One:
- Education and Reassurance: no surgical repair, ok to start moving, will not “pull anything apart”
- Sling: for comfort only, aim to cease wearing within a week, check fit, demonstrate activities of daily living (showering, dressing etc)
- ADL’s (activities of daily living): good to use the arm for light activities eg dressing/eating, function within pain limits. No repetitive or loaded work above chest height.
- Pain relief: ice, positioning, posture, pain medications as prescribed
- Postural correction including scapula positioning
- AAROM (active-assisted range of motion) exercises: no limitation in range, move into all directions as able, focus initially on flexion and external rotation, possible exercises include:
- Circular pendulum
- AA (active-assisted) external rotation at neutral
- Supine flexion
- Forward lean on bench
- Horizontal flexion
- Supine Hand to head
- Internal rotation - hand to hip with neutral scapula
- Patient may refer to Extend Rehab or Dr Cutbush's website for exercise videos
Follow up:
With local physiotherapist week 2 to check AROM (active range of motion) and PROM (passive range of motion) returning, and correction of scapula biomechanics. Week 6 with Dr Cutbush and Extend Rehabilitation Physiotherapist.
Results After Surgery
Results following scapula resection can vary, depending on the specific details of the surgery, however, overall, it typically offers improvement of pain and adequate shoulder function. Adhering to rehabilitation exercises during the recovery phase can heavily influence outcomes, though some loss of range of motion can be common.