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Shoulder Surgery and returning to safe driving

james mcleanWhen planning to undergo shoulder surgery, patients often ask: “When will I be able to drive after my surgery?”

The answer to this question depends on the procedure you will be having, your ability to drive and your recommended rehabilitation plan. Physiotherapy forms an integral part of your rehabilitation and can be an important part in working towards this goal.

There is no legislation that covers surgery and driving. However, your normal car insurer may not cover you if you are involved in an accident while wearing a cast or a brace, if you are taking pain-relieving medications, or if you have had “recent surgery”. The definition of “recent surgery” is not clearly defined. If unsure, contact your car insurer for clarification.

Deciding when you can return to driving has two considerations:

  1. Will the act of driving impact or impair the healing process and perhaps compromise the final outcome of your surgery.
  2. Are you safe to drive, i.e. Can you safely drive and perform an emergency stop.

A safe return to driving depends on:

  1. What you drive (automatic/ manual/ power steering).
  2. The conditions you are driving in (bad weather/ night/ poor roads).
  3. How long the journey will be.

Immediately after your operation you will likely be taking pain-relieving medications that are sedatives (similar to alcohol). These can interfere with your concentration, judgment and reaction time. You should not drive while you are taking these medications.

Your physiotherapist will help you work toward regaining control of your limb to allow safe driving. When successful surgery is combined with adequate, well-directed physiotherapy, excellent results can be expected. Your physiotherapist will regularly assess your progress through the rehabilitation process and tailor a programme that best suits you.

  1. Range of Motion

    A general guide to aim for is 90 degrees of forward flexion and 90 degrees of abduction. In addition, you should be able to control your vehicle in an emergency situation.

  2. Strength

    It is also important to consider your strength. Your strength should be almost equal to the other side and not compromised by pain, impingement or poor nerve / muscle function.

Once your arm is strong enough and has enough range of motion to physically go through the act of driving, it is also important to consider reaction times. As with most return to activity advice it is best to follow a graduated return: steadily increasing the duration and intensity as comfort allows. Some considerations based particular on surgery/ injury:

Shoulder replacement

The main consideration following shoulder replacement surgery is the healing of the tendons, which are normally cut to gain access to the joint. In general, tendon healing takes 6-8 weeks and gets progressively stronger to the 3 month mark. It is important to remember that returning to driving early may compromise your surgery. As a guide it will be at least 8-10 weeks before you will be able to drive and then a gradual increase in activity/ driving can be expected. To avoid disappointment, do not forget to discuss the expected post-operative restrictions with your surgeon prior to surgery.

Arthroscopy (key-hole shoulder surgery)

If you have had key-hole surgery where no tendon or ligaments have needed repair, immediate movement is encouraged and you can drive once physically able. On average most people return to driving around 4 weeks following surgery.

If a ligament, a tendon or the labrum have been repaired, you need to wait until these have healed – normally around 8-10 weeks with a graduated increase in activity. Your surgeon will likely protect your shoulder by using a sling for 4-6 weeks following your surgery. It is important to remember that returning to driving early after tendon surgery may compromise your outcome.

The length of time required for therapy varies with each patient and varies between conditions. Your physiotherapist will form an important part of your recovery and help you progress through the stages of healing. It is therefore important that you choose a physiotherapist that you feel comfortable with, and is someone with whom you can trust your health and well-being.

Some rehabilitation programmes require several sessions per week, while others require a single visit and exercises can be performed at home. Asking your physiotherapist to outline your rehabilitation plan for returning to driving will help you prepare mentally and physically for your rehabilitation, and is an important step toward a successful recovery. Understanding the process and your role in it will help you recover more quickly and you will have a lower chance of having problems.

For more information on orthopaedic surgery, including other “Frequently Asked Questions”, check out Dr McLean’s website at www.jmclean.com.au

Dr James McLean Consultant Orthopaedic Surgeon Adelaide, Australia