The upper extremity program at Humber River Health provides comprehensive care of shoulder, elbow, and wrist disorders, for management of arthritis, instability, tendon & ligament tears, as well as fractures. Complementary surgical and anesthetic procedures including minimally invasive and bone preserving techniques, coupled with regional nerve blocks allow for same-day and short-stay care.  Humber River Health is a leader in Continuous Outpatient Interscalene Nerve block (COIN), reducing narcotic requirements in the post-operative period.  Hospital and partnered community-based outpatient physiotherapy allows for co-ordinated recuperation.

The COIN involves the use of a safe and effective home-based nerve block system to block the pain signals from the shoulder to the brain. A local anesthetic pumps out of a portable bottle at a slow rate on its own, and flows through a catheter near the neck for 3 days. Patients are able to return home the same day as their surgery with minimal pain and decreased opioid use, allowing them to recovery comfortably at home.

Patients on the COIN receive thorough education before and after surgery on managing the nerve block, and an anesthesiologist will call the patient every day to make sure the bottle is working properly and is managing the pain.

Learn more about the COIN program here.

Speak to your surgeon to see if you are a candidate for the program.

Please see pamphlet below on how to manage the nerve block at home.

Managing Your Nerve Block After Shoulder Surgery

List of procedures:

• Shoulder arthroplasty: anatomic & reverse
• Rotator cuff repair: arthroscopic, including superior capsule reconstruction
• Shoulder stabilization: arthroscopic & open, including Latarjet procedure
• Shoulder reconstruction for management of fractures, acromioclavicular separation, pectoralis major tear and biceps tear.
• Elbow arthroplasty
• Elbow release: arthroscopic & open
• Elbow reconstruction for management of fracture and distal biceps tear
• Wrist fusion: total and motion preserving
• Wrist arthroscopy
• Wrist reconstruction for fracture management and ligament disruption
• Base of Thumb arthroplasty