The following are post-operative instructions for patients who have undergone arthroscopic decompression surgery to their shoulder. This is a surgery to remove the bursa, bone spur and free up space for the rotator cuff. The following are postoperative care instructions. Please refer to this reference sheet, which should probably answer most of the questions you might have. If you have further questions that need immediate answering, contact us at our office.
Sling
You will be provided with a sling for your comfort. You may remove it for eating, exercises, and as your comfort without it improves.
Dressings
You will have a dressing over your shoulder. You may notice some bloody spotting coming through the outer dressing. Although it is unlikely to be significant bleeding, contact us if it continues to become saturated. Otherwise, any small area of spotting will dry and can be ignored until you remove the dressings.
Incision care
The sutures utilized in closing any wounds are absorbable and buried under the skin, and will not need to be removed unless you are told otherwise. With a routine arthroscopic shoulder decompression these are covered with a Steri-Strips. Schedule an office appointment for about 7-10 days from your surgery so the wound can be checked. You can remove your dressings to shower on the third day following surgery (i.e., surgery on Monday, shower on Thursday). Remove the dressings to the Steri-Strips (which are small tapes glued to the skin) and you can remove the dressings including the yellow gauze. The Steri-Strips can get wet and do not require changing unless there is drainage from the wound. You can place a shirt on. To assist in doing this lean forward and allow the arm to fall away from the body to put a shirt on. If there is any noticeable or persistent drainage from the incision sites, or any surrounding red areas, please contact us immediately. Some swelling, bruising and warmth is expected after surgery. If you develop increased redness, drainage, or a fever, CALL THE OFFICE. Bruising around the shoulder upper arm area is not uncommon. This may even extend down the elbow and forearm area and will resolve in over 3-4 weeks.
Medications
You will be provided with a prescription for a pain medication when you are ready to leave the hospital. Usually, we will prescribe hydrocodone, hydromorphone, or oxycodone. These are generic names for three different narcotic pain relievers. If you are aware of a certain pain medication that you have previously had problems with or one that you normally respond favorably to, please inform us so that we can give you the appropriate prescription. You may have the prescription prior to surgery to avoid filling it the day of surgery.
Normally we will avoid using anti-inflammatory medication (i.e. ibuprofen, Advil, Aleve, etc.) as this may interfere with bone or tendon healing. If you are intolerant to most pain medications the short term use of anti-inflammatory medication is OK. In this case, you might be given a prescription for an anti-inflammatory medication Toradol (ketorolac) that will help lessen pain and swelling. If not, you are welcome to use an over-the-counter anti-inflammatory such as Ibuprofen (Advil, Nuprin, etc.). These come in 200-mg tablets. The usual maximum adult prescription dosage is 400-600 mg 3-4 times per day, usually taken with food. This would amount to taking 9-12 store tabs per day. The anti-inflammatory medicine can be taken on a regular basis along with the prescription pain medication, which is utilized on an as needed basis. You will find that the combination will lessen your need for the prescription pain pill. If you have a history of ulcers or of stomach irritation with aspirin or anti-inflammatory drugs, then you should avoid taking these medications. If you have high blood pressure you should check your blood pressure to be sure these medications do not cause an elevation in your pressure. If you have kidney problems you should avoid these medications.
Plain Tylenol is OK if you have no liver disease. Remember, the short acting pain pills often have acetaminophen (Tylenol) in them. The maximum daily dose of Tylenol if you have a normal liver is 3500-4000 mg. If your narcotic pain medicine is not lasting long enough you can use a little more or use if less often as long as you do not overuse the maximum daily acetaminophen dose.
If you have a history of nausea with surgery we can prescribe an anti-nausea medication (Phenergan or Zofran). Try to take this medication regularly at first and prior to taking the narcotic pain pills to allow it to be most effective.
Please try to anticipate the need for any refills on your pain medication, and contact our office early in the day the day before running out completely. I cannot provide prescription refills after business hours or on weekends.
Swelling
Again, swelling around the shoulder and down the hand region is NORMAL. Reducing the swelling as much as possible will improve comfort and mobility. Pumping the hand or straightening the elbow can help with swelling, also sleeping in an upright position can reduce swelling and pain. Wear the TED stockings (white) for at least 1 weeks after surgery. Once you are up and about regularly you may discontinue the stockings.
ICE Therapy
An ice pack will be applied after surgery. The ice should be replaced every 2-3 hours for the first couple days. Protect the skin from direct contact with the ice pack. (Not necessary to change as often during sleep hours.) After the first few days apply a refreshed ice pack on the shoulder, 3 or 4 times a day for 20-30 minutes. The ice and elevation may be helpful up to 2 weeks after surgery. If you feel the swelling is excessive you should call the office.
Exercise
In order to reduce stiffness and obtain the maximum functionality of your shoulder, it is important to maintain a good balance of rest and exercise. Listen to your body; too much activity will produce increased swelling and/or pain; too little activity could prolong your recovery and/or limit your mobility. The physical therapist should provide you with shoulder exercises. You may be provided with a prescription for therapy to begin in the week following surgery. If you want to avoid a course of formal supervised rehab, please inform us so that we can discuss some independent home rehab options and techniques with you. Here are a few simple exercises that everyone can begin immediately. One of the best early exercises is to straighten and bend your elbow and squeeze a light ball. You can then allow your arm to hang and rock it back and forth with your body’s momentum letting the shoulder relax as much as possible. Next, start walking up the wall with your fingers for support on the wall. Last, start actively elevating your arm watching that the shoulder blade is not overly asymmetric with the opposite side.
Office Follow-Up
Please call our office within a few days following surgery to schedule your first follow-up visit for about 5-7 days after surgery. This can vary plus or minus several days depending on your schedule and ours, as there are no sutures to be removed.
Complications
Arthroscopic shoulder surgery is a fairly simple and minimally invasive outpatient surgery, so postoperative complications are fortunately quite rare. The incidence of an infection deep within the joint is literally one out of thousands. The onset of symptoms would be approximately 5-7 days following surgery, and would consist of a significant increase in pain, swelling, warmth, and redness of the shoulder, fever, chills or night sweats. More common, but still quite rare, would be a small superficial infection or irritation at one of the skin incisions. There can also be a very small incidence of a blood clot developing deep within your arm veins or leg veins. If you have had a previous blood clot, use estrogen, or have a family history of blood clots in the legs, arms or lungs you should probably be protected with TED hose and aspirin or a blood thinner. If we did not start this let us know. If we recommended aspirin for blood clot protection you should use a baby aspirin twice a day for 2 weeks or as long as the leg or arm is immobilized. A blood clot would be characterized by a sudden onset of new pain (usually different from your surgical shoulder pain) or tightness in the shoulder or upper arm or leg. This usually begins about 5-7 days from the day of surgery. The presence or absence of a clot can usually be determined by a simple non-invasive ultrasound test at the hospital.
If you then still have any questions or concerns please notify me, my nurse, or physician assistant.
Bryan Bomberg, MD
11/16