The following are post-operative instructions for patients who have undergone arthroscopic repair of their shoulder. 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 my office.
You will be provided with an immobilizer for your comfort. You may open the wristband only to use the hand to eat or to straighten the elbow. Do not remove the immobilizer yet and elevate the shoulder.
You will have a bulky 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.
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 repair these are covered with a Steri-Strips.
Ice and elevation will help minimize the pain and swelling after surgery, especially during the first few days. You will be more comfortable in an upright position. You can keep ice packs on the shoulder continually during the first couple days without risk of frostbite injury to the underlying skin as long as the original dressings are in place. The initial post-operative wrap involves multiple layers of cotton gauze and padding, therefore insulating the skin surface reasonably well. Once you have removed the original dressing I would recommend ice applications to the shoulder region for 20 minutes at a time, up to every 2-3 hours.
You can remove your dressings to shower on the second day following surgery (i.e., surgery on Thursday, shower on Saturday). 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. Then put the immobilizer on over the shirt. If there is any noticeable or persistent drainage from the incision sites or any surrounding red areas, please contact us immediately.
Depending on the type of surgery you underwent you may be provided a prescription for formal physical therapy when you leave the hospital. All of the different therapy firms in our area are excellent with shoulder rehabilitation, so you are free to select your therapist. Otherwise, we will discuss your exercises and activity limitations when you are seen in the office.
Office Follow Up
Please call our office within a few days following surgery to schedule your first follow-up visit for 1-2 weeks after surgery. This can vary plus or minus several days depending on your schedule and ours, as there are no sutures to be removed.
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 600-800 mg three 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 antinausea 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 1-2 days before running out completely. I cannot provide prescription refills after business hours or on weekends.Complications
Arthroscopic shoulder surgery is a 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 a blood thinner. If we did not start this let us know. If we recommended aspirin for blood clot protection you should use a single aspirin twice a day for 2 weeks or as long as the 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. Contact our office for any concerns.
Bryan Bomberg, MD