The following are post-operative instructions for patients who have undergone open repair of their shoulder. This is usually performed as an outpatient procedure. 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 our office.
You will be provided with an immobilizer for your comfort. You may open the wristband (if your immobilizer has this option) only to use the hand to eat or to straighten the elbow. Do not remove the immobilizer yet and elevate the shoulder. When you are seen in the office we will let you know when it is ok to only use the immobilizer and be out of it.
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.
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. Schedule an office appointment for about 7-10 days from your surgery so the wound can be checked. Wound care instructions will be provided to you on discharge. 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. Some swelling, bruising and warmth are 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.
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.
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 1-2 weeks after surgery. Once you are up and about regularly you may discontinue the stockings.
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.
In order to reduce stiffness and obtain maximum function 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, rotator cuff surgery. Other procedures such as capsule repair we give you early exercises at your follow up and prescribe therapy at the 4-week check. To promote circulation, remember to do your ankle/foot stretching exercises regularly. Walking is encouraged.
Office Follow Up
Please call our office within a few days following surgery to schedule your first follow-up visit for 7-10 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.
Open shoulder surgery has a low rate of postoperative complications. The incidence of an infection deep within the fracture is low. 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 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