Post Operative Discharge Instructions for Shoulder Surgery
Including Arthroscopic Rotator Cuff Repair, Labral Surgery, Instability Surgery, Arthroscopic shoulder surgery and mini open shoulder surgery.
Please use the information below as a general guide. If you can not find the answer to your question or concern, call the office.
2. Cold pack or “Game-Ready/thermotek” (if ordered).
3. Medications- pain, anti nausea, Tylenol (acetaminophen), stool softener.
Pain Medication: You should expect some pain following your procedure. You will have been given a prescription for Dilaudid (hyromorphone) or Percocet (Oxycodone/APAP), which you should start taking during the early onset of pain or prior to bedtime.
Taking the medication- Tylenol (Acetaminophen) should be taken four times daily, with a maximum dose of 3500mg daily. Diluadid (hydromorohone) may start with a dose of 2-3 pills (2mg each pill). Please remember to continue taking the Tylenol if you are taking the Diluadid. If the pain is not that severe you may want to only take the Tylenol.
Alternatively begin with one Percocet (Oxycodone/APAP) 10/325mg and NO Tylenol every 3-4 hours. Do not exceed 8 pills per day. In most cases Dr. Glashow will instill local anesthetic into the shoulder, which will slowly wear off in the ensuing 8 to 12 hours.
While taking the pain medication you must also take a stool softener, we recommend colace or magnesium citrate. You should take as directed on the bottle. Notify the office should you have a problem.
You will also be given a medication for anti nausea treatment. Zofran (odansatron) should only be used if needed. Please follow directions from the pharmacy.
*Never Exceed more than 3500mg of Tylenol within 24 hrs.
*Never take Advil, Aspirin, Motrin or Aleve unless cleared by our office.
ANESTHESIA/ANESTHETIC BLOCK: Most shoulder surgery patients undergo an interscalene block with or without an indwelling catheter. It is quite variable as to when the dense numbness from the block resolves. In most cases this is between 12 and 24 hours. The catheter allows for a low to moderate level of pain relief until it is removed. The catheter must be removed by 72 hours after surgery. As described above in the directions for pain medication, be certain to take the pain medication before the block has completely worn off. It is normal in part due to the block and the surgery for the hand to be swollen and warm, in addition to it’s being numb. This will resolve within the first few days after surgery. Do not be alarmed if throughout the first night the sensation and feeling and ability to move your hand does not return, as it has taken sometimes in excess of 24 hours for complete resolution of the symptoms of the block. In addition, you may or may not notice your eye to be drooping and breathing to be labored on the same side as the surgery, this is due to the block and is normal.
SLEEPING POSITION: After your shoulder surgery, you will find it most comfortable to be somewhat propped up either with several pillows, a wedge-type device, or sleeping in an easy chair if that is available. We also recommend placing a small pillow behind the elbow so it does not dip behind the body, as this will force undue discomfort and pressure on the shoulder region. It is also best not to put any sort of pillow directly behind the shoulder itself, rather keep that pillow behind the elbow. You may certainly lie down in a horizontal position, it will not hurt the shoulder, particularly if there is a pillow behind the elbow, it is simply more comfortable in a somewhat upright position. As you feel more normal in the ensuing days, you may sleep in your more usual position.
COLD PACK OR GAME-READY/ICE MACHINE:
Ice Machine/Cold Packs:
• If you chose to get the “Game Ready” or ” NanoTherm”, the pad may already be on the shoulder; or given to you when you leave the hospital/surgery center.
• You may use the cold therapy device as much as you like. Cold therapy to the shoulder will help reduce pain and swelling.
• You may go to sleep with the cold therapy machine on.
• Compression turned on is preferred but not essential.
• If you decide to use ice packs, they should be applied to the front of the shoulder for 20 minutes on, 10 minutes off as much as possible.
• The cold therapy pad is completely independent and may be used separate from the sling/brace.
SLING/BRACE:Depending upon the exact procedure you had, the doctor will have placed your arm in a specific sling with or without a brace/pillow component in the position it need be. Please be sure you are comfortable before leaving the hospital and try to maintain this position until your postoperative visit. Certain reconstructions require the arm to be in the front of the body; others require the arm slightly rotated out to the side. It is always important that the weight of the arm is resting in the sling, particularly with the elbow in back of the sling and the weight is supported either by the strap or the pillow or brace that goes around the waist. Do not attempt to lift the arm up within the sling, as this will cause spasm in the surrounding muscles and cause more pain. Once the sling is removed by the doctor in the office and you are shown how to wear it, this will become more clear. When lying down, it is okay to loosen the neck strap so that the arm is supported directly on your torso or the pillows behind your arm as described above. When standing up or moving about tighten the band around the neck so that the sling supports the arm and you are not using the muscles of the repaired arm to hold the arm in place. One good general rule is that the elbow should not leave the side when placing the arm in and out of the sling; simply let it dangle in place as you fix the sling to the arm in the appropriate position.
BANDAGES: It is normal during the arthroscopic procedure for the bandages to become soaked with blood-tinged fluid. During an arthroscopic procedure, arthroscopic fluid is instilled into the joint. It continues to seep out of the skin wounds for the first 24 to 48 hours after surgery. Even a small amount of bleeding that occurs will cause the extravasated fluid to appear red. This should not be concerning. Once the bandage is removed after the first 24 hours, leave the underlying white (Steri-Tapes) in place; do not remove them. If there is continued drainage, apply a sterile gauze and minimal amount of tape to the incisions. Alternatively, a larger type band-aid will suffice. Many patients are seen in the office after the first postoperative day, or by the physical therapist, who may change the bandages for you.
NORMAL FINDINGS AFTER SURGERY:
• It is sometimes normal to have pain in the back of the shoulder even before the block wears off in the hand, elbow, or wrist area.
• Warmth and swelling about the hand and shoulder is normal for up to three to four weeks.
• A small amount of bloody drainage is normal after surgery and may continue for up to a few days. • Numbness to the area around the incision is normal.
• There may be bruising around the shoulder, around the shoulder area, into the upper arm or biceps area.
• A low-grade temperature of less than 100.5 degrees Fahrenheit occurs after surgery. It is often due to the anesthesia and the trauma of the surgery. It is good to walk around a bit after surgery, take several deep breaths to ensure the lungs become fully aerated. Taking several deep breaths at once and holding the last breath is a helpful way to encourage airflow into the lungs.
NOTIFY OUR OFFICE IMMEDIATELY IF ANY OF THE FOLLOWING SIGNS OR SYMPTOMS OCCUR:
• Temperature greater than 101.5 degrees Fahrenheit.
• Fever, chills, and increasing pain in the shoulder.
• Excessive drainage from the incision sites that include bright red blood.
• Drainage from the incision sites that appear yellow, pus-like, or foul smelling.
• Increasing pain in the shoulder not relieved by the measures described above.
• Any other untoward effects you feel are significant.
• If you have not heard back from the doctor quickly enough and you feel your situation is a true emergency, please proceed to the closest emergency room and notify the emergency room doctor that you had surgery with Dr. Glashow, and to contact Dr. Glashow directly.
PHYSICAL THERAPY: Depending upon the nature of the procedure you had, physical therapy may start within a few days or delayed for a couple of weeks. At your first postoperative visit, the doctor will direct you as to the exact course of physical therapy.
UNTOWARD EFFECTS: The doctor is available for emergencies by calling the office directly, at (212) 794-5096 after office hours. Please reserve emergency calls to true emergencies only. All questions and concerns that can be addressed the following day should be addressed during normal office hours, Monday through Thursday 9:00 a.m. to 5:00 p.m. and Friday 9:00 a.m. to 4:00 p.m. Please be certain the telephone number you leave with the operator allows calls from a private line.
If your phone line does not allow blocked calls, please unlock your line prior to calling otherwise the doctor will be unable to return your call. If you do not hear back from the doctor within 20 minutes, please call back again urging the page operator to once again contact the doctor.