Post Operative Instructions After Total Shoulder Arthroplasty
There is a lot to learn after shoulder replacement surgery. While this is a major surgery on your shoulder, the benefits from it can be significant – especially in terms of pain relief. Please don’t use this information as a complete authority on your rehabilitation, but as a starting point to discuss with me and your physical therapist.
Comfort and medications after Surgery
Many of you will have had a nerve block for the surgery. Your anesthesiologist is in charge of this and performs the blocks. When it works as it should, you may have no pain at all for the first 24 hours. You also may not be able to feel your fingers ! Don’t worry – the block will wear off. Call me if the block lasts more than two days. I’ve seen them last three days.
Aspirin: I typically suggest 81mg of aspirin for the first 10 days to decrease the risk of blood clots. Symptoms to watch for are worsening calf pain, or leg swelling that seems unrelated to the swelling from the surgery. Let me know right away about this. I’ll send you for a simple painless ultrasound of the leg to check.
Ibuprofen: This medicine helps with pain and inflammation. It works in your shoulder. I typically will suggest 600-800mg three times a day unless it bothers your stomach. This will help reduce swelling, inflammation and pain.
Vicodin / Percocet / ?: A strong narcotic. This does nothing for your shoulder, but tells your brain you don’t have pain. You are not required to take this, but may use it as needed. If it is not working, call me right away. You will not get addicted to a medication if taken for the right reasons.
Sleep sitting up
No one really knows why, but many people seem to be happiest sleeping in a sitting position. It’s hard and painful to lay flat, so just don’t do it. A recliner chair may be your best bet. This may go on for a week or two.
Wear the sling
The sling is important to rest your shoulder as it heals and to help keep others away from you when you are up and walking. Wear it most of the time during the first 6 weeks, but be sure to work on your flexibility 5-6 times a day. Don’t stay in the sling around the clock. I don’t want you to get stiff.
Don’t use your arm!
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This seems so simple, but I have seen a handful of patients–who don’t listen well–try to use their arm after the surgery. It’s not ready for it. If you do try to raise your arm on your own, you may risk tearing your rotator cuff that was repaired during the procedure. You may type on a computer keyboard but beyond that you should not use it at ll for the first few weeks unless I’ve told you otherwise. During the first 6 weeks, it is ok to use your arm only with the help of your other (non-surgical side) arm to do so. This is called ‘active assisted’ motion. Talk to me and your physical therapist about this is you have more questions.
Movement is good for your shoulder in most cases. Start with pendulum exercises. You can watch them here. Let your arm hang down like a pendulum or trunk of an elephant, and make small circles.
Ice your shoulder for about 20 minutes on, then give it a break for another 20-30 minutes. You can do this throughout the day to help keep the swelling to a minimum. Never put ice directly on your skin – it can give you frostbite. This is especially true if you have an ‘ice machine’ as they get extremely cold. Always keep a layer of material between you and the cold pad.
Leave the dressing in place until the 2nd day after surgery. On day 2, remove the tape, gauze and non-stick dressing on your shoulder. Leave the steri-strips in place – these are used as the stitches. Don’t remove them. Recover your incisions with gauze and tape or band-aids.
You may shower, but keep the wounds covered and don’t let them get wet until I see you back in the office in about 10 days. After that visit, and if given the green light, you may get the wounds wet in the shower. No hot tubs, spas, bathtubs, or time in the ocean until the wounds are completely healed – usually by week 3.
For most of you, physical therapy is an important part of the recovery plan. Be sure this is set up with my assistant. We will set this up close to your home or work with someone that I trust. I have a set of simple range of motion exercises that you can view at the link below: