Shoulder Surgery Information
FAQs
Do I take my regular medications the day of surgery?
It depends on what it is. This will be covered when the anesthesia staff calls you the week prior to surgery. (Refer to Day of Surgery Information)
What do I do if my pain meds don't work?
Make sure you are icing, and taking them as directed. If you are still having pain then call your doctor's office. Even if after hours, the office number should put you in touch with the doctor or PA on call to help you.
When do I take my dressing off?
You don't. Keep it on until your first post-op visit, usually 10 days - 2 weeks. If you are developing significant skin irritation from the bandage please contact your surgeon's office for further instructions.
What do I do for constipation?
Several non-medication related things are in order first: walking, fiber in your diet, prune juice and good hydration. We also recommend a stool softener such as Colace, Dulcolax, or Miralax which are available over the counter. Minimizing narcotic pain medication use is also strongly recommended. If you have a history of constipation we would encourage taking a stool softener before and after surgery to help prevent issues after surgery.
When can I drive?
In general, for post-op shoulder patients, when you are safely off of your pain medications, and feel comfortable with operating a car with the non-surgical hand and arm it is ok to resume driving. If there is any question regarding your ability to drive, please wait until your first post-op follow up appointment and discuss it with your surgeon then.
Do I need antibiotics prior to dental procedures?
This is a controversial topic and surgeons have differing opinions. You should check with your surgeon. In general it is also recommended to avoid scheduling routine cleanings 8-12 weeks before and after your joint replacement.
What exactly is this "block" I will be receiving at the time of surgery?
Pre-operative intrascalene nerve blocks are almost always used unless there is a medical reason not to have one. What this means is that the anesthesiologist will provide a shot of "numbing medicine" into the base of your neck that will numb your shoulder and arm. Because of the web of nerves in this area, many times you may loose feeling, but still be able to move your fingers. Other times you may lose both the ability to feel your arm and to move your arm. Different people have different responses, but our hope is that we will be able to keep you out of severe pain.
The type of numbing agent used can also determine the length of the effects. We have been using a new agent called Exparel which can have effects for up to 3-5 days significantly getting people out of the window of their more severe pain. It is a common belief that people need to "pre-medicate" with their pain meds when they are not truly having pain. We strongly urge AGAINST this because taking narcotic pain medications when you are not having any pain can lead to unnecessary and potentially dangerous side effects.
What should I do if I have potential signs of infection such as low grade fever or slight redness or drainage around the incision?
A low grade fever ( < 101) is normal after surgery and is usually related to your lungs being slightly "collapsed" from sitting or laying around too much. You should use an incentive spirometer, provided by the surgical center, to help your lungs return to full capacity. A fever greater than 101, call your surgeon's office. For redness or drainage, you should also call you surgeons office for further instructions.
Day of Surgery Information
• You should NOT have anything to EAT after midnight the evening prior to surgery.
• You may have small sips of water to take the medications you are instructed to take by anesthesia the morning of surgery. If you have consumed anything other than the clear liquids above, your surgery WILL BE RESCHEDULED.
• Diabetic patients: please do NOT take your diabetic medications (pills and/or insulin) the morning of surgery. We will check your blood sugar the morning of surgery and treat you accordingly. If you are hypoglycemic (low blood sugar) the morning of surgery, you may take a small amount of clear liquid (apple juice or ginger ale.) Please bring diabetic medications.
• If you cannot list your medications or do not know what they are, please bring them with you.
• Do not wear any makeup, lotion, perfume, jewelry, including any body piercing jewelry.
• DO NOT wear nail polish.
• Bring a picture ID, proof of current address and insurance card(s). Be prepared to pay your estimated financial responsibility. Leave all other valuables at home.
• Someone must remain in the building throughout your stay. If they must exit to the parking lot, a cell phone number must be left with front desk personnel.
Pain Management
Before Surgery
You will be given a regional nerve block called an intrascalene block before surgery. This will involve a numbing agent that is injected at the base of your neck that will provide pain relief during and after surgery. The length of the numbness depends on the type of medicine used. Some of the medicines can last from 3-5 days keeping people comfortable, but for some people this numbness and lack of control can be a very unusual sensation. This will gradually wear off over the next few days or hours depending on the agent used.
During Surgery
You will be provided a general anesthesia during the surgery, which means that you are asleep with a breathing tube to control your airway. You will also be given several medicines during surgery to help with post-operative pain and nausea.
After Surgery
Your surgeon will provide you medications for home use. Most often it will be a combination of the following types of medicines:
• Anti-inflammatory
• Narcotic pain medication
• Muscle relaxer
• Anti-nausea medicine
You will also receive an ice machine to enable a constant source of cooling which can significantly cut down on swelling and pain.
The main goals of your pain management are to get you comfortably through your operation and post-operative recovery without any bad side effects, with minimal need for narcotic medications.
Incision and Sling Care
Your surgical incision has a dressing over it that is waterproof. It is designed to be worn and stay in place until your follow up appointment in the office. You may remove your sling and allow your arm to dangle by your side to shower on the day after surgery. Do NOT submerge the bandage under pool or bathtub type water.
If there is excessive drainage that comes out from under the dressing, reinforce it with gauze and call your surgeon's office for instruction. If there is any redness, please contact your surgeon's office. Infection is very rare, but your surgeon is happy to see you in the office to check the incision for any of these issues.
You will be fitted with a sling at the time of surgery. Depending on your surgeon's preferences and protocols you may be given post-operative exercises to perform out of the sling. It is generally acceptable to remove the sling in a controlled environment to gently stretch your elbow and to perform simple range of motion to the elbow, wrist, and hand. It is also acceptable to remove the sling for hygiene and to allow arm to dangle to take a shower. It is strongly advised to wear your sling at all times when up walking around.
Emergency
If you suddenly become short of breath or have chest pain, call 911 and go to the hospital. If you are uncertain of whether you are dealing with an emergency, call your doctor's office and speak with someone. Most issues that arise after outpatient total joint surgery are NOT emergencies and can be dealt with by calling your doctor's office and being seen in the office during working hours or in an urgent care after hours. The doctor on call will recommend an urgent care for you to go to if he feels you need to be seen.