Total Shoulder Arthroplasty: Post-Operative Care

The following are post-operative instructions for patients who have undergone shoulder replacement. 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 staff at our office at 970-879-2663 or 855-969-2663.

IMMOBILIZER:
You will be provided with a immobilizer for your comfort. You may open the wrist band only to use the hand to eat or to straighten the elbow. Do not remove the part around your arm, just above the elbow. This part keeps your shoulder from coming away from your body. You will be instructed by Dr. Sarin, his nurse practitioner, or your physical therapist when you can do this motion.

DRESSINGS:
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.

SUTURES:
The sutures utilized in closing the wounds are stainless steel staples. We will remove these at 10-14 days after surgery.

ICE:
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. I would recommend ice applications to the shoulder region for 20 minutes at a time, multiple times each day. The initial post-operative wrap involves multiple layers of cotton gauze and padding, therefore insulating the skin surface reasonably well.

SHOWERS:
You can remove your dressings to shower on the third day following surgery (i.e., surgery on Wednesday, (shower on Saturday). Remove the dressings to the staples. You can get these wet and shower 3 days after surgery. I recommend to let the shower water fall over the wound and not hit directly onto it. I also prefer you not scrub the wound, again, just let the water fall over it. Blot the wound dry and cover it, if you desire. If the wound is dry you can leave it without a dressing unless you prefer one. You can place a shirt on but do not elevate the shoulder. Rather, lean forward and allow the arm to fall away from the body to put your shirt on. Then put the immobilizer on over the shirt. Button up shirts are usually easier to wear immediately after shoulder procedures. If there is any noticeable or persistent drainage from the incision sites, or any surrounding red areas, please contact us immediately.

PHYSICAL THERAPY:
Depending on the type of surgery you underwent you may be provided a prescription for formal physical therapy at your first office visit or if you do have therapy before your first visit, we will fax it to your physical therapist. Please visit our Rehab and Physical Therapy page for access to a list of physical therapists in the Steamboat Springs Area.

OFFICE FOLLOW-UP:
You will receive a call the day after your surgery, and the first post operative visit will be scheduled at that time unless instructed otherwise after surgery.

MEDICATIONS:
You will be provided with a prescription for a pain medication when you are ready to leave the hospital. Usually we will prescribe Hydrocodone or Oxycodone. These are both generic names for two 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. 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 adult prescription dosage is 600-800 mg up to 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 using an anti-inflammatory. Avoid taking any Tylenol with the hydrocodone or oxycodone. These two medications generally have Tylenol added in. If you’re not using hydrocodone or oxycodone you may use plain Tylenol alone. 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 you have a history of nausea with surgery we can prescribe a anti nausea medication (Phenergan). Try to take this medication regularly at first and prior to taking the narcotic pain pills to allow it to be most effective.

COMPLICATIONS:
Shoulder replacement surgery postoperative complications are fortunately quite rare. The incidence of an infection deep within the joint is literally one out of thousands. 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 or leg veins. This 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 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 at 970-879-2663 or 855-969-2663.