Post-operative instruction sheet

POST-OPERATIVE SHOULDER INSTRUCTION SHEET
J. Brad V. Butler, M.D.
SHOULDER ARTHROSCOPY AND ROTATOR CUFF REPAIR

CLOTHING FOR HOSPITAL SHOULD INCLUDE LOOSE FITTING UPPER APPAREL
A loose fitting sleeveless undershirt followed by a loose button down shirt. Please do not wear a
traditional bra for two weeks, but one with a T-back or racer back straps are okay.
GENERAL INFORMATION

Shoulder arthroscopy and arthroscopic rotator cuff repairs are generally done as an outpatient procedure,
meaning you will go home from the hospital the same day as your surgery. If an open incision is required
for the rotator cuff repair, then sometimes an overnight stay in the hospital is necessitated by your level of
pain. In order to go home, you will need to demonstrate an ability to keep down food or fluids, go to the
bathroom, and get up and move around a little bit.
PAIN MANAGEMENT
A long acting local anesthetic is generally administered in the shoulder at the end of surgery to decrease
pain. The local anesthetic will last for an average of 8-12 hours, with a range of 6-36 hours. Somewhere
during this time period, you should expect that your shoulder will begin to hurt more, indicating that the
local anesthetic is wearing off. Additionally, sometimes a supplemental block is administered by the
anesthesiologist. The anesthesiologist will discuss this option with you. Sometimes, a separate pump is
used for running local anesthetic through the shoulder, and you will be instructed in appropriate use of
this by the nursing staff prior to discharge. It is advisable to begin taking some of the pain medication as
soon as the block is felt to wear off, and to try to stay ahead of the pain for the first 12 hours after the
block wears off only. After that, pain medication should be taken only to treat pain, as opposed to prevent
it. It is not safe to set an alarm to take pain medication at a specific interval, as this can result in
overdosing of medication. The oxycodone is for more severe pain and Vicodin is for less severe. The
ibuprofen should be taken every day for anti-inflammatory assistance. The interval for taking pain
medication, noted on the bottle every 3, 4, or 6 hours, is a minimum interval only. Pain medication does
not need to be used any more often than your pain requires. If you have not had any problems with
stomach ulcers, kidney disease, liver disease or aspirin or anti-inflammatory allergies, an anti
inflammatory can be taken along with your pain medication. The medications should be taken with food.
An average sized adult, for a period of less than 2 weeks, could take 3 Advil/Nuprin/ibuprofen 3 times a
day, at the 200 mg over the counter strength. This must always be taken with food. Icing is beneficial,
particularly for the first 4 days, and can be applied as often as 10-15 minutes out of the hour while awake.
It should be applied a minimum of 4 times a day during the first 4 days. Care should be taken not to place
the ice directly over the skin. The Ace wrap or dressing, or a towel should be placed between ice and the
skin.
REHABILITATION WORK

Unless you are specifically instructed otherwise, it is okay to begin using your hand for light weight
activities immediately. If your procedure was an arthroscopy or arthroscopic decompression
(acromioplasty), you may remove the sling and use it only as needed for comfort. If you underwent a
rotator cuff repair, you will need to wear the sling with the pad in place for 6 weeks after surgery. General
restrictions for a surgery that did not include rotator cuff repair: No lifting of any object heavier than a
magazine, and no use of the arm above horizontal, except as specifically instructed by a physical
therapist, for the first 6 weeks post surgery. If you had a rotator cuff repair,
you may unbutton the sling and move your arm about freely as long as your elbow remains in contact with
the pad.

INCISIONS

Generally you will have a grey or black sling with a pad after rotator cuff repair and a blue sling with no
pad after acromioplasty. Your shoulder will typically have three to six small incisions for the arthroscopic
component of the surgery. The incision on the side of the shoulder will sometimes be extended, if need
be, for an open rotator cuff repair. Please remove dressing two days after surgery, and reapply
sterile 4x4 and micropore tape. Please see cleaning instruction sheet. The incision should be kept dry
until after your sutures are removed. You may choose to either take a sponge bath or cover the area
carefully with plastic and tape the edges securely and take a shower.
POST OPERATIVE FOLLOW UP

Please call Barbara, or the medical assistant covering for her, the day after your surgery, to check in and
troubleshoot any problems or questions that arise. Roughly a week from surgery should be your first
follow up appointment in the office. At that time, the sutures will be removed. You will receive a P.T.
prescription at this visit if needed.
REHABILITATION

Depending on your particular surgery, formal physical therapy may or may not be required. You will need
to be doing your rehab exercises essentially every day. The number of visits required with the physical
therapist will vary, depending on the extent of your shoulder surgery and how things progress post
operatively. A separate rehab protocol is available, which outlines the rehabilitation after surgery, but this
is only an outline, and rehabilitation should be individualized based on your particular situation and
particular issues inherent in your shoulder.
SIGNS OF TROUBLE

If, at any point after surgery, you develop a fever higher than 101.5° F, or if you notice significant redness,
swelling, or foul smelling drainage from the incision, please contact Barbara or the medical assistant for
her during our regular office hours. If the problem occurs after office hours, please call the answering
service at 503-214-5200. If you experience significant calf pain or swelling, this would be another issue
that would be best dealt with immediately. Other questions will generally arise; please feel free to
address them to myself or Barbara as needed.

Source: http://www.ofc-oregon.com/assets_ofc/POST-OPERATIVE_SHOULDER_INSTRUCTION.pdf