Shoulder Surgery | Ohio State Medical Center

Before Surgery

Scheduling
You will meet with an administrative assistant to schedule your surgery. He or she will help you pick a surgery date, and give you more information about the location of the surgery and other instructions to help you prepare for surgery. They will have you sign a Surgical Consent Form, which gives us permission to proceed with surgery.

You will have an assessment to review your medical history and determine if testing is necessary. Depending upon your age, medical health and smoking status, you may need pre-admission testing to identify any issues that could complicate the anesthesia or surgery, and whether or not you are healthy enough to safely undergo surgery.

Medication and Supplements

Before your surgery, tell your doctor during your appointment about any medicines you take, including vitamins and supplements. Keep these general points in mind:

Do not take any herbal medicines or supplements for up to 14 days before surgery.
Do not take non-steroidal anti-inflammatory drugs (NSAIDs) for up to 10 days before surgery, including naproxen (i.e., Aleve) and ibuprofen (i.e., Advil or Motrin).
If you take any medicine to thin your blood or to prevent blood clots make sure to discuss with both your surgeon and your prescribing physician whether you should stop your medication prior to the surgery.
If you take medicine for diabetes, you may need to stop or change your dose before surgery. Talk to the doctor who manages your diabetes to see how you should adjust your medication the day of surgery. Also, you will need to check your blood sugar the morning of your surgery. If it is above 250 or less than 70, call your doctor for more instructions. High or low blood sugar may result in a delay or cancelation of your surgery.

If you are a smoker, or use other tobacco products, quit at least four weeks before and for as long as eight weeks after surgery to help your wounds heal and to reduce your risk of infection.

Please have a family member(s), or friend(s) there to help on the day of your surgery. You will need them to take you to and from the hospital on your surgery date (you will not be allowed to drive home), to help access essentials at home and to assist with your sling and cold therapy.

Prepare for shoulder surgery

You will receive a call one to two days before your surgery to give you your surgery and arrival times. Before you arrive for surgery:

Do not shave anywhere below your neck within 48 hours of surgery.
Do not eat, drink or smoke after midnight the night before your surgery. This includes no gum, breath mints or candy. Brush your teeth and rinse your mouth, but do not swallow anything.
You MAY have up to 20oz (ounces) of CLEAR LIQUIDS between midnight and up to 2 hours before your arrival time for surgery. Clear liquids include plain water, apple juice, Coke or Sprite, sports drinks, plain tea and black coffee (NO milk or cream). You may take your morning medicine with water.
Take a shower the evening prior and the morning of surgery using the anti-microbial (CHG) soap provided to you by the office staff.
Do not put anything on your skin such as makeup, lotions, deodorant, perfume or cologne.
Do not wear contact lenses, jewelry/body piercings or nail polish.

You should wear comfortable, loose-fitting clothing. Leave your valuables at home, including jewelry and money. Bring only these essentials to the hospital: photo ID; insurance card; your co-pay; a list of medications and dosages; and cases for dentures, glasses and hearing aids, if worn.

The Surgery

What to Expect During Surgery

The Operating Room

The anesthesiology team and your nurse will take you to the operating room. You and your care team will complete a sign-in procedure to verify the correct patient, consent, surgical site marking, medication allergies and the surgery to be performed.

Once those steps have been completed, anesthesia is administered through your IV. Once you are fully asleep, we position and pad your body to protect the areas we are not performing surgery on. The surgical shoulder is then prepped and draped to properly prepare it for surgery.

Before beginning, the surgeon verifies with the surgical team on which side your surgery is being done, the type of surgical procedure(s), your medical allergies and any other special considerations or needs for your case.

Arthroscopic Shoulder Surgery

Some shoulder surgeries can be performed using arthroscopy, which means that the surgeon will use small incisions in your shoulder, called portals, to perform the surgery. A camera is inserted in one of the portals which allow the surgeon to see into the shoulder in better detail. Other tools necessary for the surgery will be used through these portals as well. After the surgery, these portals are closed using suture and covered with a clean bandage before being placed in your sling.

Open Shoulder Surgery

Some shoulder surgeries will require a larger incision into the shoulder which allows the surgeon more access to successfully perform the surgery. After the surgery, the incision is closed using suture or staples, and covered by a clean bandage before your arm is placed in your sling.

After surgery, you will be brought out of anesthesia and transported to the post-anesthesia care unit (PACU). You will remain there for typically two hours. Your family will be allowed back to the recovery room about 45 minutes after surgery.

Same-Day Surgery

Depending on your surgery, you may be allowed to go home the same day. If this is the case, plan on being at the hospital for 6-8 hours from check-in to discharge. You must have a responsible adult (over 18) to drive you to your procedure, stay during your surgery, meet with the surgeon to listen to discharge instructions and stay with you for 24 hours after transporting you home.

For same-day surgery, the nurse will review instructions regarding pain control, sling use, bathing, dressing change, restrictions, exercises, and medications with you and the person driving you home. Once you have recovered enough and are stable, you will be discharged.

Inpatient Surgery

Certain surgeries may require you to stay at least 1 to 2 nights in a hospital after surgery. This is to monitor you while you recover, and to control the pain. You may want to pack an overnight bag in the event that you are admitted to the hospital.

For inpatient surgery that requires you to stay overnight, you will be admitted to the hospital for 1-2 nights depending on your surgery and pain control. During your stay, a physical therapist, occupational therapist, and hospitalist may visit you. You will also be visited by our resident and/or the surgeon.

You will go home with prescription medication for pain control, nausea and a stool softener.

The effects of anesthesia may remain for 24 hours or longer. Do not drive, operate equipment or make important decisions during this time.

Post-Surgical Care

Your recovery after shoulder surgery can take six to nine months, and sometimes up to a year, to fully recover. It takes 12 weeks for the repair to fully heal, so it is very important to follow all precautions after surgery as directed. These instructions are intended to help you control swelling and pain, and to allow your shoulder and repaired tissues to heal properly. These instructions are a general guideline, because no patient or procedure is the same. If needed, your surgeon will give you further specific instructions.

SLING

Unless told otherwise by the surgical team, you are required to wear your sling at all times (including sleeping) at least until your follow up appointment. This is necessary to protect your repair. You may remove it to work on your hand, wrist, and elbow exercises, for getting dressed, and for hygiene. Otherwise, it should remain on at all times.
If a squeeze ball was provided with your sling, this should be squeezed a few times throughout the day to reduce stiffness and swelling that may occur in the hand and wrist. Manage any arm swelling with ice, and the hand, wrist, and elbow exercises provided.

ICE

It is recommended to ice your shoulder for 20 minutes per hour using an ice pack, CryoCuff or Iceman cooler if provided, or a bag of frozen peas. Ice can be especially helpful for the first several weeks after surgery to control pain and swelling. There is no evidence that shows one icing method is better than another, so we encourage you to use the method that works best for you.

PAIN BLOCK/PAIN CATHETER

The pain block/catheter is intended for pain relief, and can last for up to 48 hours. During this time, you may experience some pain but it will be minimal. You may not be able to move your hand and fingers; It will give you the sensation of your arm being “paralyzed”. THIS IS TEMPORARY UNTIL THE BLOCK WEARS OFF.
It is recommended that you start your pain medication as soon as possible, even though you are getting pain relief from the block. It is more difficult to control the pain once the block wears off, then to keep a constant level of the pain medication in your system.
For further questions regarding the pain catheter or block, please refer to the pain pump handout given to you from surgery or contact the anesthesia department as directed in the handout.

MEDICATIONS

You should resume all of your normal medications the day after shoulder surgery. If you are on blood thinners, these should be discussed with our team and the prescribing provider to decide on a date to resume them (typically the day after surgery).
You will be given prescriptions for pain medications
- Unless you have allergies, we will send you home with prescriptions for oxycodone 5mg and gabapentin 100mg. Please let the surgeon know if you have allergies to these medications.
- Fill the pain medications immediately and begin taking the medications before your nerve block wears off. You are encouraged to take the pain medications as directed on the prescription and on a regular schedule.
- Do not let the pain get "ahead" of the pain medications as then it will be very difficult for you to obtain adequate pain control.
- Even with the “nerve block” from surgery, it is recommended that you start on the pain medications after surgery before the block wears off. This will help you stay ahead of the pain as the medication will be in your system when the nerve block wears off.
- As the pain decreases, you may decrease the pain medication and switch to extra strength Tylenol(acetaminophen) if needed.
- Avoid driving and consuming alcohol while taking pain medication.
- Common side effects of pain medication are nausea, drowsiness, and constipation. Consider taking medication with food, and also consider using an over-the-counter stool softener.
It is important to start you pain medication as soon as you can after surgery, even if you are not experiencing any pain. If you receive a block, and when the block wears off, there can be a heightened sense of pain. If this occurs, understand that this is normal and increase your pain medication to 2-3 oxycodone every 4 hours and 1 gabapentin every 8 hours if needed. Do this for 1 day until the pain is manageable and then decrease back to normal dosing. You may also add in ibuprofen or Tylenol (acetaminophen) for added pain relief.
Please visit our Pain Policy to become familiar with our policy for managing pain after surgery
As of August 31, 2017 the State of Ohio has new rules for prescribing pain medication for treatment of acute pain. Surgical pain falls under the acute pain definition. The following information was taken directly from the Ohio State Medical Board’s website
- No more than seven days of opioids can be prescribed for the first prescription for adults
- No more than five days of opioids can be prescribed for the first prescription for minors, and only after written consent of the parent or guardian is obtained
- Except as provided in the rules, the total morphine equivalent dose (MED) of a prescription for acute pain cannot exceed an average of 30 MED per day
- For Prescribers - New Limits on Prescription Opioids for Acute Pain

DRESSING

For arthroscopic surgeries, keep the surgical dressing clean and dry for the first 72 hours (three days) after surgery.
You may remove the dressing three days postop and apply adhesive bandages (Band-Aids) over small incisions and you may tape gauze pads over the larger incisions, if you feel it is needed.
For open surgeries, keep the bandages on for the first five days. You may need to reapply clean, dry bandages if they become wet.
Please leave the Steri-Strips intact. They will fall off on their own.
If you have drainage more than 5 days after surgery, please contact our office for advice.

HYGIENE

You may shower and get the incisions wet five days after surgery, as long as there is no drainage from the incisions. Avoid letting the shower stream hit the incisions directly until the sutures are removed. DO NOT scrub incisions or soak under water (bathtub, swimming pool or hot tub etc.) Pat the shoulder dry and then re-apply the dressing if it is needed.

SLEEPING

You may find it more comfortable to sleep in a semi-reclined position (recliner-type chair or propped up on pillows) following shoulder surgery. You may return to sleeping in your bed whenever it feels comfortable to do so.

EXERCISES

You should begin the elbow, wrist, and hand exercises that you were shown at the hospital, as soon as possible. Remember no active motion of the shoulder or elbow (moving the arm without assistance from someone else) until follow up, unless you are told otherwise by your surgeon. These exercises are to keep your elbow, hand, and wrist from becoming stiff and swollen. Perform these exercises a few times each throughout the day.

FOLLOW UP APPOINTMENTS

Your first follow-up appointment is generally 10-14 days after surgery. Normally this will be with one of our physician assistants. Please refer to your preoperative packet for the date and time. If you do not already have this appointment scheduled, please contact the office after surgery to schedule this appointment (614) 293-3600.
The timing of the start of physical therapy will begin depending on what surgery you have. More information will be provided to you pre-operatively, and also at your first post-operative appointment
Wound care, pain management, and a review of your surgical procedure will be discussed at your first post-operative appointment
Additional appointments are scheduled according to the type of surgery that you had and how you are progressing.

PRECAUTIONS

You may want to rest for the first 24 hours after surgery. General anesthesia may cause a sore throat, jaw discomfort or muscle aches. These symptoms can last for several days. Do not drive, drink alcoholic beverages or make any important or legal decisions during this time.
Avoid placing your arm behind back (tucking in shirt, putting on belt), and do not lean on affected arm or use arm to push up from a seated or laying position. A good general rule is to keep your arm and hand where you can see it.
Keep your first few meals after surgery light and drink plenty of fluids, as some people are nauseas after surgery.
Smoking increases your risk of infection and can delay healing times. If you smoke, you are encouraged to quit, cut back or at least quit smoking during the postoperative period.
Pain medications are important for the first few days after surgery to treat postoperative pain, but addiction, tolerance, and side effects are important concerns. Decrease the pain medications as soon as you can tolerate (this is typically after the first few days). Most patients require narcotic pain medications only for the first few weeks after surgery (even complex procedures). Prolonged use increases the risk of problems with these medications.
If you have any concerns about pain medication use, or its potential side effects, please contact our office.

MOST COMMON POST-OPERATIVE CONCERNS

Pain: It is important to start you pain medication as soon as you can after surgery, even if you are not experiencing any pain. If you received a block, there can be a heightened sense of pain when the block wears off. If this occurs, understand that this is normal. Increase your pain medication to two to three oxycodone every four hours and one gabapentin every eight hours. Do this for one day until the pain is manageable, and then decrease back to normal dosing. You may also add in ibuprofen or acetaminophen for added pain relief.
- Please visit our Pain Policy for more information (insert link)
Swelling: From surgery, fluid may build up in your upper arm. Due to gravity and being in the sling, the swelling may move to your elbow and wrist/hand. This is normal. It is recommended that you do your hand/wrist and elbow exercises (shown above). This will help move the fluid back up your arm. Your body will naturally reabsorb the fluid over the first few weeks after surgery.
Nausea: Pain medication can cause nausea and vomiting. It is suggested to take pain medication with food. We will also prescribe anti-nausea medication (ondansetron/promethazine), which you should take before taking the pain medication
Constipation: Pain medication can cause constipation. We also prescribed constipation medication (docusate). Take this medication with plenty of water the first few days after surgery until you have your first few bowel movements. If you have not had a bowel movement within 5 days after surgery, you can pick up over-the-counter Milk of Magnesia at any pharmacy. Make sure you stay hydrated.
Sleeping:Due to the sling and pain, poor sleep is a very common concern after shoulder surgery. We suggest sleeping in a recliner the first few weeks after surgery. We also suggest scheduling your pain medication so that you are taking it before bed if possible. The pain medication may cause you to be drowsy. We also suggest taking Tylenol PM, Advil PM, or melatonin to assist with sleep.
Spasms: Due to surgery, and your arm being in a sling, you may experience muscle spasms or cramps around your shoulder and arm. This is completely normal. If this happens, we suggest using a heating pad around these muscles for 20 minutes every hour to help relax the muscles.
Numbness/Tingling: Due to swelling and your arm being in a sling, you may notice some numbness and or tingling in your hand on the surgical side. This is normal and should decrease over time. If it fails to improve, please let us know
Driving: We do not recommend driving during the period that you have to wear your sling. IF YOU ABSOLUTELY HAVE TO, then you cannot be taking narcotics, you cannot drive a manual shift car, and you have to be able to safely operate your vehicle with one arm. We suggest going to an empty parking to get familiar driving with one arm

NOTIFY SPORTS MEDICINE IMMEDIATELY IF YOU DEVELOP ANY OF THE FOLLOWING:

Increased redness or swelling over the incision area
Incision area is warm or hot to touch
Incision has foul smelling drainage
Relentless pain, nausea, vomiting, bleeding or drainage
Severe calf pain or chest pain
A fever greater than 101.4 more than 48 hours after surgery

If it is an emergency that requires immediate attention, go to the nearest emergency room or call 911. Otherwise, contact our office with any questions or concerns at 614-293-3600. After normal office hours, this number will also get you in contact with the on-call orthopedic doctor.

Returning to Activity

The vast majority of our patients are back to their normal activities in six to nine months. While some patients recover faster, it can take up to one year for some patients to fully return to normal activities.

For the first 12 weeks of recovery, the goal is to regain some of your range of motion in the shoulder. Strengthening the shoulder does not typically start until 12 weeks after surgery.

For our active patients, you may begin an exercise program as soon as your wounds are healed (generally two weeks after surgery). During the first two to nine weeks postop, a stationary bike, walking, CORE strengthening and lower body strengthening are acceptable. After the nine-week mark, you may start jogging if cleared by your surgeon. No upper body strengthening will begin until your doctor and physical therapist approve it.

If you are an athlete who is returning to sport after shoulder surgery, here are important considerations:

Stay involved with your team. You can still be learning, observing or encouraging teammates on the sideline even though you are injured. Helping track team stats and/or documenting the practice plans can help you achieve mental engagement with the team.

Walking, stationary cycling (recombinant bicycle), lower extremity strengthening and rehab exercises are all options to discuss with your physical therapist or athletic trainer. Be certain that you are protected from any plays, passes or equipment that could cause injury to your shoulder. If your shoulder begins to bother you at any time, stop activity and apply ice.

Every athlete recovers at a different pace. You might feel fit and ready to return, but you should verify the plan with your physician, physical therapist and/or athletic trainer. Be sure to keep your coach involved in the rehabilitation process as well.

Shoulder Surgery at Ohio State