Total Shoulder Replacement
For a printable version of these instructions, click here.
Wound Care:
Apply clean dressings over the incision and change daily.
Bruising down into the elbow and chest wall is not uncommon.
To avoid infection, keep surgical incisions clean and dry.
Be sure to watch for signs and symptoms of infection after surgery, which includes: redness, increased swelling, warmth, wound drainage, or a fever greater than 101.5 degrees. If you notice any of these signs and symptoms please notify your surgeon.
Showering and Dressing:
Showering is allowed with plastic covering the wounds. You may shower by placing a large garbage bag over your shoulder starting the day after surgery. Carefully remove your shoulder sling before showering. DO NOT immerse your incisions under water. This means NO baths, swimming, or hot tubs of any kind for at least two weeks after surgery.
To clothe yourself, remember to put your operative arm in your shirt first (keeping your hand at your side), pull the shirt in position and then reach through the remaining sleeve with your good arm. A helpful hint: button up shirts are the easiest and safest to wear while recovering from surgery. Once dressed, be sure to properly place your operative arm in the shoulder sling.
Sleeping:
Patients are generally more comfortable sleeping in a reclining chair or with pillows propped behind the shoulder and/or under the forearm. Some difficulty with sleeping is common for 2-3 weeks after surgery.
Ice Therapy:
Icing is very important for the first 10-14 days after surgery. Begin immediately after surgery. Use icing machine continuously or ice packs (if machine not prescribed) every 2 hours for 20 minutes daily until your first post-operative visit; remember to keep arm supported while icing. Care must be taken with icing to avoid frostbite to the skin. To avoid frostbite, place a towel or T-shirt between the ice and your skin. If you are using a CryoTherapy device, please follow the instructions given by the device representative.
Sling:
Wear your sling at all times, including sleep, except when showering or performing exercises (see below). It is important to remove it several times a day to move your elbow, wrist, and hand unless instructed otherwise.
Activity:
On the first post-op day, begin doing the Codman’s exercises. You may use your arm to assist with dressing, eating and personal hygiene unless specifically instructed not to by Dr. Farber. Be sure to use and move your hand, wrist, and elbow in order to decrease swelling in your arm. Passive range of motion (using the opposite hand to move the operated arm) is always encouraged. Squeezing a tennis ball or squeeze ball is encouraged as it will reduce the amount of swelling in your arm and hand. While exercise is important, don’t over-do it.
When sleeping or resting, inclined positions (i.e. reclining chair) and placing a pillow under the forearm for support may provide better comfort.
Do not engage in activities which increase pain/swelling over the first 14 days following surgery.
Avoid long periods of sitting (without arm supported) or long distance traveling for 2 weeks.
Exercises:
Perform the range of motion exercises taught to you by the physical therapist 2-4 times per day. Formal physical therapy (PT) will begin about 10-14 days post-operatively with a prescription provided at your first post-operative visit. There is a standard protocol that you will follow with your therapist.
• Codman’s Exercises: Bend over at the waist and let your arm relax completely. Slowly swing your arm from side-to-side as illustrated. Perform for 5 minutes 2-4 times per day.
• Range of Motion Exercises: Begin elbow, wrist, and hand range of motion exercises 24 hours after surgery. Perform these exercises 2-4 times per day.
Medications:
Local and/or regional anesthetics are used during surgery. These typically wear off 8-12 hours after surgery. It is not uncommon for patients to encounter more pain on the first or second day after surgery when the effect of these medications wears off.
Most patients will require some narcotic pain medication (such as Percocet or Vicodin) for a short period of time. Take these as prescribed. These can be taken up to every four hours as necessary. Taking pain medication before bedtime will assist in sleeping. It is important not to drink or drive while taking narcotic medication. You can supplement the narcotic medications with 200 mg or 400 mg of ibuprofen every 4-6 hours. Be sure to take ibuprofen with food.
Common side effects of the narcotics are nausea, drowsiness, and constipation. To decrease the side effects, take medication with food. If constipation occurs, consider taking an over-the-counter laxative. High fiber diet, lots of fluids, and muscle activity can prevent constipation. If you are having problems with nausea and vomiting, contact the office to possibly have your medication changed. If you have any other problems taking the medications, please stop them immediately and notify the office.
Most patients only require narcotics for the first 10-14 days. Once pain is better controlled, you may simply take extra-strength Tylenol one to two tabs every six hours as needed.
You should resume your normal medications for other conditions the day after surgery.
Eating:
The anesthetic drugs used during your surgery may cause nausea for the first 24-48 hours. If nausea is encountered, eat and drink only clear liquids (i.e. Sprite or 7-up, jello, and soup). The only solids should be dry crackers or toast. If nausea and vomiting become severe or the patient shows signs of dehydration (lack of urination) please call the office. Progress to your normal diet if you are not nauseated.
Driving:
NO driving until instructed otherwise by physician.
Follow-Up:
Your initial follow up visit will usually be 10-14 days after surgery. If you have any questions, concerns or problems please feel free to contact the office at (480) 899-2101.
EMERGENCIES**
Contact your surgeon if any of the following are present:
• Painful swelling or numbness
• Unrelenting pain
• Fever over 101° or chills (It is normal to have a low grade fever for the first day or two following surgery.)
• Redness around incisions
• Color change in wrist or hand
• Continuous drainage or bleeding from incision (a small amount of drainage is expected)
• Difficulty breathing
• Excessive nausea/vomiting
**If you have an emergency after office hours or on the weekend, contact the same office number (480-899-2101) and you will be connected to our answering service – they will contact your doctor or one of his partners. Do NOT call the hospital.
**If you have an emergency that requires immediate attention, proceed to the nearest emergency room.