Postoperative Instructions for Shoulder Arthroscopy
Christopher D. Casscells, M.D. and David K. Solacoff, M.D.
Ice and Recovery: In most cases, you will go home immediately following the shoulder surgery once you have awakened in the recovery room. In some cases, if you are very sleepy, do not feel well, or have had a great deal of surgery, we will keep you overnight and let you go home in the morning. You should plan to spend the first two to four days following your arthroscopy resting with an ice pack or cold unit on the shoulder. This is all to prevent bleeding and swelling. Your recovery will be much faster if you have less bleeding and less swelling. Furthermore, swelling causes pain. Please note that alcohol, aspirin, Motrin or ibuprofen, and Aleve will all increase bleeding and possibly make your swelling and pain worse. After several days of rest, you may begin to move around progressively more. If you have an increase in pain and/or swelling—you are doing too much. Mobilization of the shoulder is specific to your particular surgery. Refer below for surgery-specific instructions about beginning to move the shoulder. In general, if your shoulder is more comfortable held still, then keep it that way. If your surgery permits, you may move the arm. Many people find relief in slight movement. Small circular pendulum motions may give you a little shoulder relief. You may feel more comfortable sleeping in a chair. This is normal. The arm feels better hanging with gravity.
Dressings and Bandages: If your shoulder has a simple bandage on, it may be removed in three days. Afterwards, if you feel more comfortable with some other protection over the wounds, feel free to cover them with a light dressing such as a band-aid or a small piece of gauze. In general, keep the wounds clean and dry and do not touch them. The chief role of postoperative dressings is to protect the vulnerable wounds from curious fingers. If you sense that the adhesive on the Steri-Strips is causing itching, you may be allergic to it and they should be removed. A little cortisone cream or Benadryl cream will relieve the itching promptly. If the wound is dry, you may shower taking care not to scrub the wound. Steri-Strips on the wounds should be left alone and blotted dry and/or air dried if they are wet. (You may use a hair dryer if necessary.) The wounds should be covered when dry with an over-the-counter triple antibiotic ointment or Neosporin for protection. Usually, your stitches will be buried beneath the skin and do not need to be removed. If your wound begins to get a lot of redness around it like an intense sun burn, you should call the office immediately. You may need some antibiotics. Please try to check your temperature before you call.
Arthroscopic Acromioplasty: If you have had a simple acromioplasty, it is important to start moving the shoulder as soon as possible. Use the pulley or shoulder therapy kit and the "snow angels" to start getting range of motion in your shoulder as soon as possible. You should not cause pain but should move the shoulder passively to a point of tightness and then hold it there for a while. You should do no active work with this shoulder since this may cause damage to the rotator cuff. You may proceed gently increasing the motion every day but be warned that moderation is the byword.
Rotator Cuff Repair: If you have had a rotator cuff repair, the shoulder should be rested for a few weeks. You may take the arm out of the sling with the palm facing backwards and the thumb facing the mid line and do only small pendulum motions. Other exercises should not be done at this time while the rotator cuff heals.
Arthroscopic Slap or Bankart Repair: If you have undergone a labral repair of your shoulder or Bankart repair of your shoulder, the same applies as the rotator cuff repair. The tissues need to heal and your arm should be kept in a sling at your side for a period of several weeks. You may do small pendulum motions as described above but otherwise, no exercise should be given to the arm other than isometric tensing of the muscles and only if you feel the need. Any exercise or therapy program will be instituted after your first visit to the office.
Swelling: Swelling in the shoulder is fairly normal, especially early on after surgery. It can cause quite intense pain in the shoulder, especially as the numbing medicine wears off and sensation returns with a crescendo-type discomfort. If the pain does not resolve with cool compresses such as the EBI ice unit, ice bags or a cryo cuff, along with pain medication, you should call the office to have the shoulder evaluated.
Pain Medication: If you have pain, take your medicine. Some people require very little pain medicine and some require a great deal more. This is highly variable. Some people “do not like pills” and tend to remain excessively inactive in order to avoid pain. Pain medicine can help you mobilize during the recovery. You may take as much as two pain pills every three hours provided you are in a great deal of pain. After a few days you should require very little, if any, pain medication. If you take a lot of pain medication in anticipation of pain but do not, in fact, have any pain, the medication will be overly sedating and unsafe. If you require more than two pain pills every three hours and you have attempted rest, ice, compression, and elevation, then you should call the doctor on call since this represents an abnormal amount of pain and might require different measures. Please do not take any other home remedies or illegal drugs or alcohol in attempts to relieve the pain. This could be fatal.
Anesthesia: Whether you had general anesthesia, local anesthesia, or a spinal anesthetic, your shoulder will have been injected with a Novocain-like medicine which should prevent most of your pain for several hours. Occasionally, we will also use a scalene nerve block for this effect. Some of the numbing effect may extend down your arm as well. This is normal. Even though your shoulder does not hurt, you should go home and rest, keeping the shoulder cool with an ice bag or cooling unit to prevent swelling. As the numbing medicine wears off, you may take the pain medication prescribed for you in your preoperative office visit.
In most cases, you will remember most of the procedure if you had local anesthesia. In some cases, some of the medications given to help you relax will cause a loss of short term memory. This is normal. If you had general anesthesia, you may not remember any of the operation and even forget some things from shortly before the operation and have spotty memories of some of the time after the operation. It is important to have a companion or family member with you to help remember instructions given to you postoperatively. Otherwise refer to this document, rather than other instructions you may have been given by hospital employees.
Nausea: Some narcotic pain medication may cause nausea and most will cause constipation. In general, if you take pain medication in the absence of pain you will be more likely to feel nausea. The side effect of nausea can be alleviated by taking a smaller dose of the medication, breaking the pills in half, switching to a different preparation of medication, or substituting a medication known to be tolerated like Tylenol or Advil. Nausea may also be relieved by taking 25 mg of Benadryl every four hours, but be prepared to be a little sleep y from this medication. Benadryl, Tylenol and Advil can be obtained without a prescription. By taking your narcotic medication with a little bit of peanut butter you may also alleviate the nausea reaction.
Fevers: It is not unusual for bleeding inside a joint to cause a fever of 101°F or even 101.5°F. This will usually be accompanied by a warm sensation in the shoulder which will feel hot to the touch. This is fairly normal and usually does not represent an infection. However, if you have repeated fevers to 101.5°F or higher, you should contact our office immediately. Other signs of infection would be redness around the wound or purulent material draining from the wounds. We rarely see infection within the first 48 hours following surgery. Abnormal swelling or red appearance of the wounds accompanied by a fever after the first 48 hours is worrisome and you should call the doctor and potentially start some antibiotics.
Stitches: Your stitches are buried beneath the skin and do not need to be removed. On occasion, your body may have some difficulty dissolving the stitches, in which case you may “spit a stitch.” This is nothing more than your body trying to extrude a stitch and its knot. This usually occurs after a few weeks and is accompanied by a small red pimple in the area of the stitch. If you are comfortable, you can grab a knot, cut and remove the stitch, and apply an over-the-counter triple antibiotic ointment to the area. The irritation will resolve immediately. If you are not comfortable with this, then come to the office and we can remove the stitch.
Returning to Work: If you are not confident about your ability to do your job or return to work safely, call the office and we will discuss whatever documentation you feel necessary to validate your absence from work.
Driving: You should not drive until your pain has decreased to a level where you do not have sharp pains when moving and you are not taking any narcotic medicines.
Running out of Medicine: Some medications such as OxyContin or oxycodone (which is the active narcotic ingredient in Percocet, Endocet and Roxicet) are Schedule II narcotics and cannot be telephoned into a pharmacy. They cannot be renewed or given refills. They can only be prescribed individually by paper prescription. However, there are several adequately strong pain medications which can be telephoned into your pharmacy if you run out of medication. We only renew narcotic prescriptions during working hours 8 a.m. to 5 p.m. Monday through Friday. We do not authorize the on-call physician to renew narcotic medications at night or on weekends. As such, you must keep track of your pills to make sure you do not run out during off hours or weekends. You may leave a message to renew your medication with our nurse by dialing Glasgow at 302-832-6220 or Concord Plaza at 302-477-0900 and following the prompts for the nurse. The nurse will review your chart and, if appropriate, renew your prescription after consultation with the physician.
When in Doubt: If you have an emergency after hours, call the doctor on-call at 302-477-0900 and follow the prompts for emergencies. Please leave a message and your callback number. This is for emergencies only, so please be considerate of the on-call physician who may be preoccupied with surgery or another emergency. This is not to be used for routine daily business or non-emergency questions. Please leave your message and telephone number and when you can be reached and we will return your call.
Follow-up Appointments: In most cases, you should see your doctor and have the wound examined within two to three weeks after surgery. If you feel it is necessary, certainly call and see the doctor earlier. In the meantime, if you require assistance at home, we may be able to arrange to have a visiting nurse provide you with nursing care and even physical therapy at home if you are having trouble getting around. This can be arranged on the telephone by simply calling one of the nurses in the office.