INSTRUCTIONS FOLLOWING SHOULDER ARTHROSCOPY
 

DAY OF SURGERY                                               

  • Take it easy!!
  • Apply ice over the bandage
  • Start with clear liquids/foods, and slowly progress to solids
  • Drink plenty of fluids

MEDICATIONS

  • Narcotic usually is prescribed. Take the minimal amount needed to control the pain.
  • Stool softener (Colace) should be taken if narcotic is required on a regular basis. Constipation is a common side effect.
  • No driving allowed while on narcotics.
  • Narcotic medication is not refilled during evening or weekend hours. Please contact my nurse with appropriate lead time if a refill is required.
  • DO NOT TAKE TYLENOL at the same time as narcotic pills. Tylenol is included in the narcotic pills, and taking both simultaneously runs the risk of overdosing on acetaminophen.
  • Advil, aleve, or celebrex may be taken in conjunction with either tylenol or narcotic if needed.

WOUND CARE

  • Keep bandage on for 48 hours
  • While removing the bandage, do not be alarmed if the dressings are wet and/or saturated with blood. Fluid is used to distend the shoulder during the operation. This fluid seeps out the portals and often makes the bandages appear more dramatic than they are!

To Shower

  • Bend from the waist 80 degrees
  • Let the arm hang
  • Use the other arm to gently wash under the arm and axilla (arm pit).
  • Place saran wrap loosely on top of the shoulder. Keep the portals (incisions) as dry as possible. Blot dry with a clean towel. Place a band-aid over the portals until they stop draining.
  • The portals tend to not leave an obvious scar. However, to minimize this, use Vitamin E cream over the portals beginning four weeks after surgery twice a day. If, a formal incision was made and steri strips (white pieces of tape) were applied DO NOT Remove.
  • The portals will be sensitive to burning for six months to a year following surgery. Please apply SPF 45 protection during exposure to the sun.

POSTOPERATIVE FOLLOW-UP

  • You should be seen 7-10 days following surgery.
  • Please call 847-724-4978 to arrange for this before surgery.
  • You should schedule this with either myself or my physician assistant, Courtney.
  • Findings from surgery will be reviewed at that visit along with intraoperative pictures.
  • Sutures will be removed at that visit.
  • Physical therapy will be arranged at that visit.
  • If you wish to have actual clips of your surgery recorded, please bring either a blank DVD, blank CD, or flash drive and give this to Dr. Portland in the holding area before surgery. GIVE HIM THE DISC OR DRIVE IN HOLDING BEFORE SURGERY IF YOU WISH THE SURGERY RECORDED.

ACTIVITY FOLLOWING SURGERY

  • Stitches and knots have been placed to repair your torn tissue. These have a limited amount of strength. It is unreasonable to expect your repair to succeed if you freely move your shoulder about immediately following surgery. Protecting the arm maintains the repair, and allows regrowth of the torn labrum and/or rotator cuff to bone. By one month after surgery, the repair typically is strong enough to allow unrestricted movement of the shoulder.
  • A sling is to be worn all times during sleeping and moving about in public. Sleep initially is rough. Many find propping themselves upright with pillows or sleeping in a lazyboy helpful.
  • While awake, the arm may come out of the sling. The arm from your shoulder to your elbow shoulder should be comfortably at your side. Activities in front of the body such as eating, typing, or writing are allowed. DO NOT reach sideways for an object! Rather, more your body so you are facing the object. DO NOT reach upward for objects.
  • To dress: bend from your waist and let your surgical arm hang downward. Use your “good” arm to slide the shirt over your arm and head. If in doubt, button down shirts are a great alternative.
  • Driving
  • No driving while on narcotic.
  • Do not contemplate driving if you are too sore to react in an emergency.
  • Keep your elbow to shoulder tucked by your side.
  • Check with your insurance carrier. You may not be covered within a certain period of time from your surgery.

POSTOPERATIVE EXERCISES

  • Gently bend and straighten the elbow (ten times; twice a day)
  • Gently squeeze a racquetball or tennis ball (ten times; twice a day)
  • Perform pendulum and tummy rub exercises (four times a day)
  • Pendulum
    • Bend from the waist 90 degrees
    • Let the surgical shoulder hang
    • Move the shoulder gently in a north-south (front-back) direction for ten to twenty times. Subsequently, move this in an east-west (side-side) direction for ten to twenty times. Use body momentum rather than shoulder muscles to accomplish this.
    • Move the shoulder in a gentle clockwise motion ten to twenty times. Move the shoulder in a
  • Tummy Rub
    • Place your hand over your belly button (umbilicus)
    • Move the hand from the left side of your abdomen to the right.
    • Make gentle circles over your abdomen initially going clockwise, then counterclockwise.
    • This should be done ten to twenty times for each.

WARNING SIGNS

  • If you develop significant shortness of breath or chest pain, call 911 immediately. Following this, contact Dr. Portland
  • Call if you develop fever higher than 101 degrees, shortness of breath, chest pain, redness around the incisions, foul drainage from the incisions, or a significant worsening of pain not relieved by icing and anti-inflammatory
  • Infection is highly unlikely following an arthroscopy. The shoulder is bathed continuously during surgery with fluid, and this washes any bacteria away. Antibiotics are given before surgery, and no further dose is required.
  • Tips to further prevent infection
  • A nasal swab may be performed of your nose before surgery. One in five people are carriers of a bacteria called Staphylococcus Aureus. If you are identified as a carrier, nasal antibiotic ointment can be started before surgery to minimize this risk.
  • Purchase hibiclens shower solution from your nearest pharmacy. Take a hibiclens shower the morning of surgery as directed on the bottle.
  • Do not play with your incisions.
  • Keep a clean and dry band aid over the portals until they begin to heal.
  • If questions or concerns, contact me at 847-998-5680.

WHAT YOU CAN DO TO HELP YOUR SHOULDER HEAL

  • Stop smoking!!! Smoking clearly has been shown to slow down the body’s ability to heal torn tissue. Stopping smoking not only can help your repair heal, but also there are general health benefits as well. Factor in a higher retear complication rate if you decide to keep smoking.
  • Minimize anti-inflammatory usage. Advil, Aleve, Celebrex, etc. have been shown to delay rotator cuff repair healing in animal models. If possible, take Tylenol or narcotic.
  • Be compliant. Listen to Dr. Portland, his staff, and your therapist regarding do’s and don’ts. If you know you aren’t going to follow their advice, I would recommend not proceeding with surgery. A successful result is based 20% on the surgery, and based 80% on you following instructions and working hard with physical therapy.
  • Do the prescribed amount of therapy. If you’re told to do ten repetitions, do ten repetitions. A natural thought process is: “If ten is good, twenty is better.” Excessive and overly aggressive therapy may aggravate your shoulder and cause you to take two steps back instead of one step forward.
 
© Greg Portland, M.D.