Shoulder Arthroplasty Surgery

INSTRUCTIONS DURING INPATIENT HOSPITAL STAY:

You will be admitted to our inpatient floor following your surgery for one night to assure your pain is well controlled and that you receive post-op antibiotics.  You will likely be able to go home the next day after your surgery once your shoulder drain is removed.  One of our providers from Dr. Fullick’s service will see you the morning after your surgery to remove drain and discuss discharge home for late morning or afternoon.  Along with your discharge instruction, you will also receive a hand-written prescription for Norco (10/325mg) for you to fill at a pharmacy to help manage your pain.

INSTRUCTIONS ONCE DISCHARGED HOME:

MEDICATION & ICING

PAIN MEDICATION:  You may have gotten a nerve block for your operative shoulder prior to procedure. While inpatient, we will manage your pain. But when discharged home, make sure you are taking Norco (10/325mg) two tablets by mouth every 6-8 hours for pain as scheduled for at least the first 3 days post-operatively.  It's important to stay on top of your pain and take it scheduled.  At post-operative day #4, you can begin to wean off this medication and taking it as needed.  Eventually, you can transition to Tylenol Extra Strength 500mg, available over the counter.  We prefer that you do not take NSAIDS for the first 6-8 weeks including Ibuprofen, Motrin, Advil, Aleve, etc.

CONSTIPATION:  Miralax or Colace (stool softener/laxative) is highly recommended and available over the counter.  One of the most common side effect of Norco or narcotic medication is constipation, so start taking this postoperatively as instructed on label.

NAUSEA: Another common side effect of general anesthesia and Norco is nausea.  Please take the prescribed Phenergan 25mg, 1 tab by mouth every 8 hours as needed.

ICE REGULARLY: Please ice your shoulder regularly, meaning 20 minutes on, 20 minutes off during your waking hours, for the first 3-7 days post-operatively.  If you purchased a "cryocuff" which is a cuff that wraps around your shoulder and circulates water with a cooler, you can use that more frequently.  If not, you may use a bag of frozen vegetables and place on and around operative shoulder.  CVS or Walgreens also sells over the counter Cold Packs designed for shoulder.

* Due to current opioid epidemic, our clinical department and team by policy does not allow prescribing narcotic pain medication beyond 6 weeks postoperatively.   We certainly support and validate your post-operative pain, but we encourage realistic goals for weaning off pain medications by the end of week 2 or earlier to prevent side-effects and addiction.

If you require further narcotic pain medication beyond our policy guidelines, we can refer you to a pain management doctor.  If you already have a pain management doctor, please visit them prior to surgery and post-operatively to have them manage your pain.  By law, we cannot prescribe pain medication if you have a pain management doctor.

ARM SLING, EXERCISES, PT, & DRIVING

Please wear your armsling for a total of 4 weeks.  Four times daily, bring your arm out of sling and perform pendulum exercises (leaning forward, allow gravity to motion your hand and arm in small circular motions; gentle; nothing aggressive) and assisted bicep curls (with non-operative side grab the wrist of your operative side and perform arm curls to encourage elbow range of motion).  The goal is to maintain range of motion in hand, wrist, and elbow, and to obtain minimal but gentle shoulder range of motion.  Always wear sling when out in public to show handicap and inform others, "I'm injured, don't bump into me."  

At your 1 week postop clinic appointment, we will give a prescription and protocol to start physical therapy approximately 2x/week, depending on size of tear and our clinical postop assessment.  PT will start with passive range of motion (therapist motioning your shoulder), then active assisted range of motion (you motion with assistance), and finally active range of motion (you motioning shoulder by yourself).  Range of motion exercises are dedicated for the first 8-12 weeks; and then you can advance to strengthening (always start very light with strengthening in about 12 week postop).

DRIVING: Okay to drive once you are no longer taking Norco and feel confident that you can drive without your operative arm, and not be a danger to self or others.

WOUND CARE

BANDAGE: Please keep your bandage on and dry.  We will remove in clinic in 1 week at your post-operative appointment.  

SHOWERING: Keep bandage and incision as dry as possible.  When showering, place an impermeable bag or Saran wrap over bandaged area.  Bandage will be removed in clinic in 1 week.

TOPICAL CREAM: You may have received topical creams from a compound pharmacy by mail.  48 hours post-operatively, you may apply the topical anti-inflammatory cream (i.e. Diclofenac) on to shoulder 3 times per day or as needed, but not directly on incision or bandage. Pain patches can also be applied on the shoulder approximately 3 times per day or as needed.  If you have not received these topical creams, please ask us during your post-op clinic appointment(s).

CONCERNS: You may experience swelling, water/blood drainage, and bruising in shoulder post-operatively, this is expected.  Continue icing your shoulder to help with these symptoms.  And stay on top of pain meds.  Popping sounds in shoulder can occur and are expected as well.  Keep your arm immobile in sling to avoid instinctively reacting or reaching out to objects.  If you have any concerns, please contact us.

1 WEEK POST-OP CLINIC APPOINTMENT

You will need to schedule an appointment with Fabian (Dr. Fullick’s PA) in 1 week from surgery/procedure. Please call our office at (713) 486-7543 to schedule your postop clinic appointment.

CONTACT US:

If you have any post-operative questions, please call our office at (713) 486-7543 available Monday-Friday 8am-5pm.  If outside of these work hours, please email Fabian (Dr. Fullick’s PA) at Fabian.Morice@uth.tmc.edu and please include your name, DOB, and pharmacy phone number if requesting further medication. While Fabian is prompt with replies, he is not an on-call service, so please allow 24-48 hours for email response.  

In case of emergency (i.e. fever (>100.4), redness, excessive shoulder warmth, numbness >48hours, pus drainage from incision, intense shoulder pain non-responsive to meds >48hours, etc), please call 911 or go to your local emergency department.