Swedish Orthopedic Institute (SOI)

Discharge Instructions after Shoulder Surgery

Activity:

  • Keep your operated shoulder/arm in a shoulder immobilizer/sling as instructed for immobilization, support, and comfort. (Refer to the sling guide from your doctor’s office for how to properly take it on and off.)
  • Keep your operated arm elevated above your heart when sitting or lying by using a pillow or wedge under it to reduce pain and swelling.
  • Do not actively lift your operated arm to the side, away from your body, or overhead. Do not reach behind and push yourself up with your operated arm. Follow your doctor’s instructions for activity and therapy.
  • You may use your hand and wrist for simple activities, such as brushing your teeth, combing your hair, and feeding yourself.
  • You may loosen/temporarily remove the sling/immobilizer to allow your elbow to straighten a few times a day to prevent elbow stiffness.
  • Using your sling or wedge protects the surgical repair. Follow your doctor’s instructions for when you can discontinue wearing the sling or if your doctor will allow you to take it off for brief periods daily. When the sling is removed, check your skin for irritation from the sling.
  • During your recovery, your major focus will be to get your strength and function back. Plan your activities to be spread throughout the day and include rest times. Increase your activity (for example, walking) slowly and steadily.
  • Use your pain level as a guide; for example, stop an activity if pain level goes over your tolerable/acceptable level of pain.
  • Most patients find it more comfortable to sleep in a chair, or to use pillows or a wedge to elevate the head of the bed.
  • Follow your doctor’s instructions about driving.

Comfort/Use of Pain Medication:

  • During your recovery, even with the use of pain medication, you may have some pain at the surgery site. You may also have the same type of pain you had before surgery.
  • If you have pain that becomes unacceptable, more than mild pain, take your prescription pain medication as instructed. As you heal, you will notice you will not need to take as much pain medication or as often, gradually taking less and less. You do not need to finish taking all of the prescribed pain pills.
  • To decrease pain and swelling, frequently apply an ice pack to the surgical site. Use a thin cloth between the skin and ice pack and use for 20 minutes at a time.

WOUND CARE:

  • Prevent infection by washing your hands or using a hand sanitizer gel often.
  • Avoid touching your incision with your hands.
  • Do not apply lotion, cream, or ointment to the incision.
  • Check your incision daily for bleeding, change or increase in drainage, redness, or swelling. Report any changes to your doctor’s office.
  • If your incision is closed and dry, you may leave your incision uncovered without a dressing/bandage. If you have small white ‘steri strips’ in place, leave them on until they fall off.
  • If your incision is draining, keep it covered with a dry dressing and change it daily or when itbecomes wet with drainage.
  • To change your dressing (have someone assist if available):
  • Wash your hands with soap and water; dry them well with a clean towel.
  • Remove the old dressing (if you have small white ‘steristips,’ leave them in place).
  • Cover the incision with a new dressing. Be careful not to touch your incision area or the part of the dressing that touches the incision.
  • If you had a drainage tube that was removed, there will be a separate, small opening near your incision. If this site is draining (leaking fluid), follow the same dressing change instructions as for your incision and change daily. Report any changes in this drainage to your doctor’s office.

SHOWERING:

  • Your doctor will tell you when you are allowed to start showering, typically this is on the 3rd day postop.
  • When you shower, if your incision is closed and dry you may take a shower without covering it. Do not rub or wash your incision directly. Gently pat it dry.
  • If your incision is draining or if you have staples, cover the incision with a waterproof dressing for showers. Remove this dressing after the shower. If the incision is draining, apply a new dry dressing following the dressing change instructions above.
  • Avoid soaking the incision in water (no hot tubs, bathtubs, or swimming pools).

BOWEL CARE:

  • Some pain medications may cause constipation. Signs and symptoms of constipation include: loss of appetite, abdominal pain, cramps, bloating, nausea and/or vomiting, and no bowel movement for several days or passing hard stools.
  • If you have not had a bowel movement before leaving the hospital, take an over-the-counter laxative when you get home (such as Milk of Magnesia, Senna Tablets, etc.). Ask your pharmacist for advice if needed.
  • To help relieve constipation while taking prescription pain medication,you can:
  • Eat foods high in fiber
  • Add foods with a natural laxative effect (such as prunes or apricots) to

your diet

  • Drink plenty of fluids
  • Take an over-the-counter stool softener daily (such as Colace or Correctol)
  • If stools are too loose stop taking the stool softener.
  • If more than two days go by without a bowel movement use the over the counter laxative (mentioned above).

SYMPTOMS TO REPORT:

Call 911 immediately if you have any of these symptoms:

Sudden chest pain, difficulty breathing (this may appear as shortness of breath or as pain upon taking a deep breath), confusion, coughing up blood.

Other symptoms to report to your doctor:

  • Significant swelling in your shoulder or arm that doesn’t improve after elevating your arm overnight.
  • Increased pain, warmth, and tenderness in your arm or shoulder.
  • An increase or change in bleeding, redness, swelling, or drainage from your incisional area.
  • Any change in sensation of your arm (e.g. increased numbness, tingling, or pain).
  • Flu-like symptoms (e.g. nausea, general body aches, or temperature over 101 degrees).
  • Pain not relieved by pain medication, ice packs, or rest.
  • Significant swelling, pain, warmth, or tenderness in the calf of either leg that you have not had before surgery.
  • Taking strong pain medicine when not needed/necessary can result in dangerous over-sedation. Signs and symptoms of over-sedation from taking too much pain medicine (e.g. when your pain level is still tolerable or acceptable) include drowsiness, excessive sleepiness, slow breathing, slurred speech, impaired thinking, confusion, and impaired motor coordination. If any of these symptoms develop stop taking the pain medicine and call your doctor.

OTHER:

  • In the future, anytime when you have surgery, dental work, or develop an infection of any kind (e.g. bladder, tooth, ear, respiratory) you MUST notify your surgeon, dentist, or doctor if you have had an artificial shoulder joint replacement. In these situations antibiotics are often used to prevent artificial joint infections. Call your doctor’s office if you have any further questions or concerns.