Christopher D. Casscells, M.D.
Ice and Recovery:
In most cases you will go home immediately following the shoulder surgery. In some cases, if you are very sleepy, do not feel well, or have had a great deal of surgery, we will keep you over night and let you go home in the morning. You should plan to spend the first 2-4 days following the arthroscopy resting with the leg elevated and an ice pack/cold unit on the shoulder while placing a towel between the skin and ice pack. This prevents bleeding and swelling. The recovery will be much faster if you have less bleeding and swelling. Swelling causes pain. Please note that alcohol and some over the counter medications may cause bleeding and possibly make swelling and pain worse. Celebrex does not potentate bleeding and can be taken safely in the immediate post-op period.
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 activity. Mobilization of the shoulder is specific to your particular surgery (see below). 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, hanging the arm down and sleeping in a chair/recliner can provide relief. Sleeping in a chair is often more comfortable than in a bed.
Dressing and Bandages:
If the shoulder has a simple bandage on, it may be removed in three (3) days. Leave the steri-strips over the incisions; they will fall off by themselves over the next few days. A shower may be taken if the wounds are dry- no drainage. Do not scrub the area. Feel free to cover the wounds with a light dressing such as a band-aid or small piece of gauze. Keep the area surrounding the incisions clean, do not touch them.
If adhesive from the Steri-Strips is causing itching, you may be allergic to it and they should be removed. A small amount of cortisone cream or Benadryl cream will relieve the itching. After a shower the Steri-Strips should be blotted dry or air dried (a hair dryer may be used). The wound should be lightly covered, when dry, with an over the counter triple antibiotic ointment or Neosporin and band-aid. Stitches will be beneath the skin and do not need to be removed. Call the office immediately if the wound begins to have redness around it, is hot to touch, and/or you develop a temperature of 101.5 or above.
Swelling of the shoulder is fairly normal, especially early on after surgery. It can cause intense pain, especially as the numbing medicine wears off and sensation returns with a crescendo-type discomfort. If the pain does not resolve with cold compresses such as the EBI ice unit, ice bags, along with pain medication, please call the office to have the shoulder evaluated.
If you have pain, take your medicine. Everyone responds to pain differently. Some people “do not like pills” and tend to remain excessively inactive in order to avoid pain. Pain medication can help you mobilize during recovery. Follow the doctor’s prescribed directions regarding how much medication should/can be taken. After a few days a patient should require very little, if any, pain medication. If a lot of pain medication is taken, in anticipation of pain but you do not have any pain, the medication will be overly sedating and unsafe. If you require more than two pain pills every three hours and have attempted rest, ice, compression, then call the office since this represents an abnormal amount of pain and might require different measure. Please do not take any other home remedies, illegal drugs or alcohol in attempts to relieve pain. This can be fatal.
After the general anesthetic shoulder surgery, the shoulder will have a long acting block of 4 medications to prevent pain for 36 to 48 hours. Occasionally, we will also use a scalene nerve block for the effect. Some of the numbing effect may extend down the arm as well. This is normal. Even though the shoulder does not hurt, go home and rest, keeping the shoulder cool with an ice bag or cooling unit to prevent swelling. As the numbing medicine wears off, take pain medication prescribed in the 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 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 then other instructions you may have been given by hospital employees.
Nausea and Constipation:
Some narcotic pain medications may cause nausea and most will cause constipation. In general, if pain medication is taken in the absence of pain, you will more likely to feel nausea. This side effect of nausea can be alleviated by taking smaller doses 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 25mg Benadryl every four hours, be aware this medication may make you sleepy. It is recommended to eat a little something when taking narcotic medication.
It is not unusual for bleeding inside a joint to cause a fever of 101 F to 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 add usually does not represent an infection. However, if the temperature is repeatedly 101.5 or higher, please contact the office immediately. Other signs of infection are redness around the wound or draining from the wound. An infection is rarely seen in the first 48 hours following surgery. Abnormal swelling or reed appearance of the wounds accompanied by a fever after the first 48 hours is worrisome and the office should be contacted immediately to potentially start antibiotics.
Stitches are buried beneath the skin and do not need to be removed. On occasion, the body may have some difficulty dissolving the stitches, in which case you may “spit a stitch”. This is nothing more then the body trying to extrude a stitch. This usually occurs after a few weeks and is accompanied by a small red pimple. If you are comfortable, you can grab a knot, cut, remove the stitch and apply an over the counter triple antibiotic ointment to the area. The irritation will resolve immediately. The stitch can also be removed in the office if you wish.
If you are not confident about your ability to do your job or return to work safely, call the office and discuss whatever documentation is necessary to validate the absence from work. Please be advised, there is a fee for completing Disability paperwork per form. This does not guarantee all forms will be filled out (i.e. Functional Capacity Form). Forms will be completed within 5 business days. If there is a rush to complete a form sooner, the form will filled out within 2 business days and there is a higher fee for that. Please see ask our office staff for the pricing.
You should not drive until the pain has decreased to a level where you do not have sharp pains when moving and when you are no longer taking narcotic medications.
Running Out of Medications:
Some medications (Percocet, Endocet) cannot be called into a pharmacy, be renewed or given refills. These narcotics can only be prescribed individually by paper prescription. However, there are several adequately strong pain medications which can be telephoned into a pharmacy if you run out of medication. Narcotic prescriptions are only renewed during working hours Monday – Thursday 8am – 4:30pm and Friday 8am to 1pm. We do not authorize the on-call physician to renew narcotic medication at night or weekends. Please keep track of the pills to make sure you do not run out during off hours. You may leave a message to renew the medication. The request may be renewed after a consultation with the physician.
When in Doubt:
If you have an emergency after hours, call the on-call doctor as (302)477-0900 and follow the prompts for emergencies. This is for emergencies only, so please be considerate of the on-call physician who may be preoccupied with surgery or another true emergency. This in not to be used for routine daily business or non-emergent questions. Please leave a message with the following information; spell your first and last name, phone number, type and date of surgery, and which doctor performed the surgery. We will get back with you as quickly as possible.
Follow Up Appointment:
In most cases, a post op office visit is already scheduled. If you feel it is necessary, call the office to 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 physical therapy if you are having trouble getting around. Inquire from the clinical assistant.
Types of Surgery
1. Arthroscopic Acromioplasty:
Start moving the shoulder as soon as possible. Use the pulley and do ‘snow angles’ to start getting range of motion. You should not cause pain but should move the shoulder passively to a point of tightness and then hold it there for awhile. Do not do any active work with the shoulder, as this can cause damage to the rotator cuff. Gently increase the range of motion daily, but be gentle.
2. Rotator Cuff Repair:
The shoulder should be rested for a few weeks. You may take the arm out of the sling and do pendulum exercises (see back page). Other exercises should not be done until the doctor prescribes it.
3. Arthroscopic Slap or Bank art Repair:
The shoulder should be rested by keeping the arm in a sling at your side for several weeks. Small pendulum motions can be done, otherwise no exercise should be done other than isometric tensing of the muscles and only if you feel the need. Exercise or therapy program will be discussed at the post op visit.