Guidance following shoulder surgery.


After the operation:

You will wake up in the Recovery Room where a nurse will check on you until you are fully awake. You may eat and drink when you feel able. Once you are awake and comfortable you will be taken back to the ward.

Your surgeon will explain the operation and results to you. However, although you will be awake in enough to hold a conversation and acknowledge the explanation, many people find they do not remember this. Do not worry as you should be given clear rehabilitation guidelines by the physiotherapists on the ward and arrangements will be made for you to be seen in the clinic.

In the clinic, the explanation of the operation and findings can then be repeated and any questions answered. There are often intra-operative images or photos, particularly if you have had key-hole (arthroscopic) surgery and these will normally be explained to you.


Going home or staying in overnight:

Once you are awake, comfortable, had something to eat and drink and the Nursing Staff are happy with your condition you may go home. Most people can go home the same day even if their operation is in the afternoon. However, some people will choose or need to stay in over night. If so you can go home the next morning as soon as the Nursing Staff are satisfied with your condition.


Pain relief after the operation:

If you have had an anaesthetic block or injection you may still have a numb, tingly or floppy arm. This will recover but may take 24 to 48 hours to do so. The prolonged block may be irritating but does mean that the arm is more comfortable after the operation.


It is normal to be in some discomfort following an operation. This usually improves significantly over the first few days and then more gradually over the first few weeks.

You will usually be given pain-killers and anti-inflammatories to take home with instructions when to take these. Do not exceed the recommended doses.

Typically you will be given Co-Codamol or Co-Dydramol to take home with you. These can be taken regularly or only as required. It is usually best to consider taking them regularly for at least the first few days. After this they may need to be taken only as required. If taking pain-killers only as required it should be remembered that they may take 45 minutes to start to work properly. Co-Codamol and Co-Dydramol have a number of side effects including constipation and it is advisable to drink sufficient water to mitigate this.

Please note that both Co-Codamol and Co-Dydramol contain Paracetamol. Whilst they can be taken with Paracetamol, the total dose of Paractemol should not be exceeded in a 24-hour period.

Occasionally stronger, morphine like, pain-killers such as Tramadol are required. These may cause dizziness and should be avoided unless the pain is severe. They are sometimes useful at night to help with sleep, which may be disturbed following the operation and when the dizziness is less of a problem.

You may be prescribed Ibuprofen or Diclofenac (Voltarol), which are anti-inflammatoires. These should not be taken together but can be taken with other analgesics such as Co-Dydramol. It is advisable to take them with food to avoid or limit stomach (gastric) irritation.

Please note that anti-inflammatories should not be used (are contra-indicated) in the following circumstances:

An allergy to aspirin or other anti-inflammatory.
Pregnancy or Breast feeding.
Blood thinning (Anti-coagulant) medication such as Warfarin.
Any condition that increases the risk of bleeding (
eg. Haemophillia).
A stomach (gastric or peptic) ulcer.

In addition care should be taken in the following circumstances:
Asthma or Lung disease (COPD)
Kidney (renal) impairement.
Heart (cardiac) disease.
Liver (hepatic) disease or dysfunction.



Wound care:

It is common for there to be some blood-stained fluid come from your surgical wounds. This is particularly common after key-hole (arthroscopic) surgery. During a key-hole (arthroscopic) operation fluid is pumped through the shoulder to allow visualisation during the operation. It is normal for a significant amount of this fluid to accumulate in the soft tissues around the shoulder. The retained fluid is absorbed over the first few days after surgery but it is normal for some of this to leak out as a blood stained fluid from the surgical scars. It is typically most marked from the front (anterior) scar (portal).

You will normally have a large absorbent dressing over the shoulder when you return from Theatre. This will be removed before you are discharged and the Opsite
TM dressing changed before you are discharged home. The wounds should be kept clean and dry for two weeks when they will usually be checked in the clinic.

It may become necessary to change the Opsite
TM dressings again depending on the amount of fluid leakage. The Steri-StripsTM which are under the OpsiteTM dressings can usually be left alone. The wounds should be kept covered and disturbed as little as possible for 2 weeks. The OpsiteTM dressings are splash-proof rather than water-proof. The shoulder can be covered with some cling film to help keep the water off the dressings, otherwise careful direction of the shower should be sufficient. If the dressings do get wet they should be changed immediately.


Skin preparation:

When you return from Theatre, you may notice a red or yellow colouration of the skin of the arm. While you are asleep, before the operation starts, your arm will be cleaned with a special cleaning agent, which typically has a yellow or red stain. This ensures that the whole surgical area is appropriately cleaned and no areas are missed. There is no cause for concern and the colour will come off in due course.


Post-operative swelling:

Following the operation it is common for the arm and hand to swell. This may last a few days to several weeks. The swelling in the hand is helped by elevation or raising the hand in the sling or on a pillow. Keeping up with the rehabilitation exercises given to you will also help, particularly the hand and wrist movements.


If you are concerned there may be a problem:

You should contact the ward if you have any concerns on..... They ward can then contact me.


Clinic follow-up:

You will typically be reviewed at two weeks post surgery when the wounds will be reviewed.
The explanation of the operation and findings can then be repeated and any questions answered. There are often intra-operative images or photos, particularly if you have had key-hole (arthroscopic) surgery and these will normally be explained to you. You will normally be seen in clinic at six weeks, 12 weeks and at six months, depending on your condition and progress.


Problems in the future:

If you have any problems in the future, if for example, you re-injure your arm please let me know via my secretary andrea.beaumont@soc-bristol.co.uk or 0117 9339980 even it is years down the line. If you have moved away or abroad I would still like to be informed of your progress or any concerns you may have. If you are not in a position to come back to be seen I may able to recommend someone near to you who you could see for advice or an opinion.



Physiotherapy follow-up:


You will normally be seen on the ward by the Hospital physiotherapists before going home. Follow up rehabilitation should normally be with the therapist you were seeing prior to surgery. If you have no specific therapist, if this is not convenient or you would prefer otherwise alternative rehabilitation arrangements will be made. Your physiotherapists will advise you of the appropriate frequency of therapy sessions.


A guide to recovery:

Unless specifically advised any sling provided should be discarded as soon as this is tolerable.

The recovery following shoulder surgery is usually straightforward, but is dependent on the type and extent of surgery and the severity of the pathology at the time of the surgery. The rate of recovery is determined by the post-operative rehabilitation guidelines and need for immobilisation. It is crucial that you follow the rehabilitation guidelines, doing too much too soon could disrupt the surgery and effect your long-term outcome.

Driving:

The law states that the patient should be in complete control of the vehicle. It is their responsibility to ensure this and to inform their insurance company about their surgery. If your ability to drive is impaired you are obliged, by law, to notify the DVLA.

You should not drive in a sling or when taking pain medication which may effect your ability to drive. You should be able to not only drive under normal circumstances but also be able to perform emergency manoeuvres safely and without pain.


Return to work:

The required time off work will depend both on the nature of your work and the type of operation you have undergone. For most individuals with an office-based job, you may return to work even in a sling by approximately two weeks. Employment requiring heavy lifting should be avoided for at least six weeks, but may need to be avoided for four months or more depending on the operation required. Please see specific rehabilitation guidelines.


Other hints and tips:

Eating:

It may be more difficult to handle cutlery and feed yourself.
Soups, pre-cut meat and vegetables may be easier.
You may wish to consider stocking some ready-made meals.
It may be easier to eat single handedly from a bowl rather than a plate.
You may wish to move items you may need down from high shelves to allow easier access after the surgery.


Dressing:

Dress the operated arm first.
Undress the operated arm last.
Have some loose fitting clothes that will go over the arm and sling.
Feed a belt through the belt-loops before putting the trousers on.
Most ladies with shoulder or arm problems may have moved to front opening bras or have already mastered swivelling a bra backwards.
Wear front opening clothes, avoiding small or difficult fastenings or buttons.
Avoid shoe-wear with laces and opt for slip-on or Velcro fastenings.


Washing and bathing:

Try using an electric toothbrush particularly if it is your dominant-arm that may be out of action.
Avoid getting into a bath as you may then have difficulty getting out of it while only using one arm.
The dressings used are typically splash proof but not waterproof.
You will typically be able to shower, while attempting to keep the effected shoulder out of the spray as much as possible. You may find it helpful to place a layer of Cling Film over the shoulder to offer further protection.
If the dressings do become wet they will need to be changed as soon as possible.
Flip top soaps, toothpaste and shampoos may be helpful.




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