Post-Op Instructions for the Shoulder

Diet

• Begin with clear liquids and light foods (Jello, soups, clear liquids, etc.)
• Progress to your normal diet if you are not nauseated as tolerated

Wound Care

• Maintain your operative dressing, loosen bandage if swelling of the elbow or hand occurs
• It is normal for the shoulder to bleed and swell following surgery – if blood soaks onto the bandage, do not become alarmed – reinforce with additional dressing
• You may shower on post­operative day #3. Remove the Dressing and all of the gauze pads. Leave steri-strips (special white band-aids) in place. Place waterproof band-aids over steri-strips and incision areas. Be careful not to slip and fall. Do not scrub over the surgical incisions – you may apply soap to your neck and allow the soapy water to run over your shoulder. Try and keep your forearm against your stomach while showering. Pat the shoulder dry with a towel and apply new waterproof band­aids over the surgical incision.

DO NOT submerge the incision in water (i.e. NO bath, hot tub or pool, etc.) *Sling may come off to shower

Medications

• The Regional anesthesia (shoulder pain block) that you received prior to surgery will wear off within 6-8 hours
• Most patients will require some narcotic pain medication for a short period of time
• Primary Medication = Percocet (Oxycodone)
  • Take 1 – 2 tablets every 4 – 6 hours as needed
  • Do not take more than 10 pills per day
  • Plan on using it for 2 to 5 days, depending on level of pain
  • Do NOT take additional Tylenol (Acetaminophen) while taking Norco, Vicodin or Percocet
• For larger surgeries, some patients will also be prescribed Oxycodone (5mg) to be used for breakthrough pain
  • Take 1 – 2 tablets every 4 – 6 hours as needed
  • If given Oxycodone, this should be used as a supplement during the first few days after the Surgery. As the pain level improves you should transition to just Percocet medication for residual pain.
• Common side effects of the pain medication are nausea, drowsiness, and constipation – to decrease the side effects, take medication with food.
  • If constipation occurs, consider taking an over-the-counter laxative such as prune juice, Senekot, Colace (or Periocolase), or Miralax
• For nausea, take the prescribed Zofran as needed
• If you are having problems with nausea and vomiting, contact the office to possibly have your medication changed
• ***DO NOT drive a car or operate machinery while taking the narcotic medication
• Ibuprofen 400-600mg (i.e., Advil, Motrin, Aleve) may be taken in between the narcotic pain medication to help smooth out the postoperative “peaks and valleys”, reduce overall amount of pain medication required, and increase the time intervals between narcotic pain medication usage

Immobilizer

• Your sling with supporting abduction pillow should be worn at all times (except for hygiene)
• Maintain your elbow position against the pillow and even with your side or in front of this position to minimize stress on the repair
• At night place a pillow behind your elbow to prevent your shoulder from bending backward
• Sleeping with extra pillows (almost sitting upright) will help keep swelling down and may be more comfortable

Dressing/grooming

• It is advisable to wear shirts that button up the front during the initial recovery period, and to put the operated arm into the shirt sleeve first, followed by the non-operative arm. The sling may be removed while showering, with care taken to have the arm hang passively while washing.

Ice Therapy

• Begin immediately after surgery
• Use icing machine continuously or ice packs (if machine not prescribed) every 2 hours for 15 to 20 minutes daily until your first postoperative visit
• Motion Medical Ice Machine “Game ready”/Vasothermic device may be used.
  • Use unit as frequently as tolerated x 14 days
  • Unit is programmed hour on/hour off continuous of compression and ice alternating
  • If braced* – Loosen brace to avoid added pressure
  • If issues with Vasothermic device, please contact the distributor or Dr. Campbell’s office at NYU Langone Seaport Orthopaedics 212-513-7711 or at the NYU Center for Musculoskeletal Care at 646-356-9407 based on the location that you have your regular office visits.

Exercise

• Begin pendulum exercises 24 hours after surgery – complete 3-4 sets of 10-15 reps per day
• While maintaining your arm against the pillow but out of the sling, begin elbow, wrist, and hand range of motion 24 hours after surgery. Complete 3-4 times per day until first postoperative visit
• If rotator cuff repair is done with a biceps tenodesis, do not perform elbow range of motion actively
• Formal physical therapy (PT) will begin after your first postoperative visit and you will be given a script for this at that time

General Activity Guidelines

These guidelines may vary depending on your injury, healing, size of tear, and progress in rehabilitation. Activity is extremely limited during the first 4-6 weeks after surgery, even when there is little or no pain.

• Driving – not recommended while taking pain medication
• Return to driving should be discussed with physician
• Computer/desk work – 1-2 weeks after surgery with sling on
  • It is advisable to use a lap tray for keyboarding, with a wrist rest and mouse attachment, so that work can be performed with arms down and sling on for the first 4-6 weeks following surgery.
  • A head set or ear piece is recommended when using the telephone.
• Lightweight active work below shoulder level – 6-8 weeks
• Strengthening with resistance – 3 months
• Golf, fishing – 4-5 months
• Racquet or throwing sports or heavier overhead use – after 6 months

***It is useful to discuss job demands and the length of time that may be required to be absent from work or working in a limited capacity with employer prior to surgery.

**Emergencies**

Contact Dr. Campbell’s office at NYU Langone Seaport Orthopaedics 212-513-7711 or at the NYU Center for Musculoskeletal Care at 646-356-9407 based on the location that you have your regular office visits, if any of the following are present:

• Painful swelling or numbness
• Unrelenting pain
• Fever (greater than 101° – it is normal to have a low grade fever for the first day or two following surgery) or chills
• Redness around incisions
• Color change in wrist, hand or lower extremity
• Continuous drainage or bleeding from incision (a small amount of drainage is expected)
• Difficulty breathing
• Excessive nausea/vomiting
• **If you have an emergency after office hours or on the weekend, call 212-513-7711 for NYU Langone Seaport Orthopaedics or 646-356-9407 for the NYU Center for Musculoskeletal Care based on the location that you have your regular office visits, and you will be connected to our page service – they will contact Dr. Campbell. Please Do NOT call the hospital or Surgicenter.

**If you have an emergency that requires immediate attention, proceed to the nearest emergency room.

Follow-Up Care/Questions

• Dr. Campbell will call you on your first day after surgery to address any questions or concerns. If you have not been contacted within 48 hours of surgery, please email Dr. Campbell or call directly (NYU Langone Seaport Orthopaedics 212-513-7711 or at the NYU Center for Musculoskeletal Care at 646-356-9407; or the HJD Sports Medicine Clinic on 23rd Street at 212-598-6321 or 212-598-6322, based on the location that you have your regular office visits).
• If you have additional questions that arise at any time, please send an email to Dr. Campbell for the fastest reply (Kirk.Campbell@nyumc.org). If email is not an option please call the office.
• If you do not already have a postoperative appointment scheduled, please contact the scheduling office during normal office hours to make a follow-up appointment.

If You Have Concerns

If you have concerns/questions, please read the following information before calling the office.

What if my hand/arm swells after surgery?
It is not uncommon to experience swelling after surgery. Sometimes, you will not swell until several days after your surgery. Remember that your body is healing from the surgery and some swelling is normal. The more activities and physical therapy you perform, the more swelling you may experience.

With that said, we do want you to remain active and participate in therapy. But, the swelling will decrease by using ice and working with your grip ball.

You should be alarmed if you have swelling for several days that is accompanied by redness and heat or coolness in your surgical arm, or if the swelling does not resolve after ice and exercise. If this is the case, please contact Dr. Campbell’s office.

Will I have bruising after surgery?
Yes, you will have some degree of bruising after surgery, but everyone is different. Some will only experience redness around the incision, others will have bruising down the entire arm and chest. Both are considered normal and will resolve over 10-14 days.

What should I expect my activity level to be?
Every patient is different. Every day you should be increasing your activity level, but let your pain level and swelling be your guide. You will make 80 percent of your recovery in the first three months, and the remaining twenty percent will come within the next year.

At some point, most patients overdo with activities and therefore take a few steps back in their recovery. You may have increased swelling or discomfort if this happens. You need to become concerned if you cannot control your pain with rest and pain medications. If this is the case please contact Dr. Campbell’s office.

What if I am having problems sleeping?
Make sure that your pain is well controlled throughout the day. During the day be careful about taking naps. Try to plan your activities as near normal as possible. Also you can try over the counter sleep medication by consulting your pharmacist.

When can I shower or bathe?
You can shower and get your incision wet 7-14 days after surgery once your sutures are removed.

How long do I have to wear the sling?
This will vary based on the type of surgery you had procedure. This can range from a sling to be used for comfort, to using the sling for up to 6 weeks. Dr. Campbell will give you specific instructions after your surgery.

What positions can I sleep in?
On your back or in an upright position with your arm well supported in your SLING. Some patients find it more comfortable to sleep in a recliner.

When can I restart the meds I was told to stop prior to surgery?
Please check with your primary care physician.

How long will I be on narcotic medication for?
You can stop taking the narcotic medication when you are no longer experiencing pain. Most patients take the narcotic medication for approximately one month.

Now that I am no longer requiring narcotic pain medication, what can I take if I should experience discomfort?
You make take Tylenol or Extra-Strength Tylenol. Because you are already taking an anti-inflammatory, you may not take over the counter medication, such as Advil or Aleve (Ibuprofen).

When to call the doctor?
If you have a fever above 101.5, chills, sweats, excessive bleeding (example: you had to change the dressing twice), foul odor, excessive redness, excruciating pain, yellow or green discharge, or if you think you have an infection call Dr. Campbell’s office. Evenings, nights and weekends, 212-513-7711 for Seaport Orthopaedics or 646-356-9407 for the NYU Center for Musculoskeletal Care Office, or you may go to your local emergency room if you are having a medical emergency.

What should I do to avoid constipation?
Drink plenty of fluids and eat fruits and fiber. If you continue to have symptoms of constipation you can take Milk of Magnesia, which is a mild oral laxative, or use Magnesium Citrate, which is much stronger. In addition, you can also try Dulcolax suppositories of a Fleets enema. All of these medications can be bought over the counter at a pharmacy.

If you have had a shoulder replacement?

You should take antibiotics before the following procedures:

• Any Dental procedure
• Sigmoidoscopy/colonoscopy
• Any infection
• Tonsillectomy
• Bronchoscopy
• Liver Biopsy
• Genitourinary Instrumentation
• Prostrate and Bladder surgery
• Kidney surgery
• Vaginal exams and GYN surgery
• Barium Enema

Whoever is performing the procedure should prescribe the appropriate antibiotic. You may contact the office to obtain the antibiotic from Dr. Campbell. The dosage is usually four tablets one hour prior to the procedure. Please note that premedication for these procedures need to be taken 2 years postoperatively.

What about using a hot tub or whirlpool?
Because of the heat and bacteria in the water, we do not want you to use a hot tub or whirlpool for six weeks.

When to call:

• Fever above 101.5 consistently
• Increased drainage or swelling
• Pain not controlled by pain medication
• Severe insomnia
• Swelling in arm/hand that is accompanied by coolness or decreased sensation in the arm/hand.