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patient education : 22028--Total Shoulder Arthroplasty Discharge Instructions

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    TOTAL SHOULDER ARTHROPLASTY DISCHARGE INSTRUCTIONS

    Contact the Sports Medicine Clinic at (434) 243-7778 if you have questions about your instructions or follow-up appointment.

    DIET:

    Start with clear liquids and light foods to minimize nausea. Once these are tolerated, advance to a regular diet.

    DRESSING AND WOUND CARE:

    Keep the dressing clean and dry. It is normal for there to be some drainage after surgery since the shoulder was irrigated with large amounts of fluid. Reinforce with additional gauze as necessary.

    Remove the dressing the 7th day after surgery and begin changing daily with clean gauze or Band-Aids®. Keep your incisions covered until you follow up in clinic.

    If you have Steri-Strips™ in place of stitches, allow them to stay in place as long as possible. Steri-Strips™ are made of a fabric material that can get wet in the shower and pat dry with a towel. They usually fall off on their own within 7 to 10 days. You may trim the edges as they begin to curl. 

    BATHING:

    You may bathe or shower on the 7th day after surgery, but do not scrub or soak the incisions. Dry the area by gently blotting it with a gauze or towel. After it is completely dry, cover the wound with clean gauze or Band-Aids®. Do NOT submerge the incisions (bath/swim) until after the sutures are removed and the wound has completely healed.

    ACTIVITY:

    Ice should be applied to the shoulder for 20-30 minutes, 5-6 times a day, to help control pain and swelling. Apply additional times as needed, especially after exercise, for the first 3-4 weeks. Do not apply ice directly to the skin; use a thin barrier in between. Also, do not use heat.

    Elevate the shoulder by sleeping as upright as possible using extra pillows or a recliner. Do this for the first few days to help decrease pain and swelling.

    Wear the sling at all times for 6 weeks including while sleeping. The only time you may remove the sling is for bathing and exercises. Do not lean or put your body weight on your arm.

    Remove the sling for 5-10 minutes, 3 times a day, to do the following exercises:

    • Fully bend & straighten your fingers, your wrist, and your elbow several times.
    • Lean forward, bracing yourself on a table/counter with your normal arm. Let your surgical arm relax and hang straight down. Shift your weight so that your arm moves side to side, front to back, and in gentle circles like a pendulum or elephant's trunk. Use your body to generate the movement for this, NOT your surgical shoulder's muscles. (see drawing below)

    Physical therapy should be started within 3 days of surgery. Take your therapy prescription to the PT clinic of your choice. If you have not received a therapy prescription, please contact your surgeon’s office to have a script sent to your physical therapist.

    PAIN CONTROL:

     It is important to stay ahead of pain as it becomes challenging to get under control if you fall behind. Ice and elevation can help and should be used as much as possible in the first few days.

    • Narcotic pain medications, such as hydrocodone and oxycodone, should be taken as prescribed. Wean off as soon as possible. Take these with food to decrease the chances of nausea and vomiting. Do not drink alcohol, drive a vehicle, or use heavy machinery while taking narcotic pain medications.

    • NSAID medications are used for pain control and to decrease inflammation. You may be prescribed an NSAID such as ketorolac (Toradol). Take as instructed. Other NSAID medications such as ibuprofen, Motrin, Advil, naproxen, or Aleve can be used once you have finished the Toradol, or if a prescription for Toradol was not provided.

    • Acetaminophen (Tylenol) is an effective over-the-counter pain medication that can be used with NSAID medications and non-acetaminophen containing narcotics such as plain oxycodone.

    ASPIRIN FOR PREVENTION OF BLOOD CLOTS:

    You should take one 81 mg baby aspirin twice daily for two weeks starting the evening of the day you have surgery unless instructed otherwise or taking a different blood thinner such as enoxaparin or warfarin. If you are aware that you are at high risk for a blood clot, notify your physician as soon as possible.

    Take immediate-release aspirin at least 30 minutes before taking ibuprofen or wait at least 8 hours after last ibuprofen dose. Take extended-release aspirin (may be marked "EC" for "enteric coated") at least 2 to 4 hours before taking ibuprofen or wait at least 8 hours after last ibuprofen dose.

    CONSTIPATION PREVENTION:

    Anesthesia and pain medications, changes in eating and drinking, and less activity can all lead to constipation after surgery. To prevent or reduce constipation, take an over-the-counter stool softener (brands include Colace and Miralax).  Follow the directions on the bottle. Drink plenty of water and eat high fiber foods including whole grains, fresh fruits, vegetables, beans, prunes or prune juice.

    PROBLEMS TO REPORT:

    • Persistent bloody drainage that soaks through reinforced dressings.
    • Fever greater than 101F or 38C.
    • Incision that is very red, swollen, draining pus, shows red streaks, or feels hot.
    • Inability to urinate within 8 hours of surgery (a rare effect of the anesthesia).
    • If you develop a rash, generalized itching or swelling from the medications, STOP the medication and call. 

    Daytime - call Sports Medicine Clinic at 434-243-7778.

    Night-time and weekend - call the UVA operator at 434-924- 0000.  Ask for the Orthopedic surgery resident on call.

     FREQUENTLY ASKED QUESTIONS

    WHAT DAILY ACTIVITIES CAN I DO?

    After shoulder surgery, you may do what you feel comfortable doing in the sling.  Do not lift anything with your operative arm or put yourself at risk of falling.

    CAN I DRIVE OR RIDE BY CAR/ TRAIN/ PLANE?

    You should not drive while using a sling. There are no forced restrictions regarding operating a motor vehicle, however you must always be the judge of whether you are able to operate it safely. You should not drive while taking narcotic pain medications. You may ride in a car after surgery as needed. You may take a train or even fly the day after your surgery as long as you feel secure and comfortable.

    WHAT ABOUT WORK?

    You may return to an office-type job or to school whenever comfortable. For most patients this occurs 1-2 weeks after surgery. For more active jobs that require some lifting, you can wait until after your follow-up appointment. Any other unusual types of jobs should be discussed to determine a date for return to work.

    WHAT ABOUT SWELLING?

    Expect swelling as a normal process after surgery. Ice, elevation, and other treatments provided at physical therapy will allow this to improve in time. Some swelling may remain for up to 8 weeks, and this is normal.

    WHAT IF IT REALLY HURTS TOO MUCH?

    Surgery hurts and you cannot expect to be pain free, but our goal is for it to be tolerable. Try to use all available pain therapies such as narcotics, NSAIDS, and acetaminophen. Always try more ice and elevation. If the pain is not tolerable, call the clinic or the orthopedic resident on call.

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