Food
Start slowly. It's natural to want to eat a lot after surgery, but start with small amounts of your normal food, and eat more as your nausea improves.
Incision
You will go home with a waterproof antimicrobial (silver) dressing. You may shower starting the day after surgery with the dressing on — let the water run over it and pat it dry, steadying yourself and letting the arm hang. Leave it undisturbed for 5 to 7 days; we will tell you at discharge whether we change it in clinic or you change it at home. If it starts leaking at the edges, peels off, or the incision starts to drain, please contact the office. Do not soak your shoulder — no baths, pools, lakes, or hot tubs — until the incision is fully healed.
Activity & Sling
The sling is for comfort and protection, not strict immobilization — wear it out of the house, around pets and grandchildren, and at night early on; at home, sitting quietly, you may take the arm out and let it rest in your lap. Most patients wean out of the sling over about four weeks. For the first six weeks, lift nothing heavier than a coffee cup with the surgery arm — no pushing up out of a chair with it, no pulling doors, no lifting a gallon of milk.
There is one position to avoid, and it depends on your operation. After an anatomic replacement, avoid reaching behind your back and forcing the arm outward for six weeks. After a reverse replacement, avoid reaching behind your back with the elbow tucked in toward your body and the arm turned inward. Your therapist will show you exactly what this means for you.
Sleeping propped up in a recliner — or on a wedge of pillows, with a small pillow supporting the arm — is far more comfortable than lying flat for the first week or two.
Swelling
Ice machines or reusable ice pads (search “shoulder ice machine” on Amazon) can be great for reducing pain and swelling. I like them, but frozen peas work just as well. Be careful not to freeze your skin: use 20 minutes on and 10 minutes off, unless your machine has temperature settings that prevent freezing.
Physical Therapy
Please arrange physical therapy to begin within about a week after surgery — starting early is how we keep the shoulder from getting stiff. You will continue therapy for several months.
Medications
Start your pain medicine the first evening — before your nerve block wears off. The block quits suddenly, usually 12 to 24 hours after surgery and often in the middle of the night. Patients who wait for pain to arrive spend the night trying to catch up to it.
If you went home the same day, you were sent home with a steroid tablet (dexamethasone 16 mg). Take it the morning after surgery — it is one of the best tools we have against pain, swelling, and nausea in the first days. If you have diabetes, your blood sugar may run higher for a day or two; keep an eye on it.
Take Tylenol and an anti-inflammatory on a schedule rather than as needed: for example Tylenol, then the anti-inflammatory 2 hours later, through the day. If you were prescribed celecoxib, take it as directed; over-the-counter naproxen or ibuprofen works if you prefer. Do not take more than the daily dose shown on the label. Take over-the-counter Pepcid or another antacid alongside the anti-inflammatory to protect your stomach, and keep it at least 30 minutes after your aspirin dose — or at least 8 hours before it.
Narcotics
You may need narcotics for a few days, but the sooner you stop using them, the better you will feel. Refills are rarely needed. We do not refill these medications after hours or on weekends, and a refill takes about 72 hours, so please plan ahead. If you take narcotic medications regularly, you will need to make arrangements with your regular prescribing provider.
Post Operative Visits
Call to schedule an appointment about 2 weeks after surgery.
Dental Care
I do not recommend routine dental care for 3 months after surgery. Unless you are at high risk for infection (a reduced ability to fight infections), I do not recommend antibiotics before dental procedures — a change made by the American Dental Association and our academy (AAOS) several years ago.
Precautionary Measures
- To prevent infection, you were given IV antibiotics before your surgery.
- To prevent blood clots, stay active. Walk around your living room once every hour while you are awake, and take aspirin 81 mg twice daily for 2 weeks. If you are at high risk for blood clots — a previous DVT or PE, a clotting disorder, active cancer treatment, or any other reason for increased clotting risk — aspirin is not enough: you should be on a stronger blood thinner instead, such as Eliquis, Xarelto, or Pradaxa. Please make sure this is arranged with Dr. Allred within 24 hours after surgery.
- If you are taking narcotic pain medication (such as Percocet or Vicodin), you may need a laxative to prevent constipation. We recommend an over-the-counter stimulant laxative such as Senna. Narcotics slow the bowel down, and Senna works by stimulating it. Fiber-only products (like Metamucil) usually aren't enough on their own, since they add bulk but don't stimulate the bowel.
When to Call / Emergencies
Call the office or go to the ER if you experience any of the following:
- Incision opens
- Increased redness at incision site
- Pain uncontrolled by pain medicine
- Uncontrollable bleeding
- Fever > 101.5°F or shaking chills
- Difficulty breathing or chest pain
- New calf pain or ankle swelling
- Painful swelling
- Numbness or weakness in the arm or hand still present more than about 24 hours after surgery, when the nerve block should have worn off
- A fall onto the shoulder, or a sudden pop with a change in the shape of the shoulder or loss of motion
If this is a life-threatening emergency, call 911.
Don't know which number to call? Every clinic's emergency and daytime number is on one page — worth saving to your phone before surgery.