Keep This Handy

Quick Reference

Phone numbers and warning signs, all in one place. When in doubt, call — I would rather you call us ten times for nothing than wait once on something real.

Watch: Welcome — and congratulations — on the web version of this guide at darinallredmd.com

Orthopedic Clinic — Convergence Health

2098 Idaho Street, Elko, NV 89801

(775) 389-5777 Weekdays, business hours.

Convergence Health Surgery Center

2098 Idaho Street, Elko, NV 89801

(775) 389-5777 Your surgery happens here — a surgery center, not a hospital. If something urgent — but not life-threatening — comes up after hours, call our emergency line first: (775) 375-7484. For a true emergency, call 911 or go to the nearest hospital emergency room (Northeastern Nevada Regional Hospital, Elko).

911

Call 911 right away for sudden chest pain · sudden shortness of breath or trouble breathing · fainting, confusion, or one-sided weakness. Do not drive yourself. Do not wait to see if it passes.

Travelling, or not sure which number you need? Every clinic's emergency and daytime number is on one page.

Call the clinic the same day — after hours, call the emergency line first

Fever over 101.5°F or shaking chills
An incision that opens, drains fluid, or becomes more red or more painful
New calf pain or new ankle swelling
Pain your medicine no longer controls
Bleeding that won't stop with pressure

Good to know

Bruising down the arm and chest, and a numb patch near the scar, are normal — what matters is redness, drainage, or pain that is getting worse rather than better
Blood clots most often appear a few weeks after surgery, when your guard is down
Day 2–3 is often the hardest stretch of recovery — it gets better from there

Before Anything Else

Let’s get to know each other.

A great result is a team effort — and teams do best when they know and trust each other. Take a few minutes to see how I think about your joint and your surgery: watch a few videos, read a little, and you’ll understand why I do things the way I do.

Website: darinallredmd.com · YouTube: @DarinAllredMD · Instagram: @darinwallredmd · TikTok: @darinallredmd

And help me get to know you: come to every visit with your questions written down, and tell my staff what you’re hoping to get back to — hunting, hiking, keeping up with the grandkids. The better we know each other, the better you’ll do.

QR code to Dr. Allred's videos and social media

Reading this on paper? Scan to watch.

Part 1

Understanding Your Shoulder and Your Surgery

Why does my shoulder hurt?

Your shoulder is a ball-and-socket joint: the ball at the top of your arm bone (humerus) sits against a shallow socket on your shoulder blade. Both surfaces are covered with smooth cartilage that lets the joint glide. Arthritis wears that cartilage away, and when it wears down to bare bone, bone grinds on bone — that's the deep ache, the grinding, the stiffness, and the night pain that wakes you up.

Which shoulder replacement am I having?

There are two kinds, and which one you need depends on your rotator cuff. I will tell you which one you are having — and wherever the recovery differs, this guide says so.

Anatomic total shoulder (TSA) rebuilds the joint the way it was made: a smooth metal ball on the arm bone, a plastic socket on the shoulder blade. It works beautifully when your rotator cuff is still intact.

Reverse total shoulder (RTSA) switches the parts around — the ball goes on the shoulder blade, the socket on the arm bone. That sounds backwards, but it is the answer when the rotator cuff is torn or worn out: the reversed design lets your deltoid, the big muscle over the outside of your shoulder, lift the arm instead. It is one of the great problem-solvers in orthopedics.

Did I try everything else first?

Surgery should come after non-surgical care has been given a fair chance: activity changes, therapy, anti-inflammatory medicine, and injections. When those measures no longer control your pain — and especially when the pain is keeping you awake at night — replacement is the reliable next step. Shoulder replacement is exceptionally good at relieving arthritis pain. The final decision is always yours — my job is to make sure you have what you need to make it.

The benefits

Pain relief is the main reason to do the operation, and it is what shoulder replacement does best — most patients are struck by how quickly the deep arthritis ache and the night pain disappear. Motion and strength improve too, but more gradually, over months. The goal is a comfortable shoulder you can use for everyday life — reaching the top shelf, casting a line, sleeping through the night.

90–95%of patients get good to excellent pain relief

1–2 hrstypical time for the operation itself

15–20 yrstypical implant survival, often longer

4–6 mosto your full result — pain relief comes much sooner

Be realistic about motion: pain relief is excellent and dependable, but you may not get every degree of reach back — especially after a reverse replacement, where reaching behind your back often stays limited for good. Most patients tell me the trade is well worth it. I'd rather tell you that plainly now than have you find it out later.

The risks — honestly

Serious complications are uncommon — overall in the range of a few percent — but no surgery is risk-free, and I won't pretend otherwise. These are the ones we watch for, and what we do about each:

Infection (about 1%)

The complication we work hardest to prevent — it's why we ask for the skin washes, the nose treatment, blood-sugar control, and postponement when risks aren't optimized. A deep infection can require more surgery, sometimes removal of the implant while it clears.

Blood clots

A clot in the leg (DVT) can travel to the lungs (pulmonary embolism), which can be life-threatening. Prevention: early walking, moving often, and a blood thinner — aspirin for most patients; a stronger one (such as Eliquis, Xarelto, or Pradaxa) if you are at higher risk. The red-flag symptoms are in the Quick Reference above.

Stiffness

Some shoulders tighten up during healing. Starting therapy early — within about a week — is how we prevent it, which is why we do not immobilize you for six weeks the way shoulder surgery used to.

Nerve irritation (uncommon)

Nerves to the arm run close to the shoulder and can be stretched or irritated, usually causing temporary numbness or weakness that recovers. Lasting nerve injury is rare. Separately, the numbness from your nerve block is expected and wears off within about a day.

Anesthesia complications (rare)

Your anesthesia team reviews your specific risks with you before surgery.

Implant problems over time

Components can loosen or wear over many years, and after a reverse replacement the socket can occasionally wear the bone below it. A second ("revision") surgery is possible if needed. Dislocation is uncommon and is why the early position rules matter.

What will my new shoulder feel like?

Clicking or a soft clunk with certain motions is normal — it is metal and plastic.
The arthritis pain usually goes away much faster than the strength comes back. Pain relief in weeks; strength over months.
The first two weeks are the hardest, mostly because of sleeping. Almost everyone sleeps better in a recliner at first.
Bruising down the arm and onto the chest is normal and drains downward with gravity.
Reaching overhead and behind your back come back last — and after a reverse replacement, behind-the-back reach may stay limited.

Am I too old? Too young?

Your general health matters more than your age. Healthy patients in their 80s do well; patients with uncontrolled medical problems need those problems addressed first, at any age. For younger patients, the trade-off is that the implant may not last a lifetime — a conversation we will have together.

Part 2

Getting Your Body Ready

This is the part you control — and it's where good results are made. We postpone surgery (never cancel it — postpone it) until your risks are optimized, because operating on an unprepared body invites the complications we most want to avoid.

Watch: Getting your body ready — on the web version of this guide at darinallredmd.com

Do you need to see a dentist before surgery?

Mouth bacteria can travel through the blood to a new joint, so an active infection needs to be treated first. But a routine dental visit is not required for everyone. Check anything that applies to you:

Tooth pain, or pain or swelling in my mouth or jaw Bleeding, sore, or swollen gums A loose or broken tooth, an abscess, or a broken filling Dental work I know I need but have been putting off Diabetes or a weakened immune system, and no dental visit in the last year

See your dentist before surgery. Have any active problem treated, and finish needed dental work — especially extractions — at least 2 weeks before your surgery date (extractions need a little longer to heal). Ask our office for a dental referral letter if it helps. This usually will not delay your surgery — it protects your new joint.

You likely don’t need a separate dental visit. A routine dental appointment is not required before surgery. Keep up your normal brushing and flossing. If a mouth problem comes up before your surgery date, call the clinic.

Quick dental self-check. A routine dental visit is not required before surgery. But see your dentist first if any of these apply: tooth pain or mouth/jaw swelling; bleeding, sore, or swollen gums; a loose, broken, or abscessed tooth or a broken filling; dental work you have been putting off; or diabetes or a weakened immune system with no dental visit in the past year. Finish any needed work — especially extractions — at least 2 weeks before surgery.

The optimization targets

Target	Why it matters
Blood sugar: HbA1c below 7 for outpatient surgery; below 7.5 for the inpatient pathway	High blood sugar dramatically raises infection risk
No smoking or nicotine for at least 4 weeks before surgery	Nicotine chokes off healing blood flow and raises infection risk
Body mass index below 36 (below 40 for the inpatient pathway)	Higher BMI raises wound and anesthesia complications
Good nutrition: albumin 3.5 or above	Low protein stores predict wound problems and infection
Blood count: hemoglobin above 12	Low blood counts may need iron treatment before surgery
No cortisone/steroid injection into the surgical shoulder within 3 months	Recent injections raise infection risk
Healthy teeth — no active dental infection	Mouth bacteria can travel through the blood to a new joint. Finish needed dental work at least 2 weeks before surgery

Eat like healing depends on it — because it does

Surgery is an athletic event for your body — and you wouldn't start a long day of ranch work on an empty tank. Starting at least 2 weeks before surgery and continuing 4 weeks after:

Protein: about 120 grams per day for women, 150 grams per day for men. A chicken breast or a steak is about 25 grams. Eggs, dairy, beans, and protein shakes all count. Muscle is what moves a new shoulder — protein is how you protect it.
Daily vitamins (start 2 weeks before, continue 8 weeks after): Vitamin C 1,000 mg, Vitamin D 5,000 IU, and magnesium glycinate 400 mg.
Water: at least 8 glasses a day.
Alcohol: cut back now, and none in the 5 days before surgery.
Caffeine: taper down gradually to avoid a withdrawal headache on surgery day.

Prehab: exercise before surgery

The stronger you go in, the faster you come back — I see it in my patients every week. Spend 10–15 minutes twice a day on these four exercises from now until surgery:

Pendulums. Lean forward with your good hand on a table and let the sore arm hang. Let it swing gently in small circles and side to side. 1–2 minutes. This is the same exercise you will start after surgery, so learn it now.
Shoulder blade squeezes. Sit or stand tall and pinch your shoulder blades together, hold 5 seconds, relax. Repeat 10–20 times. Strong shoulder blades carry a lot of your recovery.
Elbow, wrist, and hand motion. Bend and straighten the elbow, circle the wrist, open and close the fist. These keep everything below the shoulder moving and are safe from day one after surgery.
Get the other arm ready. Practice everyday tasks one-handed with your non-surgery arm — brushing teeth, opening jars, buttoning a shirt. Most patients are surprised how much this helps the first two weeks.

Walking and stationary cycling are excellent for overall conditioning before surgery and do not stress the shoulder.

Medicines to review before surgery

Go over every medicine and supplement you take with your primary care provider and with us:

Blood thinners (warfarin/Coumadin, Eliquis, Xarelto, Pradaxa, Plavix, and others): your prescribing provider must tell you whether and when to stop and restart them. Never stop these on your own.
Weight-loss / diabetes shots (Ozempic, Wegovy, Mounjaro, and other GLP-1 medicines): these must be held before surgery for anesthesia safety — they slow stomach emptying. If you take one for diabetes, discuss the hold with your prescribing provider. If you take one for weight loss only, stop it at least 2 weeks before surgery.
Rheumatoid arthritis or immune-suppressing medicines: ask your rheumatologist which to stop and when.
If you take daily narcotics: work with your prescriber to reduce them before surgery. Patients who take fewer narcotics before surgery have better pain control and better results after.

Part 3

Getting Your Home and Your Help Ready

Your coach

You must have a responsible adult with you around the clock for at least the first 3 days after you come home. This is a requirement, not a suggestion — if no one is available, we may have to postpone surgery. Pick someone steady — a spouse, a grown child, a good neighbor. Your coach's job description is in the Coach section of this guide.

Fall-proof your home

Do this before surgery week, while you can still move things — an afternoon of work now can prevent the fall that sets you back:

Set up your sleeping spot. A recliner is the single best thing you can arrange — most patients sleep in one for the first week or two. No recliner? Build a wedge of pillows so you can sleep propped up, with a pillow under the surgery arm.
Move everything you use down to waist or counter height — dishes, coffee, phone charger, medicines. You will not be reaching overhead or into low cabinets for a while.
Put a lightweight cup, a jar you have already opened, and easy-open food where you can reach them one-handed.
Set out button-front or zip-front shirts. Pullovers over your head are hard early on.
Remove throw rugs and clutter, and add night-lights — a fall onto a new shoulder is the thing we most want to avoid.
Plan for pets: no leash-walking a strong dog with the surgery arm.
Cook and freeze meals now, or line up family, friends, or a meal program.

Equipment to have at home

The full shopping list is in Checklist 3: ice supplies, button-front shirts, a grabber, and shower/bathroom help. Your sling is provided — you do not need to buy one.

A recliner is the most valuable thing you can borrow or set up — if you don't own one, ask around before surgery. Bathroom safety equipment is often not covered by insurance.

Insurance and paperwork

Verify your coverage and expected out-of-pocket costs with your insurance company.
If you think you may need home health or a skilled nursing facility after surgery, ask your insurer before surgery what qualifies. Choosing a facility without qualifying can leave you with the bill.
Bring your insurance cards, photo ID, and any advance directive to the surgery center.

Coming from out of town?

Many of my patients drive in from across northeastern Nevada. If you'd like to stay in Elko the night before surgery, we recommend the Holiday Inn Express & Suites Elko (IHG), 2542 Ruby Vista Drive — (775) 299-4800.

On the drive home after surgery, stop every hour, get out, and walk for a few minutes. Long stretches of sitting still are how blood clots start.

Part 4

The Countdown

From four weeks out to the morning of surgery — what happens when, so nothing catches you off guard.

Put these dates on your calendar

Enter your surgery date and we'll build a personal set of reminders — skin washes, the night before, warning signs, your follow-ups — and add them straight to your phone's calendar. Twelve gentle nudges, timed to your surgery.

Your surgery date

Please pick your surgery date first.

Your personal schedule

Your surgery date stays on this device. Nothing is sent to us or to anyone else — this tool runs entirely in your own browser. You can change or delete the reminders in your calendar anytime.

Reading the printed guide? On the web version of this guide (darinallredmd.com → Protocols → Surgery Guides) you can enter your surgery date and add all of these reminders to your phone's calendar automatically.

About 4 weeks before

See your primary care provider for a history and physical (H&P). This must happen within 30 days of surgery — schedule it early. Expect a physical exam, an EKG, and labs (blood count, chemistry, HbA1c, albumin).
Review all medicines (Part 2) and make your stop/restart plan for blood thinners.
Work the optimization targets: blood sugar, nutrition, no smoking. Do your prehab exercises daily.
Line up your coach, your ride, and your home setup.
Watch my videos on this site and re-read this guide.

1 week before

Stop aspirin and anti-inflammatories (ibuprofen, Motrin, Advil, Aleve, naproxen, and similar) — unless your doctor told you to stay on aspirin for a heart stent or similar reason. Tylenol (acetaminophen) is OK for pain this week.
Stop blood-thinning supplements and herbal products: fish oil / omega-3, vitamin E, garlic, ginkgo, ginseng, turmeric/curcumin. Natural does not mean harmless. Keep taking your Vitamin C, Vitamin D, and magnesium.
Buy your supplies: CHG antiseptic soap, benzoyl peroxide 5% wash (acne aisle), and your two bottles of Ensure Pre-Surgery Clear Carbohydrate Drink. If you cannot find that exact drink, skip it entirely — do not substitute juice, soda, or Gatorade.
A pre-op nurse will call you this week with your arrival time (about 2 hours before surgery), your personal fasting instructions, and a health-history review.

Watch: The skin washes — on the web version of this guide at darinallredmd.com

5 days before skin & nose cleansing begins

Getting your skin and nose clean is one of the most important things you personally do to prevent infection. It takes a few minutes a day, and it is some of the cheapest insurance you will ever buy. Every day for the 5 days before surgery — and the morning of:

Nose: apply the nose antiseptic we give you (povidone-iodine or mupirocin) to both nostrils twice a day.
Two soaps, one shower, in this order. Your surgery shoulder gets both. First shower normally with your own shampoo and soap and rinse. Then benzoyl peroxide on a clean washcloth — gently wash the surgery shoulder, the armpit, and the upper chest on that side, let it sit about a minute, and rinse it off. It bleaches towels and colored clothing, so use white ones and keep it out of your eyes. Then CHG on a fresh clean washcloth — your whole body from the neck down, surgery shoulder included, avoiding your face, eyes, ears, and private areas. Rub gently about 3 minutes, rinse with warm water, and do not use regular soap afterward.
Pat dry with a clean towel and put on freshly laundered clothes. No lotion, deodorant, powder, or perfume.
Do not shave the shoulder, chest, or armpit during these 5 days (face is OK). Shaving makes tiny cuts that let bacteria in.
If your skin becomes red or irritated, stop and call us. (If you're allergic to CHG, use an antibacterial soap like Dial instead.)
Sleep on clean sheets, in clean pajamas, after each wash.

Watch: The night before & morning of — on the web version of this guide at darinallredmd.com

The night before

Eat a normal dinner, then aim for about 100 grams of healthy carbohydrates in the evening (roughly 5 slices of whole-wheat bread — pasta, rice, potatoes, and fruit count too). Diabetic patients: skip the carb-loading if it will spike your blood sugar.
Drink one bottle of Ensure Pre-Surgery in the evening.
No solid food, gum, or mints after midnight.
Do your final washes (benzoyl peroxide, then CHG) and nose treatment. Clean sheets, clean pajamas. Remove nail polish and all jewelry.
Pack: this guide (or your phone), insurance cards, photo ID, advance directive, a complete medication list with doses, your inhalers/eye drops/CPAP if you use them, glasses/hearing aids/dentures with cases, and a loose button-front shirt to go home in. Leave valuables and jewelry at home.

The morning of surgery

Clear liquids are allowed until 2 hours before your arrival time — water, black coffee, clear juice without pulp. Drink your second Ensure Pre-Surgery bottle in this window, finishing at least 2 hours before arrival. (If your care team gave you different fasting instructions, theirs win.)
Do your morning washes (benzoyl peroxide, then CHG) and nose treatment.
Take only the medicines your doctor told you to take, with a small sip of water. Diabetic patients: do not take your diabetes medicines — but bring them with you.
Wear loose, comfortable clothing. Arrive at your scheduled time — about 2 hours before surgery.

Part 5

Surgery Day

When you arrive

Check in at the front desk. In the pre-op area you will change into a surgical gown and meet your nurse, who verifies your identity, allergies, medicines, and consent forms — you'll hear the same safety questions several times on purpose. An IV is placed for fluids and medicines, the surgical site is cleaned again (any hair removed with clippers, never a razor), and you'll receive IV antibiotics plus medicines that reduce pain, swelling, and nausea before they start. You'll meet your anesthesia provider, and I'll see you to answer last questions and initial your shoulder.

Your family member can stay with you in pre-op. When you go back to the operating room, they'll wait in the surgical waiting area, and I will come find them as soon as we're done.

Anesthesia: what to expect

For shoulder replacement we use a nerve block plus general anesthesia. The block — an interscalene block — is numbing medicine placed near the nerves at the base of your neck that feed the shoulder and arm. It is the workhorse of your comfort: most patients wake up with essentially no shoulder pain. General anesthesia keeps you fully asleep while we work, with you positioned semi-sitting in a "beach chair."

Two things to expect from the block: your whole arm will be numb and heavy — it will not move, and that is normal, not a complication — and your hand may feel clumsy for a day. Protect the arm in the sling while it is numb; you cannot feel it bump into things.

Watch: Your nerve block — on the web version of this guide at darinallredmd.com

The most important thing about your block

The block wears off suddenly, usually 12–24 hours after surgery and often in the middle of the night. Do not wait for pain to arrive before starting your pain medicine. Take your scheduled Tylenol and anti-inflammatory that first evening, while you still feel fine — patients who wait get caught behind the pain and have a miserable night.

Things we do during surgery that you won't see — but that matter

Tranexamic acid (TXA) — a medicine that dramatically reduces bleeding. Transfusions after shoulder replacement are rare.
Dexamethasone — a single steroid dose at surgery, repeated the next morning. One of the best-proven medicines in joint replacement: less pain, less nausea, less inflammation, and it does not raise infection risk.
Antibiotics into the bone at the surgical site for extra infection protection.
Active warming — staying warm reduces infection risk (we supply the warm blankets).
Antibiotic delivered directly into the bone at the shoulder, in addition to the IV dose — extra protection against the specific bacteria that live in shoulder skin. No drains and no routine bladder catheter — older practices we've retired.

Right after surgery

You'll spend about an hour in the recovery room (PACU) while you wake up fully, then move to the discharge area, where your family can join you.

You will be up and walking the same day — your legs are unaffected, so walking is easy and it is the best thing you can do to prevent blood clots and pneumonia.
Your arm will be in a sling, and it will be numb from the block. Keep it supported and protected.
You'll start with liquids and advance to normal food as your stomach allows. Nausea is common and treatable — tell your nurse.
Do not get up without help on surgery day. Between the anesthesia, the medicines, and a numb arm, this is when falls happen — and a fall onto a new shoulder is a serious setback. Use your call light every time.

When do I go home?

The same day — every patient at the Elko surgery center goes home the day of surgery. That isn't rushing; it's the plan you were selected for, and recovery genuinely goes fastest in your own home. After a few hours in recovery you'll be discharged when you can walk safely, get in and out of a chair, manage pain with pills, eat and drink, and pass urine — and your coach is with you.

We only schedule surgery in Elko for patients who meet the same-day criteria in Checklist 2 — if your health picture calls for a hospital stay, we plan your operation at one of our hospital locations from the start.
Plan for the whole day: arrive about 2 hours before surgery, and expect 4–6 hours at the center after your operation before heading home.

Before you leave, your nurse will review every discharge instruction with you and your coach, including your medicines, your exercises, and the warning signs. You'll leave with written instructions and prescriptions.

Part 6

Recovering at Home

Shoulder recovery is a patience game with a simple rule set: protect the repair, keep the joint moving gently, and let strength come later. Your legs are fine — you can walk all you want from day one.

Watch: The sling & the coffee-cup rule — on the web version of this guide at darinallredmd.com

Your four jobs in the early weeks

Wear the sling — but don't hide in it. 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.
Nothing heavier than a coffee cup. For the first six weeks, the surgery arm lifts nothing of consequence — no pushing up out of a chair with it, no pulling doors, no lifting a gallon of milk. This is the rule patients break most, and it is the one that matters most.
Do your gentle motion every day. Pendulums and the exercises your therapist gives you keep the shoulder from tightening. Gentle and often beats hard and occasional — never push into real pain.
Move your elbow, wrist, and hand constantly. They are not injured, and keeping them moving prevents stiffness and swelling in the hand. Walk every day too.

The one position to avoid depends on your operation. After an anatomic replacement, avoid reaching behind your back and forcing the arm outward for the first six weeks — that stresses the tendon we repaired at the front. After a reverse replacement, avoid the combination of reaching behind your back with the elbow pulled in toward your body and the arm turned inward — that is the position that can pop the joint out. Your therapist will show you exactly what this means for you.

Physical therapy

Therapy starts early — within about a week of surgery — and continues for several months. That is deliberate: shoulders that are locked away in a sling for six weeks get stiff, and stiffness is harder to fix than soreness. Early sessions are gentle motion only; strengthening comes later, and your therapist follows the shoulder arthroplasty protocol written for your operation. If you don't have an appointment within a few days of going home, call the clinic and we'll arrange it.

Watch: Your pain plan — on the web version of this guide at darinallredmd.com

Your medicines after surgery

Aspirin 81 mg twice daily with food for 2 weeks (14 days) — this prevents blood clots. Do not skip a dose. If you are at higher 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 on its own: you will be prescribed a stronger blood thinner instead, such as Eliquis, Xarelto, or Pradaxa. Take whichever one you were prescribed — never both — and follow its instructions.
Start your pain medicine the first evening — before your nerve block wears off. Do not wait for pain to arrive. The three medicines below are taken on a schedule, at set times, not just when it hurts.
A steroid tablet (dexamethasone 16 mg) the morning after surgery. One dose. It lowers pain, swelling, and nausea, and it does not raise your risk of infection. If you go home the same day, this tablet goes home with you.
Tylenol (acetaminophen) 1,000 mg every 8 hours, on a schedule, for 2 weeks. "On a schedule" means at set times — not only when it hurts. This is the backbone of your pain control, and it works best when you never let the pain get ahead of you.
An anti-inflammatory twice a day, also on a schedule. We usually prescribe celecoxib 200 mg. If you would rather use over-the-counter naproxen or ibuprofen, that is fine — take it with an acid reducer such as Pepcid to protect your stomach, and keep it at least 30 minutes after your aspirin dose or 8 hours before it. Never exceed the daily maximum printed on the label.
Narcotic pain pills are for breakthrough pain only. You may need them for several days; the sooner you're off them, the better you'll feel. Refills are rarely needed, are never done after hours or on weekends, and take about 72 hours — plan ahead. If you take narcotics regularly for another condition, refills must go through your regular prescriber.
While on narcotics, take a stimulant laxative such as over-the-counter Senna. Narcotics slow the bowel; fiber alone adds bulk but doesn't wake the bowel up. Drink plenty of water.
Keep taking your Vitamin C, Vitamin D, and magnesium for 8 weeks after surgery, and keep protein intake high (120–150 g/day) for 4 weeks.

Pain: what's normal

Expect real soreness. Our goal is not zero pain; it's pain controlled well enough to do your exercises and sleep. The hardest stretch is the first night or two, when the block wears off — get ahead of it with scheduled medicine. Sleeping is the most common complaint of the first two weeks, and a recliner solves most of it. Ice helps a lot; use it freely.

Caring for your incision

You will go home with a waterproof antimicrobial (silver) dressing. Leave it alone — it works best undisturbed.
You may shower starting the day after surgery, with the dressing on. Let water run over it; pat dry. No scrubbing.
Do not soak the shoulder until the incision is fully healed — no baths, hot tubs, or pools. Showering is fine with the dressing on; steady yourself and let the arm hang.
The dressing stays on for about 5–7 days. We'll tell you at discharge whether we change it at the clinic or you change it at home (we'll send supplies and instructions if it's you). Change it sooner only if it's leaking at the edges or peeling off — and call us if you see that.
Wash your hands before any contact with the dressing. Do not touch the incision itself, and do not apply lotions, creams, or ointments to it.
If you have stitches or staples that need removal, we'll take them out at your 2-week visit.

Sleep, swelling, and the little stuff

Sleep propped up — a recliner, or pillows built into a wedge, with a small pillow or rolled towel supporting the surgery arm. Lying flat pulls on the shoulder and is why most patients don't sleep well the first week or two. This passes.
Poor appetite for a week or two is normal; keep drinking fluids and hitting your protein anyway (shakes count).
Constipation is nearly universal — stay ahead of it with fluids, walking, and the laxative.
Feeling emotionally low or tired in weeks 1–2 is common and passes. If it doesn't, call us — we care about all of it.
Bruising down the arm, into the elbow, and across the chest can look dramatic. It's gravity, not a problem. Swelling in the hand is common — keep the elbow, wrist, and fingers moving.

Everyday life one-handed

Dressing: surgery arm goes into the sleeve first, and comes out last. Button-front and zip-front shirts are far easier than pullovers.
Showering: most patients manage by the second or third day. Take the sling off, let the arm hang loosely at your side, and wash under the arm with your other hand — do not lift or scrub with the surgery arm.
Eating: you may use the surgery hand for light things at table height — a fork, a coffee cup — as comfort allows. It's the lifting and reaching that are off limits, not gentle use.
Riding in the car: sit with the seat belt clear of the shoulder; a small pillow between the belt and your arm helps on longer trips.
Protect the arm from surprises — dogs, grandchildren, slippery floors. A fall or a hard yank in the first six weeks is the main way this operation goes wrong.

Part 7

Milestones: What to Expect When

Every shoulder is different — these are typical ranges, not deadlines. Don't measure yourself against your neighbor's shoulder; pain relief runs well ahead of strength, and the last of your motion arrives months after you feel good.

Weeks 0–2 protect and settle

Sling for comfort; pendulums and gentle motion begin with therapy in the first week; elbow, wrist, and hand moving constantly; walking daily. Sleeping propped up. Nothing heavier than a coffee cup. Stitches or staples out around 2 weeks. The arthritis pain is often already gone.

Weeks 2–6 motion returns

Weaning out of the sling as comfort allows — most patients are out of it by around 4 weeks, sooner in the house. Gentle motion progresses steadily; still no lifting, no pushing up with the arm, and keep respecting your position rule. Many people are sleeping in a bed again by the end of this stretch.

Weeks 6–12 strength begins

The six-week mark is the turning point: light strengthening starts, everyday use opens up, and driving usually returns once you're off narcotics and can control the wheel comfortably. Desk work often resumes well before this; physical work waits longer.

Months 3–6 building back

Progressive strengthening and return to most activities — golf, swimming, fishing, yard work — as your therapist clears them. Reaching overhead keeps improving through this window.

Months 6–12 your full result

Strength and endurance keep improving for a year. Most patients reach their full result somewhere between 4 and 6 months, with slow gains after that.

Driving

Never drive while taking narcotic pain medicine, and never drive with your arm in a sling. Beyond that, you need to be able to control the wheel with both hands and react without hesitation — for most patients that means around 6 weeks. Start with short daytime trips on familiar roads, with your coach along the first time.

Returning to activities

Encouraged for life: walking, hiking, cycling, swimming, golf, fishing, gardening, bowling, and normal household work — once your therapist clears each one.
Lifting: long term, keep it to about 25 pounds at or below shoulder height with the surgery arm, and lift closer to your body rather than out at arm's length. After a reverse replacement, be especially careful with heavy overhead work — the implant does not tolerate it as well.
Discouraged: heavy repetitive overhead lifting, chain saws and jackhammers, and contact sports.
Reaching behind your back may stay limited after a reverse replacement — plan for that with dressing and personal care.
Intimacy: safe to resume when you're comfortable, generally within a few weeks. Mind the sling and your position rule early on.

Part 8

Warning Signs — Read This Twice

911

Call 911 for: sudden chest pain or sudden shortness of breath — this can be a blood clot in the lungs (pulmonary embolism). Also for fainting, confusion, or stroke symptoms. Do not drive yourself. Do not wait to see if it passes.

Watch: Warning signs & when to call — on the web version of this guide at darinallredmd.com

Blood clot in the leg (DVT) — call same day; after hours, the emergency line

New calf pain — a deep ache or cramp that doesn't act like muscle soreness
New or increasing ankle/calf swelling, especially one-sided, with warmth or redness

Blood clots most often appear a few weeks after surgery — often after you've relaxed your guard. Keep walking hourly, finish your full 2-week course of aspirin (or your prescribed stronger blood thinner), and stay suspicious of new calf symptoms through week 6. Bruising and swelling are normal after a shoulder replacement; what raises concern is new, worsening pain, spreading redness, or drainage.

Infection — call same day; after hours, the emergency line

Fever over 101.5°F or shaking chills
Increasing redness around the incision (a thin pink rim early on is normal; spreading, angry redness is not)
The incision opens, or drains cloudy or foul fluid — especially new drainage after day 5
Pain that gets worse day over day instead of better

Also call us for

Pain your medicines no longer touch
Numbness or weakness in the arm or hand that is still there more than about 24 hours after surgery, when the block should have worn off
Bleeding that soaks through dressings and doesn't stop with pressure
Signs of bleeding from blood thinners: bloody nose that won't stop, bleeding gums, blood in urine or stool, vomiting blood, severe headache
A fall onto the new shoulder, or a sudden pop with a change in the shape of the shoulder or a loss of motion — this can mean a dislocation; after hours, this is an ER visit
Inability to pass urine

Clinic: (775) 389-5777 (business hours) · After hours emergency line: (775) 375-7484 · Life-threatening: 911 or the nearest hospital ER

Part 9

For Your Coach

You are half this team. Patients with an engaged coach recover faster, fall less, and get off pain medicine sooner. Thank you.

Watch: Your coach — watch this one together — on the web version of this guide at darinallredmd.com

Before surgery

Read this guide — especially the warning signs (Part 8)
Help fall-proof the house and stock the freezer
Plan to drive to and from the surgery center, and to stay around the clock for at least the first 3 days home
Be at the discharge teaching — you are a second set of ears, and you'll hear things the patient (still on medication) won't retain

The first week

Falls are the enemy. A fall onto a new shoulder is a serious setback — clear the path, be nearby for the first days, and watch for slippery floors
Help with dressing (surgery arm into the sleeve first, out last), showering, and hair washing — these are the hardest one-handed tasks
Run the medication list: right pills, right times. Keep a written log so doses aren't doubled or missed
Make sure the scheduled pain medicine gets taken the first evening, before the nerve block wears off — this is the single most useful thing you will do
Encourage the daily gentle exercises and walking, and gently enforce the "nothing heavier than a coffee cup" rule — patients forget within days
Handle meals, fluids, and the laxative schedule
Watch for the warning signs — you may notice a fever, confusion, or a swollen calf before the patient does

Ongoing

Drive to therapy and follow-up appointments until driving is cleared
Expect fatigue and some discouragement in weeks 1–2. Encourage, don't push
Progress in this operation is measured week over week, not day over day

Part 10

Follow-Up and Living With Your New Shoulder

Follow-up schedule

2 weeks: wound check, stitch/staple removal, progress review — call the clinic after surgery to schedule this visit
6 weeks: exam and X-rays
3 months: progress check
Possibly 6 months and 1 year, then periodically for the life of the implant — a well-functioning replaced shoulder should still be checked every few years

Pain-medicine refills in the first 2 weeks go through the orthopedic clinic; after 2 weeks, through your primary care provider.

Dental care and your new shoulder

No routine dental work (including cleanings) for 3 months after surgery. Finish dental work before surgery instead.
After that, you do not need antibiotics before routine dental visits unless you have a weakened immune system — this is the current guidance of the American Dental Association and the American Academy of Orthopaedic Surgeons. If your dentist has questions, have them call us.

Everyday life with an implant

Tell every doctor, dentist, and nurse who treats you that you have a joint replacement.
Airport security: your shoulder will set off metal detectors. Just tell the screener you have a shoulder replacement — no card or proof is required.
If you ever develop a serious infection anywhere in your body (skin, urinary, dental abscess), get it treated promptly and mention your implant — bacteria in the bloodstream can seed an artificial joint.
Keep your weight in a healthy range and your muscles strong — the implant's best friends.

Watch: The partnership — on the web version of this guide at darinallredmd.com

A shoulder replacement is a partnership: my team brings the operation, the protocols, and the follow-through; you bring the preparation, the exercises, and the patience. Hold up your end and the odds are strongly in your favor that a year from now, this shoulder will be the one you don't think about.

We're honored to take care of you — here at home in Elko.

— Darin W. Allred, MD

Before Your Pre-Op Call

The Knowledge Check

Ten quick questions on the things that keep you safe — do them together with your coach. Wrong guesses are fine: you'll see the right answer on the spot, and that's the point. At the end you'll get a completion code to share with the pre-op nurse when she calls.

Watch: The knowledge check — on the web version of this guide at darinallredmd.com

Using the printed guide? No problem — your pre-op nurse will go through these questions with you by phone. You can also do the interactive version any time at darinallredmd.com (Protocols → Surgery Guides).

1. A week after surgery you suddenly have chest pain and trouble breathing. What do you do?

2. How do you take your aspirin after surgery?

3. Which of these is a warning sign of a possible blood clot?

4. When do the pre-surgery skin washes start?

5. The morning of surgery, which is true?

6. Call the clinic the same day if your temperature goes above:

7. For the first six weeks, how much can you lift with your surgery arm?

8. Your arm is numb and comfortable the evening after surgery. What should you do about pain medicine?

9. While taking narcotic pain pills, you should also:

10. It's 9 PM and something urgent — but not life-threatening — is going on with your shoulder. What do you do?

Attestation — patient & coach together

Patient: I have read this guide and completed the knowledge check. Patient name Coach: I have read the coach sections, and I will be with the patient around the clock for at least the first 3 days home. Coach name

Private by design: nothing you enter here is sent or stored anywhere online. It stays on this device only — you'll simply read your completion code to the nurse.

Knowledge Check complete

Keep this handy: read the code to the pre-op nurse when she calls (or show this screen at your visit), and we'll record it in your chart. It's saved on this device, so you can come back to it any time.