So You’re Having Shoulder Surgery

Your friends at Patient Action are so sorry that you require shoulder surgery. We know first hand that it will be no picnic, but hard work and commitment to your physical therapy will make it all worthwhile. Remember that once you’ve had your surgery there is no turning back. You must do what you have to do to regain as much shoulder function as you can. This information will help you prepare for your operation…. both physically and mentally. It is our hope that this information will empower you to advocate for yourself in achieving a quicker and less complicated surgical recovery. We wish you all of the best wishes for a complete and speedy recovery as you embark on this journey towards wellness.

Preparing For Surgery:

If you are having extensive shoulder surgery, you will probably need help with many of your activities of daily living (bathing, toileting, dressing, meal preparation, etc.) after your surgery. Make plans to have someone who is physically able to help you stay with you during your first week home, especially if you have small children that need to be picked up. It’s nice to have someone there to answer your phone calls or the door bell, if you drop something, or if something heavy has to be lifted. It’s especially nice to have someone prepare your meals and to cater to you in other ways during that first week or two after your surgery.

If you can’t get someone to stay with you, you can prepare yourself by freezing some meals which can be easily zapped in the microwave as the need arises. Have small containers that you can open with ONE hand of cereal, milk, yogurt, cheese crackers, pretzels, etc. available. If you are alone, put non-perishable items and bottled water in a cooler and leave near where you will be spending most of your time that first week. Put bottled water and other liquids that you enjoy into the refrigerator. Have your husband, significant other or child prepare your lunch and beverages and put in a cooler so you have easy access.

Buy paper plates, cups and plastic silverware to use when you are alone.

Make sure you have a phone nearby (cell or cordless phone) or hook your phone up to an answering machine so you don’t have to answer every call. You can retrieve messages when you are up to it. Don’t feel obligated to call people back the first week after surgery. People just want to let you know that they are thinking of you and most will understand that you aren’t up to talking on the phone or retrieving messages.

Buy one of those long grasper tools that you can pick things up with without having to bend down. They cost about $7 and can be purchased at most retail drug stores. They’re also good for retrieving items off of high shelves or cabinets, but you shouldn’t be doing this after you’ve had shoulder surgery!

If you have health insurance, call them and find out if you are entitled to any home health care. If you have Long Term Care Insurance, you may also be entitled to home health care depending on your policy and the extent of your surgery.

Buy yourself a lap desk with a clip or a clip board for reading. You can turn the pages using one hand. Make a pile of all of the magazines and books you haven’t had the time to read. You probably won’t have the energy or desire to read during your first week or two home, but after that, reading helps to pass away the time.

Have a radio and/ or TV (with remote) nearby where you will be spending much of your recuperation. It helps pass away the time.

Have a notebook so that you can write down the names of those who sent you gifts, flowers, meals, etc., or who visited you so that you can send them a thank-you note later on. You may also use this notebook for journaling your thoughts as you get stronger. It is very useful to write down things that you are grateful for each day- it takes the emphasis away from feeling sorry for yourself.

Let everyone important to you know about your operation in advance. Tell them the exact date and time of the operation and ask them to send you loving and positive thoughts and prayers at the very moment your operation starts.

If anyone asks you how they can help, ask them to bring over a dinner that you can put in your freezer. Ask them to drive you to physical therapy, the doctor, the store or to run errands for you. Ask them to visit when you are ready for that.

Learn to ask others for help. When people ask what they can do for you, let them know exactly what you need. Make a list of the names and phone numbers of people who offer to help and keep it handy.

Buy some lavender oil. Research shows that the fragrance of lavender sends a calming message to the brain which counters adrenalin-producing stress signals. Lavender can be purchased in many health food stores.

By the time you opt for surgery, you will have probably acquired a variety of pillows to help you sleep. These will be put to good use after your surgery.

Purchase items such as soap, shampoo, and conditioner with pumps. It will make it easier for you to use them with one hand.

Buy a hand held shower head. This will allow you to shower without getting your sutures wet and will make showering easier for you once your sutures are removed. Don’t go for the cheapest one- they leak. Set it up before your surgery so you will know that it fits in your shower and doesn’t leak.

Obtain a sturdy shower chair for the shower. A cheap plastic chair will work but make sure it is sturdy. You don’t want to have an accident in the shower.

Put all of the personal items you use on a daily basis in an open container so that you will have easy access.

Buy toothpaste that has a flip top which can be easily manipulated with one hand.

If you like to use dusting powder, buy powder in a container with a mitt that can be manipulated with one hand.

Buy flushable personal wipes and put a container in each bathroom. They will help you feel clean, especially during the period when you cannot shower. Be sure they are flushable or they will clog up your toilet.

Buy facial wipes for cleaning your face. They are far easier to use with one hand than trying to wash your face using soap and water. Check to see if they are flushable.

Hang a large bath sheet on a hook in your bathroom. You can back up against it in order to dry your own back.

Buy a box of powdered laundry detergent and cut the lid off. It will be easier to manipulate with one hand.

Make a pile of clothing that you will be wearing for the next month or so including: elastic loose fitting pants/shorts, extra large tee shirts that will fit over your splint, socks that are easy to put on, slip-on shoes/sneakers, underwear, etc. It’s a lot easier than having to go into your closet or dresser each day. Ladies, don’t worry about wearing bras for quite some time. If you absolutely cannot go without a bra, go on the internet and research strapless bras. You should also research Silicon Bra Cups. This is a new type of bra that is strapless and backless and very comfortable. They retail for about $20 each. Be sure the tee-shirts you get are large enough to slip over your surgical splint as you won’t be able to put your arm through the arm hole.

Prepare a pile of blank thank you cards so that you can start writing them when you have the energy. Be sure to have stamps in the house.

Discuss the use of magnet therapy with your doctor. Magnets increase blood circulation and can promote healing. Small magnetic dots are perfect for shoulder surgery as they can be placed around your incision as soon as the bulky bandages are removed. They can be held in place with small round band aids and can be worn for 1-2 weeks post-op. They can be purchased on line at www.promagnet.com. They cost about $15-20.

You will be probably be icing your shoulder after surgery. Speak to your doctor about this. S/he can give you a prescription for a continuous icing machine. If so, ask if you will need ice for the machine. The Relax the Back Stores sells some really nice ice packs for such purpose but they are costly. You can make your own ice packs and save lots of money. Make three ice packs before your surgery so you will always have one available:

Fill a gallon size ziplock plastic bag with water and rubbing alcohol, in a 2:1 ratio ( 2 parts of water for every part of alcohol; ie. 2 cups of water to one    cup of alcohol.) Put them in the freezer.

OR  fill a gallon size ziplock bag with green Palmolive dish detergent leaving 2 inches of space for expansion during freezing. 

You may also be applying moist heat to your shoulder prior to doing physical therapy at home. You can make a moist heat pack by filling up a ziplock plastic bag with any kind of white rice. “Cook” the sock in your microwave for about 45 seconds. It will be hot! Make sure you put a cloth barrier between the plastic bag and your skin to prevent burning yourself.  As an alternative, you can also fill up a “high” sock about 2/3rds of the way with any kind of rice and tie it in a knot. Then “cook” it in the microwave for the same 45 seconds. You will be able to wrap the sock around your shoulder joint and it will feel great.

If you will be going to an out-patient physical therapy center, you will need to make arrangements for people to transport you as you will not be able to drive for a few weeks. If you have no one to drive you, let your therapy center and doctor know. You might find some volunteers at your synagogue or church that can help. If you have a neighbor with small children, trade transportation for babysitting services once you are feeling better. If it’s a neighbor with grown kids, figure out what you can offer them in return for taking you to therapy.

If you have no one to shop for you after surgery, fill up your pantry, freezer and refrigerator with desired and necessary items before your surgery.

If you normally take medications each day, make sure you have enough to get you through your recuperation period (probably about 6-8 weeks). Buy a pill box that will allow you to prepare your meds in advance for a 2 week period so that they will be easily accessible to you. You can also pour each of your medications into a separate small ziplock plastic bag for easy access. Be sure to put the medication container in the plastic bag so you will know which drug is which. You should also label the bag with the drug name, dose, and time(s) taken. Be very careful about doing this if there are small children in the home.

If you are going to be hospitalized and you have a favorite pillow that you usually sleep on, you may want to bring it with you for comfort. Be sure to bring a brightly colored pillow case(s) with you so the staff will know that the pillow is yours and so it won’t end up on another patient’s bed!

Prepare Advance Directives and bring them with you. If you don’t have these documents, go to www.putitinwriting.org and obtain them. Or let your nurse know you want to fill these documents out.

Ask someone to be your patient advocate and accompany you for surgery so they can speak for you in the event that you can’t use your own voice.  They will need to drive you home as you won’t be able to drive yourself.

SURGERY DAY:

Wear pants with an elastic waistband to the hospital or surgery cente and slip on shoes.  It will be easier to get dressed after the surgery when you can only use one arm. Be sure to bring an extra (or extra extra ) large tee shirt with you to wear home that will slip over your surgical splint.  Bring your personal items and clean underwear with you if there’s a chance you might be spending the night in the hospital.

You will be admitted to a pre-op area where you will be assigned a nurse who will admit you. An Intravenous (IV) line will be started. You will be seen by the anesthesiologist. Be sure to tell him/her if you have any head, neck, back or extremity problems so that extra attention can be paid to the positioning of your body during the operation. You will also be visited by your surgeon. This is the time to ask any last minute questions. You can also ask your surgeon to participate in a prayer for his/her skill and a good surgical outcome.

You will most likely be asked to sign an Informed Consent for the surgery unless you have already signed one.  When you sign this form, it indicates that you understand the procedure being performed and the possible risks.

If you feel really nervous, put some lavender oil on your forearm and take a big whiff of its fragrance. Do some deep breathing- breathing in through your nose and out through your mouth.

If you are so inclined, ask your doctor, nurse, and family to say a prayer with you.

Tell your loved ones to bring with them a jacket, reading materias, cell phone with charger, laptop with charger, music and something to eat or drink.

DURING THE FIRST FEW DAYS AFTER SURGERY:

Continue to use your lavender as needed. Stroke a drop of it over your temples to reduce tension headaches; massage a drop across the exterior of your throat to calm tickly coughs; place a drop on the pillow to relieve insomnia. Put some on your forearm so that you can keep smelling it to reduce stress.

If you planned on using magnets, ask someone to place your magnets around your incision as soon as possible after your bulky bandages are removed. If the magnets fall off, re-apply them with new circular band aids. You can get them wet.

Your throat may be sore after surgery. This soreness is due to the breathing tube they insert into your throat during surgery while you are asleep (don’t worry! it will already be removed by the time you wake up). Your doctor can order a throat spray if the soreness is very uncomfortable. Throat lozenges or lollipops can also help.

You do have a voice! Be your own advocate! Don’t be afraid to ask questions. Write them down so you won’t forget to ask them when you see your doctor. If you have a patient advocate with you, have them write down your questions and have them ask the questions for you if you are unable to ask them yourself.

Be aware of the major role that hand washing plays in the control of infection. Wash your hands frequently and make sure your health care team washes their hands before touching you! Don’t be afraid to remind them to do this. Hand washing between patients is an industry standard.

Don’t be afraid to cough – even if it hurts. Coughing reduces your risk of pulmonary complications, such as pneumonia.

Some shoulder surgery is performed arthroscopically which involves tiny 1/4 inch incisions for the passage of instruments into your shoulder joint. There is no major incision and no suturing with arthroscopic surgery. If your surgery is not going to be arthroscopic, you will probably have a larger incision with surgical sutures that will need to be removed. Do not worry about their removal. It really doesn’t hurt! If you feel very anxious, do some deep breathing – breathing in through your nose and out through your mouth during the removal. Plan your pain medication to coincide with the timing of the removal. Take a whiff of lavender to relax you.

Ask your doctor if s/he will be willing to give you your prescriptions for post-op medications a day or two before surgery or hospital discharge so that you can have them in the house upon your arrival home from the hospital. Keep your medications nearby once you go home so that they are easily accessible to you. If you don’t have to worry about small children getting into your medications, ask the pharmacist for container tops that are EASILY OPENED. You can also dump your pills into a small zip lock plastic bag for easy one-handed accessibility. Make sure you leave the pill container in the bag so that you can identify the pills. Label the bags in advance with medication name, dose, and time(s) to be taken.

Discuss post-op bowel function with your doctor, ESPECIALLY if you tend to be constipated. The anesthesia, decreased activity and pain medication will predispose you to constipation. It can be a real problem. Make sure you have what you need at home before your surgery. Find out what you can use and use it!

If you are hospitalized, plan to take your last dose of pain medication about 45 minutes BEFORE you leave the hospital for home. It will help ease the discomfort during the ride home.

ONCE HOME:

Carefully follow all of your doctor’s instructions!

You may continue to have what the doctors call “referred” pain in your upper arm on the operated side for many weeks post op. Don’t be afraid to speak with your doctor about pain management. Icing helps a lot. Don’t be a martyr. You don’t need to suffer. Take your pain medications as prescribed for at least the first two weeks. It’s important to stay on top of the pain. You may even want to set your alarm so that you can keep on top of the pain during the night. This will actually help you recover more quickly as your body can focus on healing, not on coping with pain. Keep your pain meds and water close by so you can easily reach them. (Be careful to make sure that young children do not have access to them). Do not drive or operate any dangerous equipment or machinery while taking pain medications.

Adequate rest is important for your recovery, but sleeping can be a real problem for you both pre and post operatively as you toss and turn trying to find a comfortable place for your affected arm. It is not uncommon for patients to have problems sleeping after they go off their pain meds. Let your doctor know if you are having trouble sleeping. Your doctor may consider prescribing something to help you sleep. Sleeping in a recliner both pre and post op may be the best thing you can do for yourself . If you don’t have one, you can rent one by the week or month from your local medical supply store. Do the research BEFORE your surgery so if you need one it is only a phone call away. Ask if they come with an electric seat- elevator. That can be really helpful. If a recliner is not an option for you, prop yourself up with several pillows.

If you sleep on your back, try positioning a pillow under your effected arm. A pillow under your knees may also help you get more comfortable. A body pillow can also be helpful. They can be purchased at many retail stores (Walmart, Target, Bed, Bath & Beyond, etc.) Buy a pillow case to fit it so you can launder it as needed.

If possible (or desirable), sleep alone the first week so you have the full space in your bed to get yourself comfortable.

Make a list of any questions you might want to ask your doctor at your first post-op visit, which usually takes place within 7-10 days after surgery. Your sutures will probably be removed at this visit.

Time your pain medication so that you take it about 45 minutes prior to any outings.

Showering: If you feel you must shower before you are allowed to get your incisions wet, cut an inexpensive slicker in half so that it will cover your shoulder area. Wear it when showering to protect your shoulder from getting wet. You’ll have to hold it tight around your neck to prevent the water from getting in but it will be worth the effort to be able to shower. You’ll be able to shampoo using the slicker, too. Don’t forget to use a plastic chair in the shower if necessary. And the use of a hand held shower will come in handy here, especially if someone is helping you with your shower.

PHYSICAL THERAPY IS CRITICAL TO YOUR COMPLETE RECOVERY! It is no picnic, but you must actively participate. The pain you experience during therapy is normal.  Take your pain medication about 45 minutes prior to therapy which will reduce your pain and help maximize your therapy session. Don’t expect an overnight recovery. It takes a good 6 weeks of therapy to see any real progress.  Be patient. Be persistent. Be commited to your therapy.

Call your doctor immediately if you have any of the following symptoms:

    • Fever
    • Sweats
    • Redness around or drainage from your incision
    • shaking chills

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