Preparing for Shoulder Replacement

When you arrive at the hospital, the preoperative team will start an IV and antibiotics. You will likely receive an arm block (regional anesthesia) that will numb and paralyze your shoulder temporarily. The effects could last anywhere from 6-24 hours after surgery. Sometimes the blocks are not 100% effective.

Depending on the severity of arthritis, patient size and overall health, and history of prior surgeries to your shoulder, most patients’ surgery will take between 1-2 hours. For the first 30 minutes before and after the actual surgery you are being placed under anesthesia and positioned for surgery, and being woken up. So to your family and friends it could be 3 hours between when they say goodbye to you and when they hear from me. Not all of that time is surgery. You will probably spend a couple of hours in the recovery area (PACU) before they take you up to your room or discharge you. 

If you aren’;t too nauseous or sleepy from the anesthesia, you should try to walk with someone’s assistance or supervision the afternoon of surgery. This will keep your lungs well aerated and the blood circulating in your veins to prevent clotting. It will also help you feel more oriented.

As soon as you regain control of your arm, you should bend and straighten your fingers into a fist to keep them from getting stiff. You can also bend your elbow to bring your hand to your face or on a table surface for eating, brushing your teeth, texting on your phone, etc. No shoulder motion until you come to the office for an appointment.

Most patients will be released from the hospital the day after surgery. Some patients may be able to go home the same day. 

Yes. Discontinue the prescription medication as soon as your pain levels allow you to do so, with a goal of being off prescription pain medication by one week after surgery. 

Most patients recovering from shoulder surgery find it easiest to sleep in a recliner chair for up to several weeks after surgery. An alternative is to sleep propped up in bed with multiple supportive pillows. The sling should be on for sleeping. 

If you are interested in renting an ice machine that circulates ice water around your shoulder, please let my office know. Whether you use an ice machine or a reusable pack/gel pad, ice is an excellent means of reducing pain and swelling in the shoulder.

The cleanest bandage your shoulder will have is the one placed in the operating room immediately after the surgery, because it is placed in a sterile environment. Furthermore, this bandage has a water resistant cover that makes it easier to keep the incision dry while showering (so long as the operative shoulder is pointed away from the showerhead or a hand held wand is used). As long as the bandage remains clean and adherent, retain it for at least 7 days until the incision is partially healed before removing it. The hospital staff will provide you with replacement bandages. Do not get the incision wet until you see Dr. Diaz at 2 weeks after surgery.

Remain in the sling at all times except to shower or to periodically bring your hand to your face for eating, brushing teeth, shaving, etc or periodically extend your elbow. Your hand on the surgery side should remain in front of your face until instructed. Do not move your shoulder or discontinue the sling until I have instructed you to do so. When you are bathing you can bend forward at the hips and lower back and dangle your arm out of the sling to straighten out the elbow to prevent stiffness and so that you can access under your arm for bathing.

For anatomic total shoulder replacement, the sling is usually worn for 6 weeks to allow the front part of the rotator cuff (subscapularis) to heal after it is opened to expose the shoulder and then repaired. For reverse total shoulder replacement, the period of sling immobilization will last between 4-6 weeks.

Try to maintain light levels of activity in a climate-controlled environment. Walking around your home or in a cool environment with even footing will help prevent blood clots and constipation. Avoid sweating as this can lead to wound infection.

Many patients want to know when they can resume driving after shoulder replacement surgery. This is contingent upon a variety of factors including duration of sling immobilization, manual or automatic transmission, etc. Generally, reaction time can be affected for up to 6 weeks following shoulder surgery, with variability from patient to patient.

You should ask Dr. Diaz before resuming driving after shoulder surgery. You should begin with short, familiar distances and have a licensed driver in the passenger seat the first time you resume driving. 

Return to work or sports is dependent on a number of variables. Patients with sedentary jobs may be able to return as early as two weeks. Patients who have to use their arm for lifting, carrying, climbing, driving, or above eye level work will generally need 12 weeks of modified or no work. I generally allow patients to return to golf, tennis, and swimming between 4-5 months, but in select cases earlier.

Please call the office or use the Patient Messaging Portal should you have any further questions.