Most patients stay 1 night in the hospital after shoulder replacement and go home in the afternoon on the day after surgery. Occasionally, patients will need to stay in the hospital for 2 nights for medical reasons. If you are planning on going to an extended care or rehabilitation facility, you will likely need to stay 3 nights due to insurance requirements.
The day after surgery, prior to being discharged home, a therapist will teach you how to place, adjust, and remove your sling and strategies for getting dressed and daily hygiene. The therapist will teach you hand, wrist, and elbow exercises. You will also be taught 2 shoulder exercises that are performed while you are laying down, using your non-operative arm to move your new shoulder. All of the exercises that you are taught need to be performed 3-5 times each day after discharge home. These are the only exercises that you will do until you start physical therapy 2 weeks after surgery.
You will have a drain placed during the surgery to evacuate blood from the surgical site. This will be removed by a member of the Orthopedic team before you leave the hospital.
The requirements for discharge from the hospital are as follows: adequate pain control, stable vital signs (heart rate, blood pressure, oxygen level), and clearance from a therapist. Most patients meet these requirements and leave the hospital the day after surgery.
Icing is very important for the first 7-14 days after surgery. You will be given the option to rent/purchase a cooling machine – this will be arranged before surgery. For the first 3-4 days, a bag of ice or the cooling machine should be used as frequently as possible. After 4 days, ice or cooling machine is applied for 20-minute periods, at least 4 times per day. Care must always be taken to avoid frostbite – there should be a layer of clothing or a cloth/towel between the ice and skin.
Anesthesia will typically provide a nerve block prior to surgery. It is your choice as to if you would like to receive the nerve block, but it is generally recommended to help with pain control. This decision is made the day of surgery after the anesthesia team explains the risks and benefits. The nerve block is an injection in the area of your neck that numbs the nerves in your arm to reduce pain after the surgery. There are 2 types of nerve blocks: single shot and continuous (nerve catheter). The single shot block typically lasts 14 to 24 hours but this is variable. The continuous nerve block involves the placement of a catheter to allow medication to numb your arm for several days. It is not uncommon to lose the ability to move your arm and hand after the block (often described as a dead arm) – this will resolve as the block wears off.
A sling with a small pillow will be fitted and placed in the operating room and is to be worn at all times for the first 2 weeks after surgery. You may release the strap on the sling to straighten and bend the elbow 3 to 4 times per day starting the day after surgery. During the first 2 weeks, the sling may be completely removed only for showering and to perform your shoulder exercises. After 2 weeks, you may remove your sling at home during the day but need to wear the sling in public (around other people) and when sleeping. After 6 weeks, the sling can be removed at all times.
Physical therapy is to be scheduled to start 2 weeks after surgery. It is important to select your physical therapy location and call ahead of time to setup an appointment as many physical therapy locations are scheduled out for 1-2 weeks. Below are phone numbers to schedule at a UCHealth facility if desired:
Lone Tree: (720) 848-2200
Aurora (University of Colorado Anschutz Campus): (720) 848-2000
Stapleton: (720) 848-2000
Sports Medicine Center (Colorado and I-25): (720) 848-2000
Boulder: (720) 848-2000
If these locations are not convenient or you would like to go to an outside physical therapy center you may do so. You will be provided a prescription for physical therapy and a rehabilitation protocol at your first post-operative appointment. Again, you are encouraged to call before or soon after surgery and schedule an appointment to start 2 weeks after surgery.
- Showering: Immediately
- Deskwork: When comfortable with sling
- Driving: 2 weeks, if no longer taking pain medications
- Using arm for Activities of Daily Living: 6 weeks
- Using arm to reach overhead: 6-12 weeks
- Using arm to reach behind back: 12 weeks
- Using arm to carry objects: 12 weeks
- Pushing/Pulling: 12 weeks
- Sport/Heavy Activity: When finished with therapy program
After surgery, you will have a clear waterproof dressing on your incision. This will stay in place until I remove it at your first post-operative appointment (10-14 days). You may shower immediately after surgery with the dressing in place. To wash the underarm area, lean forward and let the arm hang in front of you. It is okay to allow water and soap to run over your incision and waterproof dressing – do not scrub. Upon completion of your shower, pat dry the dressing/incision with a clean towel – do not rub. DO NOT get into a bathtub, pool, or spa until you are seen in clinic and it is determined that your incision is completely healed (typically 4-6 weeks). Always wash your hands before touching your dressing/incision. DO NOT use any creams or ointments on your incision.
Please contact my office immediately if you notice any of the following as these could be a sign of an infections:
- Excessive fluid leaking from the incisions after 3 days
- A foul odor from the incisions
- Any redness or warmth around the incisions
- Significant increase in pain.
In addition, please check your temperature if you begin to feel ill, warm, or if you have chills. Contact my office immediately if your temperature is above 101.5 degrees or you think you may have an infection anywhere in your body. It is common to have a low-grade temperature within the first week of surgery. You should drink fluids and breathe deeply.
Swelling and Bruising
It is common to have swelling and/or bruising after surgery. This is caused by bleeding and is expected. The bruising may start out black-red-purple and will change to a yellowish-green color as it fades over a few weeks. The bruising may go down the arm. You may also have some swelling in your hand which should go away; squeezing a ball or making a fist repeatedly will help with this. In time, the swelling will go away.
You may need help with your daily activities, so it is a good idea to have family and friends around to help you. You will have some mild to moderate shoulder discomfort. You will be provided a prescription for pain pills after the surgery. Please take your pills as directed and remember to use ice or your cooling device to help reduce pain. If you have pain that your pain pills do not take care of, please contact my office.
Nausea and Vomiting
It is common to have nausea and/or vomiting for the first 24 hours after surgery. You have been provided with a medication (Ondansetron) that will help with nausea. Please contact my office about any nausea/vomiting that does not go away. You may eat whatever you wish, however, it is suggested that you start with fluids and bland food before moving to a regular diet.
You should start taking all your regular medications right after surgery. If there are exceptions to this, you will be informed. If you have questions contact my office.
Surgery may slow the blood flow in your legs, which might (rarely) cause a blood clot to form in the leg. If a clot were to form, the leg is usually painful and swollen. Blood clots can be serious and, if you have one, you will need to go to the hospital. Walking regularly early after surgery can prevent blood clots. Moving the ankle frequently and rising up on your toes can lower the risk of this problem. If you are not already on a blood thinner, I would like you to take a full-strength Aspirin (325mg) once daily for 3 weeks – this can help prevent a blood clot. If you were taking a blood thinner before surgery, I will let you know when you can start taking this again after surgery (most often the day after surgery).
Please contact your doctor right away if:
You have swelling, tenderness, pain, warmth or redness in your thigh, calf, or ankle.
Call 911 if you have signs that might mean a blood clot that has moved to your lungs:
- Chest Pain
- Trouble Breathing
- Rapid Breathing