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RECOVERY AFTER SHOULDER OPERATION

What does recovery after shoulder surgery involve?

Every operation has a healing process that is similar to the way in which the body responds to injuries. As such, the corner stone of this period is analgesia, rest, ice, and gentle movement.

1. Pain killers (analgesia) after shoulder surgery

Pain can be modified through a number of pathways, and medications are tailored accordingly.

Oxycontin 10mg twice per day by mouth – this is the most powerful orally taken pain killer. Its main side effects are drowsiness and constipation. If drowsiness is a big problem, spread out the time between doses, or take only at night–time. Make sure to drink plenty of water and have more fruit, to prevent constipation. When you no longer need these tablets, safely dispose of them or return them to your pharmacist for disposal.

Naprosyn SR 1000mg daily – this is a long lasting non–steroidal anti–inflammatory drug (NSAID) that can work very well. Their effect lasts 24 hours. Like most medicines, it may upset your stomach and trying a different timing related to food or a different brand can help. On rare occasions, stomach anti ulcer medication is taken if a NSAID is absolutely necessary. NSAIDs should be avoided if you have a known gastric ulcer or suffer from frequent indigestion.

Paracetamol (Panadol) 500mg ×2 four hourly – regular paracetamol its by itself is very powerful analgesic medication. It has minimal side effects and is often combined with codeine for extra analgesic effect. These include Panadeine and Panadeine Forte. It is very important not to take Panadol and/or Panadeine and/or Panadeine forte together on a four hourly basis – this would double your paracetamol intake and would be dangerous.

2. Rest and use of sling

If you have been provided with a sling or brace, this is to remind you and others to rest the affected limb. Pain is reminding your body to do this, but we are modifying this with the analgesia. The sling or brace also has a protective effect if a tendon or ligament repair has been performed. The duration of the sling or brace will be discussed with you.

3. Ice after shoulder surgery

Ice packs in the form of frozen peas or commercially available products are very good at decreasing the inflammatory response. It is important not to place them directly against the skin. You should have at least a tea towel between you and the ice to minimize any chance of a cold burn. They are applied for 20 – 30 minutes or until they thaw out and up to every two hours.

4. Gentle Movement

The inflammatory response results in you keeping the affected joint still, and prolonged immobility often results in stiffness that can be difficult to treat later. Prevention is the best form of treatment, and with periodic controlled gentle movement in combination with analgesia and ice, stiffness can be avoided.

5. Wound Management

Most wounds are managed with an absorbable (dissolving) suture that will not need removing. They are usually supported with steristrips for a period of 10 to 14 days. Prior to your discharge from hospital, the nursing staff will re–do the dressings. The dressings can become wet in the shower and dabbed dry afterwards. Please avoid swimming pools, the beach and baths.

They can become wet in the shower and dabbed dry afterwards. If the dressings need to be redone prior to your follow up, please contact your GP Nurse. Alternatively you can get simple dressings from a chemist (e.g. 3M Primapore).

If there is discharge associated with redness around the wound, this may represent infection. You should be seen earlier and have the wound reviewed.

6. Smoking

Smokers are disproportionately represented in all forms of surgical complications. From increased local problems such as delayed wound healing, wound infection, tendon/ligament repair failure, stiffness and bone delayed healing to the general complications such as thromboembolism (Deep Venous Thrombosis and Pulmonary Embolism), pneumonia and heart complications.

7. Physiotherapy

In the early phase of your recovery, you will be shown exercises in hospital to help avoid stiffness. If a repair has been performed, physiotherapy will generally start at 6 weeks. The initial period is crucial to allow the tendon or ligament to heal, where it has been repaired. Your post operative care will be documented on your operation report, and I will also discuss further at your first post op visit.

Once movement is regained, strength will follow. If, at three months, you have not regained significant range of motion, the role of a hydrodilation will be discussed.

The tendon / ligament healing process is weakest at 3–4 months. I would like to avoid the possibility of you being able to generate near maximal power and potentially pull the repair apart at this time. Complete tendon remodelling takes up to 12–18 months following repair.

8. Post Operative Appointment

Your first post–operative appointment will be scheduled for 10 to 14 days after your operation. At this appointment, your wound shall be inspected, an explanation of your operation provided, the rehabilitation plan discussed and you shall have an opportunity to ask further questions.

Any concerns, please contact my rooms on 9416 1466.