Arthroscopic surgery is performed through small incisions around your shoulder. A camera is inserted inside your shoulder which magnifies your anatomy onto several HDTVs in the operating room. This allows Dr Schwartz to see in extremely fine detail the problems better than with a naked eye! Sterile water is pumped into your shoulder to create space to work. You may have anywhere between 3-6 small incisions the size of the tip of your pinkie around your shoulder depending on the complexity of surgery. There will be black nylon sutures placed on your skin that will be removed at your first postop appointment.
This surgery is most often done outpatient at the First Hill Surgery Center on Madison and Boren. This is a brand new facility and is state of the art. Sometimes this might have to be done at Swedish Orthopedic Institute for insurance or health concerns. Either way, you will be asked to arrive early. You will get a phone call normally 24-48 hours in advance letting you know the specific time. Please be punctual! The nursing staff will ask you many questions, not because we do not know the answers, but because we need to confirm everything about you for your safety. They will start an IV when finished with their “intake” and an anesthesiologist will come in to meet you. Usually somewhere around this time, Dr Schwartz will also come in to say a quick hello, mark the correct shoulder, and ask if there are any remaining questions. The anesthesiologist will continue on to perform a nerve block. This is vital to your postop pain control, and will function for 12-18 hours after the surgery. As it wears off, the necessity to start taking oral pain medications begin, so it is really your friend while it is working.
Once this is finished, and the room is ready, you will be greeted by a nurse that will escort you to the operating room. You may find the OR to be cold, bright, and a little uncomfortable. We will do our best to make you comfortable, and well positioned on the narrow but firm OR table. You will then drift off to sleep, and we will perform the required surgery. Dr Schwartz always will call your contact phone number and provide them with an update at the end of your surgery.
You will wake up in the “PACU” which is the recovery room. You will have a very large dressing on your shoulder which is really there to catch any water that may leak from your wounds over the next several hours. Your shoulder/arm will be swollen. This is normal, and will resolve over the next few days. You will also notice a bruise develop over the next few days along the front of your arm, extending into your biceps and maybe into your chest. This also is normal. You will be wearing a sling for a period of time as determined by your procedure.
Once you are awake enough, walking safely, reporting how you feel adequately with well controlled pain and tolerating POs (PO intake is oral intake, like drinking water, eating crackers, etc) you will be discharged home. The facility will reach out to your ride to come pick you up, and go over discharge instructions with them. Once at home, it is okay to walk around if you have the energy. Comfort foods like soup are best to use at least initially, as postop nausea is a common occurrence, and narcotics can also cause this as well.
Dr Schwartz will call you around 7 pm if you had outpatient surgery. This is a call to discuss your surgery with you, answer any questions, and advise you on pain control. He will not talk to you postoperatively at the surgery center by design. Drugs, anxiety, and meeting a lot of new masked faces sometimes adds to messages getting lost. In general, the most important message he provides is to stay on top of your pain. Nerve blocks wear off from your fingertips on up. As you start to feel your hand and move your hand, it is a safe bet that you should start taking your pain medication. Set an alarm in the evening 4-6 hours after going to sleep to check to see if you need to remedicate. The first 24-72 hours are always the most difficult, and if you fall behind the pain initially rather than having a rough 1-3 days, you may have a rough 3-5 days. So be cautious.
Icing your shoulder helps with pain control. A LOT! If you have a plan to ice with the ice machine that you can purchase from our clinic, we recommend removing the big bulky dressing the day after surgery, and placing band-aids over your incisions. This will better allow the ice to penetrate, and help you. If you are using ice packs, leave the dressing on until 2 days after surgery and then remove for icing. Either way, be sure to not leave ice on for too long and to give your skin breaks so you don’t hurt yourself.
Narcotics cause nausea, and they constipate. For constipation we recommend drinking plenty of fluids, a high fiber diet, walking/activity and an over-the-counter stool softener (such as Colace or Docusate) after surgery while you are taking the narcotic pain medication. If you are still experiencing constipation even after these preventative measures, you can try taking a laxative such as Miralax (polyethylene glycol) or a stronger laxative such as magnesium citrate. For nausea we give a prescription (Zofran is brand name, generic is odansetron).
You will likely receive some of these prescriptions on the day of your surgery. We do not routinely give prescriptions prior to surgery, but can upon request. Do not worry about picking them up the day of your surgery, the surgery center will fax them to your pharmacy, and with the nerve block you won’t have pain until late in the evening.
Diclofenac (may not be routinely prescribed)
Please take all of the Diclofenac prescribed. You will take this twice a day for three days. It is an anti-inflammatory and will help with the pain immediately after surgery. You may start this medication in the evening after your surgery.
Please take all of the antibiotic prescription, which is usually either Keflex (cephalexin) or clindamycin. You will be taking this for three days. It helps decrease your risk of a post-operative infection. You may start this medication in the evening after your surgery.
Percocet (5mg oxycodone with 325mg acetaminophen/ Tylenol)
Instructions: Take one or two tablets every 4-6 hours as needed for pain
Side effects include nausea/vomiting and constipation
Please take this medication on a regular basis for the first few days after surgery. After the first few days you can try taking it less frequently as you feel comfortable, for example taking one tablet every 8 hours. When your pain has decreased you can wean down to an over-the-counter pain medication like Tylenol.
Instructions: take one tablet every 6-8 hours as needed for nausea
You only need to take this medication if you are experiencing nausea after surgery or with taking the narcotic pain medication.
Getting around after surgery will be a little challenging because you may be required to wear a sling for some time. It is not recommended to drive a vehicle while wearing a sling. If you should decide to drive there could be liability associated if you are cited or in a collision. You shouldn’t drive, operate heavy machinery or sign any documents if you are taking narcotic pain medication as they can impair your judgment and slow your reaction time. You may require some help getting to your first appointment with Dr. Schwartz 7-10 days out from surgery, and even your first physical therapy appointment depending on when that is scheduled.
Sling use is often a common concern for patients.
It is very important to follow shoulder precautions to protect the healing tissue that was repaired during your surgery.
–Do not put weight on the surgical arm
(Do not lean on it, lift objects with the hand or actively use the surgical arm).
–No active internal rotation
(Do not pull objects toward your stomach).
–No external rotation beyond 20 degrees
(Do not roll out your shoulder beyond the specified limited range).
–No extension of your shoulder beyond neutral
(Do not bring your elbow behind your body).
In general you will feel more comfortable with your elbow supported, so if your sling is off while lying down, make sure pillows are propping up your elbow and your shoulder so that they don’t roll backwards.
How to Safely Use Your Shoulder Immobilizer
Taking the Shoulder Immobilizer Off:
- Loosen the Velcro on the shoulder strap.
- Use the unaffected hand to pull the shoulder strap over your head.
- Unfasten the waist strap.
- Unfasten the lower arm strap and undo the Velcro.
- Straighten your elbow and keep your arm supported on your lap or a pillow beside you.
Putting the Shoulder Immobilizer On:
- Use your nonsurgical arm to place the waist strap to go from the effected to the unaffected side.
- Place the elbow back as far as possible in the sling. Keep arm bent at 90 degrees.
- Fasten snaps and the lower arm strap.
- Pull the shoulder strap over your head and adjust the strap.
- Fasten the waist strap.
Activities that are safe do while in your sling:
You can allow your arm to hang by your side when you are at home and not around crowds.
You can use a keyboard and mouse to type.
Use silverware to feed yourself.
Remember to take your arm out of your sling often to straighten out your elbow, wiggle your fingers and wrists around. This will prevent your elbow, hands and wrists from becoming stiff and painful.