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A Patient’s Guide To Shoulder Arthroplasty

 

Getting Ready

 

You will be scheduled for a pre-surgery physical exam in the Orthopedic Clinic.  You may be asked to see your primary doctor before surgery.  You will also be scheduled in the anesthesia clinic.  Expect to be in the hospital for about 3-4 hours for these appointments.

 

You will be meeting with an Occupational Therapist (OT).  A therapist will teach you exercises you will be doing after surgery.  They will assist you in planning for your needs after discharge from the hospital and how to care for yourself with the use of one hand.  Be sure to practice these exercises before surgery.  If you have GHC insurance, you will need to schedule a visit with a GHC physical therapist.

 

Medicines

 

Do not take any blood thinners or nonsteroidal medicines such as aspirin, ibuprofen, Naproxen®, Aleve®, or Motrin® for 1 week before surgery.  You may take Tylenol® if needed.

 

If you are on Coumadin® (warfarin), you will be told when to stop taking your medicine.

 

Planning Ahead

 

Many people who have a total joint replacement find it useful to plan ahead. 

  • Expect to be in the hospital for 1-2 days after your surgery. 
  • If you plan to go home or live alone, you should arrange for someone to stay with you at least for a few days.
  • Some people need further rehab or nursing home care.  A social worker or nurse case manager can work with you to arrange for these services.  It is also helpful to visit nursing homes in your area ahead of time.  If you know that you plan to go to a nursing home, please alert the nurse at your pre-op visit.
  • To prevent falls after surgery, prepare your home in advance.  Watch out for:
    • Loose rugs or loose carpets.  Remove all of them.
    • Pets that may run in your path.
    • Water spills.
    • Bare slippery floors.
    • Long cords across floor, such as phone or fan cords.
    • Ice on steps and porches, etc.

The Day before Surgery

 

  • Because of constant changes in the schedule due to emergencies, the time of your surgery will not be set until the day before.  A nurse will call you at your home or the number you gave us between 10:30 am and 3:00 pm on the day before your surgery (on the Friday before a Monday surgery).  She will tell you when to arrive, where to go, and answer questions that you may have.  Before this call, please review any special instructions that were given to you.  If you do not hear from us by 2:00 pm, please call (608) 265-8857 by 5:45 pm.  Tell the nurse where you will be staying the night before surgery.
  • Try your best to have a restful night’s sleep.  If you are coming from out of town, you may wish to stay in Madison.  A Housing Accommodations Coordinator, (608) 263-0315, can provide you with a list of nearby motels and arrange for your stay at a discount rate.
  • Eat a light supper.  Stop eating and drinking after midnight.  This includes water, ice chips, gum, candy, and chewing tobacco.
  • Clean the shoulder with an antibacterial soap (Hibiclens®) for at least 10 minutes.  If time allows, clean again the next morning using the Hibiclens®.
  • Remove nail polish, make-up, and jewelry.  Plan to leave any valuables at home.

The Morning of Surgery

 

  • With a sip of water, take only the medicines that you have been instructed to take.
  • Arrive at the hospital by ____________.  Take the D elevators to the 3rd floor, turn left, and follow the signs to the First Day Surgery unit.
  • Bring shoes that are easy to slip on, a shirt that buttons up the front or any loose fitting shirt large enough to go over a bulky dressing.
  • Bring along any inhalers or CPAP equipment, glucose meter, eye glasses, eye drops, hearing aids, dentures, prostheses, or other special equipment that you will need during recovery.  Be sure these items are labeled and in a case, if appropriate.  Please do not bring bottles of medicines with you unless you have been told to do so.
  • If you did not stop at the Admissions Department the day of your work-up visit, plan to come to the hospital 15 – 20 minutes early, and stop at Admissions to sign forms.  If you are scheduled for surgery before 7:00 am, a family member will need to go to Admissions and confirm your information sometime after 7:00 am.

 

If you have diabetes, you will be given special instruction about your insulin or oral medicines at your clinic visit.

 

A Note to Families

 

You can wait in the Surgical Waiting Area (C5/2) on the second floor.  If you have other family calling the hospital, please have them call patient information at(608) 263-8590.

 

Some time during the day, take your parking pass to the main l Information Desk to have it stamped and to get one pass to be used during your loved one’s stay.


After Surgery

 

Occupational Therapy

 

You will begin occupational therapy twice a day, starting on the day after surgery.  The therapist will come to your room.  You will learn exercises and precautions. These exercises are designed to improve the strength and flexibility of your arm without harming the surgical repair.

 

Asking your nurse for pain medicine 30 to 60 minutes before therapy often helps decrease pain with exercises.  Once home, the exercises should be done 2-3 times per day. 

 

Precautions

 

  • Do not raise your operated arm.
  • Do not rotate your arm outward or away from your body.
  • Wear the sling at all times except when doing your exercises or unless your doctor or therapist tells you otherwise.
  • Keep the sutures dry until removed at your 2-week clinic visit.

 

Pain Relief

 

We want you to feel comfortable and able to do your exercises.  Your doctor will prescribe pain medicine for you.  The medicine may upset your stomach or cause constipation.  Eating something first will help.  Or you may wish to take only half of the pill or use over-the-counter drugs like Extra Strength Tylenol® or ibuprofen.

 

Antibiotics

 

You also need to be extra careful not to get an infection in the joint.  Taking antibiotics before and after certain procedures can reduce your risk.  Let your doctor or dentist know that you have had a joint replacement.  Plan to take antibiotics before:

 

  • Dental care, even routine cleaning 
  • Major or minor surgery
  • Diagnostic procedures that could cause trauma to body tissues (colonoscopy, endoscopy, some rectal exams or bladder exams)

 

The clinic staff can give you a “joint replacement card” that alerts doctors and dentists of your needs.  It can also be used to get through airports since you now have metal that will be detected as you go through security.

 

Going Home

 

Incision Care

  • Keep the incision clean and dry until the sutures/staples are removed in 2 weeks.
  • If swelling occurs, use an ice pack for 10-15 minutes until the area is numb.
  • After the sutures/staples are removed, your occupational therapist will let you know when to begin massaging the scar.

 

Activity

 

Common sense will tell you when you are over doing it.  Too much activity can interfere with progress.  Moderate activity helps in your recovery.  Too little activity can delay the return of your strength and stamina.  Exercises you have been taught should be continued.  They are important to your recovery.

 

Sling

You will be wearing a sling to support your arm for 3-4 weeks.  It may be removed only when doing exercises and for bathing, when allowed.

 

Sleeping

You must sleep with your arm in the sling for 3 weeks.  You may wish to place a pillow under your arm to support both your arm and shoulder while in bed.

 

Bathing

Sponge bathe for 2-3 weeks to avoid getting the incision wet.  At your first clinic visit, the staples or stitches are removed.  Two days after that, you will be able to shower. 

 

People who have had a joint replacement are at high risk for infections.  Infection of a joint implant can occur when bacteria enter the bloodstream.  Before having any dental, medical or surgical procedure, tell your doctor or dentist of your joint replacement or metal implant.  To prevent infection, you may need an antibiotic before the procedure.  If you have further questions, please call our office or your primary care doctor.


Limits

 

Driving:  Most people need to wait 6 weeks.  Do not drive a vehicle when taking any prescribed pain pills.  Your surgeon will let you know when you can drive. 

 

Lifting:  No lifting with your operative arm for 6-8 weeks.

 

Housework:  Any activity you can do with one hand is allowed.

 

Sports:  No sports for 3-6 months or per your doctor’s instructions.

 

Clinic Visits

 

You will be scheduled for a clinic visit in 10-14 days to remove the staples.  Other visits are based on your needs.

 

Therapy Exercises

 

Below are some of the exercises you might be taught.  Please note that some of them might not be right for you.  Your doctor and occupational therapist will talk with you about the best exercise program for you.

 

Upper Extremity

 

Perform p endulum exercises while standing and bending at the waist.  Support your uninvolved arm on a table or chair and allow your involved arm to hang freely.

 

Pendulum Exercise 1

 

  • Keep your elbow straight throughout the exercise.
  • Make clockwise circles with your arm for one minute.
  • Reverse the direction and make counterclockwise circles for one minute.
  • Gradually increase the size of the circles.

Repeat __________times.

 

 

 

Pendulum Exercise 2

 

Keep your elbow straight throughout the exercise.

  • Swing your arm up toward your head, and then back along the side of your body.
  • Repeat for one minute.

Repeat __________ times

 

 

 

Pendulum Exercise 3

 

  1. Keep your elbow straight throughout the exerc ise.
  • Bring your arm across your chest, and then out to the side of your body, in a side-to-side motion. 
  • Repeat for one minute.  

 

Repeat ____________ times.

 

 

 

 

 

 

Special instructions

 

___________________________________________________________


 

Important Phone Numbers

 

Admissions

To speak with a financial counselor or verify insurance ... (608) 263-8770

 

Hospital Paging Operator................................................ (608) 262-0486

 

Toll-Free........................................................................ 1-800-323-8942

 

Housing Accommodations ............................................ (608) 263-0315

 

First Day Surgery Unit ................................................... (608) 265-8857

Fax ............................................................................... (608) 265-8858

 

Patient Information (for room number) ........................... (608) 263-8590

 

Outpatient Pharmacy (E5/236) ....................................... (608) 263-1280

 



The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 04/07/2010

Copyright © 04/07/2010 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. UWH #5209

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