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Discharge Instructions & Physical Therapy Instructions for Hemiarthroplasty or Total Shoulder Replacement and Type II Poor Fixation, Muscle or Bone Deficiencies

Initial recovery after shoulder surgery entails healing, controlling swelling and discomfort and regaining some shoulder motion. The following instructions are intended as a guide to help you achieve these goals until your 1 st postoperative visit.

Comfort

Although surgery uses only a few small incisions around the shoulder joint, swelling and discomfort can be present. To minimize discomfort, please do the following

  • Ice - Ice controls swelling and discomfort by slowing down the circulation in your shoulder. Place crushed ice in plastic bag over your shoulder for no more than 20 minutes, 3 times a day
  • Pain Medication - Take medications as prescribed, but only as often as necessary. Avoid alcohol and driving if you are taking pain medication
  • Antibiotic Medication - If an antibiotic has been prescribed, start taking the day of your surgery. The first dose should be around dinnertime. Continue taking until the prescription is finished
  • Sling - A sling has been provided for your comfort and to stabilize your shoulder for proper healing. Continue wearing the sling for a period of approximately six weeks or until Dr. Forsythe directs you to stop
  • Driving - Driving is NOT permitted as long as the sling is necessary

Activities

  • You are immobilized with a sling and abductor pillow, full time, for approximately the first 6 weeks. Your doctor can tell you when you can discontinue use of the sling at your 1 st postoperative visit. The sling may be removed for exercises
  • Your sling may be removed for gentle PASSIVE range-of-motion (PROM) exercises. (SOMEONE ELSE MOVES YOUR SHOULDER). This should be done 3x a day /15 repetitions (ABDUCTION ONLY - away from your body)
  • While your sling is off you should flex and extend your elbow and wrist - (3x a day for 15 repetitions) to avoid elbow stiffness
  • Active range-of motion (AROM - you move your shoulder) should be performed for shoulder internal/external rotation. Keep elbow positioned at the side and flexed at 90 ° so forearm is parallel to the floor. This should be done within a comfortable range until you feel slight pain (3x a day for 15 repetitions). You can shrug your shoulders
  • Ball squeezes should be done in the sling (3x a day for 15 squeezes)
  • You may NOT move your shoulder by yourself in certain directions. NO active flexion (lifting arm up) or abduction (lifting arm away from body) until Dr. Forsythe or your therapist gives permission. These exercises must be done by someone else (Passive Range of Motion)
  • Physical therapy will begin approximately 3 - 4 weeks after surgery. Make an appointment with a therapist of your choice for this period of time. You have been given a prescription and instructions for therapy. Please take these with you to your first therapy visit
  • Athletic activities such as throwing, lifting, swimming, bicycling, jogging, running, and stop-and-go sports should be avoided until cleared by Dr. Forsythe
  • Antibiotic Prophylaxis- Having a Total Joint Replacement requires you to take antibiotics prior to all future procedures that may cause bleeding. These include
    • Dental cleaning
    • Dental procedures
    • Surgical procedures
    • Colonoscopies or Endoscopies

    Notify your physician or dentist prior to any procedure so antibiotic treatment can be started

Wound Care

  • Keep the dressing on, clean and dry for the first 3 days after surgery
  • Remove the dressing 3 days after surgery. The steri-strips (small white tape that is directly on the incision areas) should be left on until the first office visit. You may apply band-aids to the small incisions around your shoulder
  • You may shower 5 days after surgery with band-aids on. Apply new band-aids after showering
  • Tub bathing, swimming, and soaking should be avoided for two weeks after your surgery

Eating

  • Your first few meals after surgery should include light, easily digestible foods and plenty of liquids, as some people experience slight nausea as a temporary reaction to anesthesia

Call your physician if

  • Pain persists or worsens in the first few days after surgery
  • Excessive redness or drainage of cloudy or bloody material from the wounds. (Clear red tinted fluid and some mild drainage should be expected). Drainage of any kind 5 days after surgery should be reported to the doctor
  • Temperature elevation greater than 101°
  • Pain, swelling, or redness in your arm or hand
  • Numbness or weakness in your arm or hand

Return to the office

  • Your first return to the office should be within the first 2 weeks after your surgery. Call Dr. Forsythe’s office to make your first postoperative appointment

Total Shoulder Rehabilitation Protocol Type II Poor Fixation, Muscle or Bone Deficiencies

In subjects with poor fixation or muscle or bone deficiencies, it will be necessary to alter the rehabilitation goals to maintain stability and prevent tendon, muscle or bone disruption. This is a limited-goals category of rehabilitation. Examples include, 1) large repaired rotator cuff tears, 2) poor stability due to inherent tissue problems, and 3) when glenoid or humeral bone grafts are needed to fill bony deficiencies.

In this setting, initiation of exercises is delayed and the extent of passive or assisted early motion is reduced. Typically, elevation should be limited to 90° and external rotation to 20°. Most of these patients will be in an abduction splint or pillow, and passive elevation and external rotation should be carried out with the splint on, thus not allowing the arm to fall to the patient’s side. After the initial 4 weeks, the total shoulder protocol, Type I (Good Fixation and Stability) should be initiated. Individualized rehabilitation protocols for the above groups of patients are very common and are dependent on the pathology noted and repaired during surgery.