What You Need To Know: Getting Ready for Shoulder Surgery

Shoulder surgery is a big deal. The rumors of pain, difficult rehab, and long-term return to function are real. I spend my workdays treating shoulder conditions and frequently this leads to surgery. We always maximize conservative or non-op treatment before surgery, but sometimes the pain, sleep disturbance, or lack of function requires surgical intervention. 

The shoulder evaluation requires a history and physical exam in the office. We will order appropriate imaging including x-ray, CT, and MRI. The first critical point is establishing the appropriate diagnosis and making sure this diagnosis is causing the symptoms. Once the diagnosis is made and all conservative measures have been exhausted, then we discuss surgery. You need to understand the procedure, the commitment to rehab, and the time frame for recovery. Risk and benefits of surgery should be clear. You need to understand the reasonable expectations of the outcome. 

Preparation for surgery requires medical clearance. The existence of heart disease, lung disease, diabetes, and even malnutrition should be addressed to maximize the outcome. You should not be smoking! This prevents healing. You should prepare your home. Complete all projects. Your most comfortable position will be sitting in the “beach chair” position in a recliner or propped up in bed. You should have your pain meds or multimodal pain control plan in place. You need to have access to the bathroom and kitchen using minimal stairs for the first couple of days. You should think about the limits to your activity of daily living in the sling. Understand you will not drive safely for 3-4 weeks. 

Once surgery is complete you will go home for the recovery. If a patient’s medical status is required, they will need an overnight stay in the hospital. During surgery, you will receive a regional block that truly helps post-op pain. After surgery, you should begin taking your pain meds before the block wears off and take them on a scheduled basis! If you take the meds before the block wears off, this drastically reduces the post-op pain. If you control the pain early, then you will be able to discontinue the pain meds sooner. As you take the pain medicine, you should consider constipation preventions as well. Use ice as much as you can with either bags of ice or special cryo machines. As recovery progresses ice is important 2-3 times per day for 20-30 min. 

The recovery is separated into 3 stages. 

Stage 1: (usually 4-6 weeks): Maximum protection phase: You will remain in a sling. You will begin PT. You will not stress the repair. Sleeping in the beach chair position is key. ICE ICE ICE! No driving. 

Stage 2: (usually 4-6 weeks) Intermediate function; no sling, 5-10 # weight limit. NO sling NO overhead lifting. Focus on shoulder blade position and strength. 

Stage 3: Return to normal: Building strength and return to function. 

If you must undergo surgery, proper preparation beforehand can make a dramatic difference in the stress and quality of the outcome..