Shoulder Arthroscopy Preoperative Instructions

Shoulder arthroscopy is an outpatient procedure used to treat a wide variety of shoulder conditions. Below please find information on how to prepare for shoulder arthroscopy, and what to expect after your surgery.

Everything in life has risks, and shoulder arthroscopy is no exception. Below is a list of common risks in shoulder arthroscopy; Dr. Burns and her team do everything possible to minimize your risks.  This list does not include every possible risk.

Bleeding. Usually only a very small amount of blood is lost with arthroscopic surgery, equivalent to a few tablespoons.

Infection. Infection is uncommon with appropriate precautions in shoulder arthroscopy. You will receive antibiotics through your IV on the day of surgery to minimize this risk.

Nerve, blood vessel, or tendon injury. Any nerves, blood vessels or tendons in the shoulder can be injured during surgery, but injury is rare. The most common complaint is skin numbness, but even that is rare.

Medical problems. Blood clots, stroke, heart attack, pneumonia, and even death may be related to the procedure or a complication of the procedure, but these problems are exceedingly rare. Dr. Burns will work together with your primary medical doctor to minimize this risk and determine that you are healthy enough to undergo surgery.

No or incomplete relief of pain, failure of repaired tissues to heal, or other failure of the surgery. No surgery is guaranteed to have a 100% success rate. Most people experience pain relief and improvement of their symptoms after shoulder arthroscopy. Results can differ from one person to another. Torn rotator cuffs cannot always be repaired, or repaired fully, depending on the size and age of the cuff tear. Even when the tissues are repaired, the healing rates are not 100%.

Dr. Burns may order preoperative blood work or EKG if necessary depending on your age and medical history. Your primary care doctor also may need to evaluate you and determine if you can safely undergo surgery.

For the 7-10 days before surgery, stop taking aspirin and ibuprofen or other anti- inflammatory medications because they can increase bleeding during surgery. Tylenol is safe to take as an alternative pain medicine prior to surgery.

Dr. Burns recommends that you take Tylenol 1000 mg (2 over-the-counter extra strength Tylenol) for three days prior to surgery. This has been shown to reduce postoperative pain and need for opioid pain medication after surgery.

Do not eat or drink anything after midnight on the night before surgery. If you have a fever or a cough before surgery, please call the office at (314) 291-7900. Make sure that you have arranged a ride to and from the hospital or surgery center.

You will check in at the surgery center 1 hour to 11⁄2 hours before your scheduled surgery time. An IV will be placed and the anesthesia team will give you a shoulder nerve block by injecting numbing medicine at the base of your neck before your surgery. This medicine makes your shoulder and arm numb and weak for 12-24 hours after surgery. This is the same type of medication that is used by your dentist. Most people cannot lift or move their arm while the block is working. The shoulder block usually lasts around eight hours, which will decrease your anesthesia requirements and reduce postoperative nausea and vomiting. The block also will provide good postoperative pain relief, even after your leave the hospital.

You will spend approximately 1-2 hours in surgery, depending on what your surgeon finds at the time of arthroscopy. After your procedure is completed, expect to have your shoulder bandaged and elevated. Your arm will be placed in a sling. The incisions will be stitched with absorbable stitches and taped with steri-strips. You should use ice on your shoulder to help minimize postoperative pain.

After your surgery is completed, you will spend about one hour in the recovery room where your blood pressure, pulse, respirations, and temperature will be closely monitored. When you are stable and comfortable, you will return to your room in the outpatient surgical area. After the nurses give you any final instructions, you will be ready to go home. You should not drive immediately after your surgery, so arrange for someone to take you home.

Your arm will be placed in a sling after surgery. You can slip your arm out of the sling intermittently to move your elbow, wrist, or hand. You should not move your shoulder unless instructed to do so.

You should apply ice to your shoulder (20 mintues on, 20 minutes off) for the first 48 hours and then as needed for pain and swelling.

You should elevate your shoulder to reduce pain and swelling. Many people prefer to sleep in a recliner or propped up on pillows in bed.

You should take Tylenol or opioid pain medication as needed for pain. Opioid (or narcotic) pain medication such as Norco or Percocet is prescribed after surgery. Most patients only require opioid pain medication for the first 1-2 weeks after surgery, and then only rarely (at night, or after therapy). It is important to understand that opioid pain medication is addictive, and by accepting a prescription with Dr. Burns, you agree to use them responsibly.

You may be able to take ibuprofen or an anti-inflammatory medication to reduce pain and swelling. NSAID (anti-inflammatory) medications can interfere with healing of tendons to bone, and Dr. Burns recommends avoiding NSAID medications for the first 3 weeks after repair procedures, including rotator cuff repair and labral repair. If Dr. Burns recommends that you take this medication following surgery, it is prescribed on a regular schedule to maintain a constant blood level of the drug in your body for the first 3 weeks after surgery. An upset stomach can occur when you take this medicine, so take it with food. If your stomach continues to be upset, stop taking this medication. After the first few weeks, you can take this medicine on an “as needed” basis.

You may remove your dressing and shower 24 hours after surgery. Do not soak your incisions in a bath, pool or whirlpool for 2 weeks. After showering, pat your shoulder dry or allow it to air dry. By leaning over and allowing the arm to hang, you can use this motion to wash under your arm and to pull on a shirtsleeve. (See pendulum exercise).

You will have small bandages, called steri-strips, over your incisions. These should remain in place for about 1 week, and will typically fall off after 1 to 2 weeks. We will change or remove your steri-strips over your incisions on your first follow-up visit 3 weeks after surgery as necessary. At this visit, Dr. Burns will review what was done at your surgery and typically will prescribe a physical therapy plan.

Call Dr. Burns’ office if you have excessive bleeding, pain uncontrolled by the medication prescribed, fever (>101 degrees), severe nausea or vomiting, or shortness of breath. The office number is (314) 291-7900 and the exchange (for after-hours calls) is (636) 474-0615.