Tips After Shoulder Surgery

Shoulder
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How do I look after my wound and stitches?

Keep the wound dry until it has healed – usually 10-14 days. There will be a waterproof dressing over the wound but try to avoid getting it too wet in the shower. Avoid any spray on deodorants, lotions or talcum powder etc until the wound has healed entirely. If the dressings start to lift away, you can buy additional dressings at your local chemist to reinforce or replace them. You will see Mr Lau at ~2 weeks for it to be checked.

The Sling

Wearing a sling is important to protect your shoulder during the early stages of post operative recovery. Generally, its use is divided into stages (this may change depending on your specific type of operation):

  • 0-2 weeks: wear sling at all times. Can come off for hygiene only
  • 2-6 weeks: wear the sling most of the time, but you can wean out of it for longer periods
  • >6 weeks: sling only if necessary, out most if not all of the time

When out of the sling, ensure your elbow is supported with pillows or cushions. For shoulder replacement patients, do not allow the elbow to drop behind you as it risks dislocating your shoulder. A nurse or physio will help you fit the sling and make sure you know how to put your arm in the sling in a correct way. Unless specified, you should not need the body strap.

It is recommended you wear your sling at night for the first 6 weeks. Try to find a comfortable position, either on your back, propped up or on your side, and support the elbow/shoulder with cushions. Armpit hygiene can be difficult with a sling, and it is OK to come out of the sling from time to time to wash. Moist towels to wipe down the armpit can be helpful

Tips for Sleeping after Shoulder Surgery

  • A reclined position is generally the easiest. Try a recliner chair or propped up in bed with lots of pillows/cushions.
    Generally patients will do better on an incline for 4-6 weeks. Don’t forget pillows for your shoulder as well
  • Wear your sling at night for the first 4-6 weeks. It helps to limit movement
  • Pillows are your friend. Elevate the arm as much as possible
  • Time your medication including taking something long acting just before you sleep. Have pain relief next to your bedside within easy reach
  • Ice before bed – can help reduce inflammation and improve pain
  • Take it easy!

Concerns or questions?

If you have any concerns post operatively, or you would like further information, please contact Mr Lau through the VBJS on 03 5752 5020 or via email at admin@vbjs.com.au

If you need urgent medical help, call 000 or go to your nearest emergency department.

Your post-operative rehabilitation protocols are on the Post-Op Protocols page.

Next steps

Ongoing Follow Up and Planned Appointments

1. Wound Check

Appointment scheduled with our VBJS Nurses – approx. 10-14 days post op

  • Date and Time:
  • Location:
    • Fitzroy: Victorian Bone & Joint Specialists, Suite 7/55 Victoria Parade, Fitzroy VIC 3065
    • Knox: Victorian Bone & Joint Specialists, Suite 1C, Knox Private Hospital, 262 Mountain Hwy, Wantirna VIC 3152
    • Peninsula: Beleura Consulting Suites, Beleura Private Hospital, 925 Nepean Highway, Mornington VIC 3931
    • Arrange with GP
    • Wound to be checked by Hand Therapy – Mr Lau will refer
    • None required

2. Follow Up Appointment with Mr Lau

Appointment scheduled – at approx 6 weeks

  • Date and Time:
  • Location:
    • Fitzroy: Victorian Bone & Joint Specialists, Suite 7/55 Victoria Parade, Fitzroy VIC 3065
    • Knox: Victorian Bone & Joint Specialists, Suite 1C, Knox Private Hospital, 262 Mountain Hwy, Wantirna VIC 3152
    • Peninsula: Beleura Consulting Suites, Beleura Private Hospital, 925 Nepean Highway, Mornington VIC 3931

3. Physiotherapy or Hand Therapy

    • You have been referred to a physio or hand therapist who regularly works with Mr Lau, and will have correspondence including the operative report and usual post operative protocol.
      They will call you to arrange an appointment to commence after your wound check
      Recommended Physio/Hand Therapist:
    • Please phone and arrange an appointment with your own physiotherapist or hand therapist for ongoing rehabilitation to commence after your wound check.
      Remember to bring the post operative protocol provided in your post op pack

4. Post op XRs

    • No Post Op XRs required
    • Please have an XR taken the few days prior to your 6 week appointment. Alternatively, an XR on the day of your appointment as a “walk in” is also possible. You will have been provided with an XR slip in your post op pack

Pain Relief After Shoulder Surgery

A guide to managing your pain safely at home

Why pain management is important:

Some discomfort after shoulder surgery is normal. Good pain control helps you to:

  • sleep more comfortably
  • begin your rehabilitation exercises
  • breathe deeply and move around safely
  • reduce stress and muscle spasm

Pain is usually worst during the first 2-5 days after surgery and then gradually improves over the following weeks.

Your shoulder nerve block

Most of Mr Lau's shoulder operations are performed with an interscalene nerve block - an injection of local anaesthetic around the nerves supplying your shoulder.

  • Provides excellent pain relief immediately after surgery.
  • Usually lasts 8-16 hours (commonly around 12 hours; sometimes up to 36 hours).
  • May leave your arm feeling numb, weak or heavy while it is working.

VERY IMPORTANT

Do not wait until the block has completely worn off before taking your pain medication. Start your prescribed pain medicines before the numbness disappears, usually around 8-10 hours after surgery. Mr Lau and the ward nurses will guide you. The block can wear off quickly, so having pain relief on board is important.

Your pain medication (analgesia):

Mr Lau and his anaesthetists (typically Dr Sutton, Dr Lai or Dr Gouldthorpe) may prescribe several medications that work together. Follow the dose and frequency on your discharge prescription.

1. Paracetamol

This forms the foundation of your pain relief. Take it regularly for the first 5-14 days, even if your pain seems mild. Do not exceed the recommended daily dose.

2. Anti-inflammatory medication (NSAID)

Examples include celecoxib, meloxicam and ibuprofen. These reduce inflammation and improve pain control. Take exactly as prescribed, usually for 5 days to 2 weeks. Tell Mr Lau or his team if you have been advised not to take NSAIDs because of stomach ulcers, kidney disease, certain heart conditions, stroke, allergy or pregnancy.

3. Immediate-release opioid

Examples include tapentadol IR and oxycodone (Endone®). These are for breakthrough pain when pain is not controlled by paracetamol/NSAIDs, increases as the block wears off, or prevents sleep or exercises.

Take the lowest dose that controls your pain and do not exceed the maximum prescribed frequency. As pain improves, reduce the dose and frequency before stopping.

4. Slow-release opioid (only if prescribed)

Some patients are prescribed a slow-release opioid such as tapentadol SR. Take it exactly as directed and reduce it when pain is tolerable. Do not crush or split tablets. Use immediate-release medication only for breakthrough pain.

A simple way to manage your medications:

Morning Paracetamol + NSAIDs + slow-release opioid (if prescribed). Take immediate-release opioid only if pain is not adequately controlled.
During the day Continue regular medicines. If pain increases, take an immediate-release opioid as prescribed.
Night Pain may increase overnight. Take your regular evening medicines as directed.

Weaning your medications, as your pain improves:

  • First: reduce the immediate-release opioid - take fewer tablets and increase the time between doses.
  • Next: stop the slow-release opioid, if prescribed.
  • Continue: paracetamol until pain is mild; stop NSAIDs after the prescribed course.

Common side effects

Opioids may cause drowsiness, nausea, constipation, dizziness or itching.
To reduce constipation: drink plenty of fluids, eat fibre, and consider a stool softener or laxative if needed.

SAFETY

Do not drive after shoulder surgery for 6 weeks unless discussed with Mr Lau. Opioid medicines can cause drowsiness and may limit your ability to drive beyond 6 weeks. Do not operate machinery, drink excessive alcohol, or combine opioids with sleeping tablets or other sedating medicines unless specifically advised by your doctor.

Non-medication strategies:

  • Wear your sling as instructed.
  • Ice the shoulder regularly for 15-20 minutes at a time, protecting the skin.
  • Sleep slightly upright for the first few nights.
  • Perform only the exercises recommended by Mr Lau in your postoperative protocol.
  • Avoid overusing the shoulder during the first few weeks.

When should I seek medical advice?

Contact Mr Lau on 03 5752 5020 or admin@vbjs.com.au (or your GP or physiotherapist) if:

  • pain is worsening rather than improving
  • you have uncontrolled pain despite taking medications correctly
  • you develop significant medication side effects
  • you run out of medication unexpectedly

Seek Urgent Medical Attention if you develop the following:

  • difficulty breathing or severe drowsiness or inability to wake
  • chest pain
  • an allergic reaction such as rash, swelling or difficulty breathing
  • fever, increasing redness or wound discharge
  • severe calf pain or swelling

Frequently asked questions

Will I become addicted to opioids?

Most patients use opioids for only a few days. Taking them exactly as prescribed for acute postoperative pain carries a low risk of dependence. Reduce and stop them as soon as they are no longer needed.

Is it normal to have severe pain when the block wears off?

Yes. Many patients experience a temporary increase in pain around 12 hours after surgery. Starting your prescribed pain medicines before the block wears off can significantly reduce this "rebound pain."

How long will I need pain medication?

  • Regular pain medication is commonly needed for 1-2 weeks.
  • Opioids are often required for only a few days to one week.
  • Pain usually improves gradually over 2-6 weeks, although recovery from shoulder surgery often continues for several months.

Practical tips for safe self-administration

  • Take medications exactly as prescribed - more is not necessarily better and increases side-effect risk.
  • Do not wait for severe pain before treating it; pain is easier to control when managed early.
  • As pain improves, stop the opioids first, then continue simple pain relief until it is no longer required.
  • If you are unsure whether to take another dose, or pain remains uncontrolled, contact Mr Lau or your GP rather than increasing the dose yourself.

IMPORTANT

This guide provides general postoperative advice. Your discharge prescription and instructions from Mr Lau and your anaesthetist take priority, as medication plans vary between patients.

These notes have been prepared by Mr Simon Lau. They are general overviews and information aimed for use by his patients. They reflect Mr Lau’s views, opinions and recommendations. They do not constitute medical advice. The contents are provided for information and education purposes only. Please seek Mr Lau’s specific advice with any questions regarding medical conditions and treatment.

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