What is shoulder arthroscopy?

The arthroscope is a fiber optic instrument narrower than a pen, which is put into a joint through small incisions less than 5 millimeters in length. A camera is attached to the arthroscope and the image is viewed on a television monitor. Small instruments ranging from 3-5 millimeters in size can be inserted through the incision. These instruments allow the surgeon to feel the various joint structures, to diagnose the injury and then to repair, reconstruct or remove the damaged structure. To help your surgeon view the shoulder joint, traction is placed on your arm and sterile fluid is pumped into the joint.

How long is surgery?

1-2 hours. You will be in the recovery room approximately 1 hour, depending on how fast you wake up and are able to eat, drink and go the bathroom.

What are the possible risks?

In consultation with your orthopedic surgeon, you have decided that surgery is the appropriate treatment for your shoulder condition. It is important to understand this is elective surgery. Other treatment options include medicine for pain and inflammation, use of a sling, physical therapy, cortisone injections and restricting your activities. Many patients try these measures before choosing surgery.

Generally, shoulder surgery is very successful. Pain is relieved and patients resume many activities. The long-term success rate depends on your age, shoulder condition and your activity level.

Potential risks include, but are not limited to, problems from anesthesia, infection, surgical bleeding, damage to nerves or blood vessels, blood clot, infection, weakness, stiffness, continued pain, and possibly tearing of the repaired tendon or cartilage, requiring the need for further surgery.

How long will I be out of work or school?

Take at least 1 week off from work and at least 3 days off from school. Try not to take any exams the first days back to school (if you are taking pain medication you will not be thinking clearly). If your job requires lifting with the operative arm it may be 3-4 months before you return. We will discuss this further at your preop visit.

Disability forms

If you have disability insurance, check your coverage and bring your disability forms to our office. Make sure your portion is filled out before dropping off.  We are required to mail them directly and cannot return the forms to you. Please call Lyn at ext 103 with questions.

Traveling

Stay in the area until your first postop visit. If you have any problems or complications after surgery it is difficult to treat if you are more than a couple hours away. Take this into consideration when making travel plans.

If you need to travel in the first 4 weeks after surgery by airplane, we recommend you take aspirin 81mg (baby aspirin), 1 pill per day until you return to help prevent against a blood clot. A blood clot is rare after shoulder surgery, but we would rather be cautious.

When will physical therapy start?

·        If you are having surgery for impingement to remove a bone spur you should schedule therapy to start in 1 week.

·        If you are having surgery on your rotator cuff, schedule therapy to start in 1 week.

·        If you are having surgery for a dislocating shoulder or cartilage damage (labral tear) schedule therapy to start in 4 weeks.

·        If you are having surgery for stiffness or scar tissue removal, schedule therapy to start the next day.

You will be given the therapy prescription and referrals for a therapist 

at your preop visit. You must call and schedule your appointments with the physical therapist. You will have more options on dates and times if you do this as soon as you know your date for surgery.

How long do I wear the sling?

·        For impingement surgery and removal of bone spur you will wear the sling for 1-2 days.

• For rotator cuff repair you will wear the sling at all times for 4 weeks. If you have a very large tear you may have to wear the sling for 8 weeks.

• For a dislocating shoulder or cartilage tear you will wear the sling at all times for 4 weeks.

• For stiffness or clean up of scar tissue you will wear the sling for 1  day.

IceMan (cold therapy)

We have ordered an iceman unit to help decrease pain and the need for narcotics. This is the treatment of pain and/or inflammation by lowering the temperature of the skin over the affected area. It can significantly reduce swelling after an injury or surgery. The representative from the company will call your home 1-2 days before surgery to discuss insurance coverage and cost of the unit. 

PainBuster

If your surgery is an open procedure, a painbuster will be used for pain control.  The painbuster is filled with marcaine (numbing medicine) it will drip into the shoulder for 2 days and then will be pulled out.

Physical Examination/EKG/ Labs

If you have diabetes, heart or lung disease, a physical examination by your internist is required to ensure you are well enough to undergo surgery. You will need to schedule this appointment. You will also need an EKG and blood test within a month of your surgery.

If you are over 50, or have high blood pressure even if you are younger than 50, you will also need an EKG and labs. If your surgery is at Alta Bates this will be done at the preop visit scheduled with Alta Bates.

If your surgery is scheduled at one of the surgery centers you will need to have the EKG done at your medical doctor’s office or at one of the hospitals in the area. You will need to call your doctor or a hospital to schedule this. Please let us know if you do not have a prescription for the EKG and labs. The results should be faxed to 510-704-7765 and you should be given a copy to bring to your preop visit at our office.

Prepare your home

Stock your freezer and pantry. Have extra ice available for the iceman.  Prepare to sleep in a recliner chair or propped up with pillows. Most patients cannot sleep flat for several weeks due to pain.

Prepare for the hospital

Discuss hospital and discharge plans with family and friends. You will need someone to pick you up after surgery. You cannot drive yourself home. Have someone stay with you for the first 2 nights. If this is not possible, you should have family, friends or neighbors check with you a couple times per day to make sure you are ok.

Review insurance coverage, deductible, therapy coverage and co-payments.  Although we will get authorization for your surgery, it is your responsibility to make sure the facility, anesthesiologist, surgeon and  physician assistant are covered by your insurance. You should also be aware of the cost of your deductible and co-payment. Shoulder surgery cost including the facility fee, equipment, staff, anesthesiologist and surgeon can average between $10,000-20,000 dollars.

What should I do the week before surgery

Check your paperwork from our office.

Practice getting dressed and undressed before your surgery, using just one arm. Try to do all your regular daily activities using just one arm. This will help you to know how much help you will need after surgery.

Schedule physical therapy for after surgery.

Fill your prescriptions for pain medications (You will get the prescriptions at your preop visit).

Buy stool softeners, gauze, bandage tape, iodine or hibliclens soap  and waterproof dressings at the pharmacy.

Decide if you want the icemachine and let us know at your preop visit.

Buy bland food to have after surgery- toast, oatmeal, banana, soup, rice.

A week before surgery, stop taking any blood thinners, which includes Coumadin, Plavix, Aspirin, Advil, Motrin, Ibuprofen, Aleve, Ginger, Ginseng and all herbal medicines or any prescription anti-inflammatory drugs. Please contact your prescribing doctor before discontinuing Coumadin or Plavix or if your doctor told you to take Aspirin.  You may take Tylenol for pain up until the night before surgery.

If you get a cold or flu before surgery and have any of the following; a cough, sore throat, temperature or are not feeling well, please cancel your surgery. If you are unsure please call our office.

What to do the night before surgery

You should not have anything to eat or drink 8 hours before surgery.  This includes water, coffee, candy and gum. This is to prevent getting fluid in your lungs.

If you normally take heart or high blood pressure medication in the morning, you should take it as soon as you get out of bed the morning of surgery with just a sip of water.

Take off all rings, watches and bracelets. You may leave on body jewelry but inform the nurse the day of surgery.

Check your cell and home phone incase your surgery time was changed.

Find loose clothing, something you can easily get over the sling, like a button or zip up shirt or large sweatshirt. Put this on the day of surgery.

What happens on the day of surgery?

You will meet with the nurse and the anesthesiologist. The anesthesiologist will explain the anesthesia – general anesthesia with an interscalene block.

Your intravenous line will be started. Dr. Eppley will answer any final questions and mark your shoulder.

When the operating room is ready you will be brought into the room.  You will be introduced to the operating team, which includes the nurse, scrub tech, surgeon, PA and anesthesiologist.

The anesthesiologist will then put in a nerve block for the shoulder surgery. This is to help relieve postop pain and decrease the amount of general anesthesia. The block will last 16 hours.  You will then be given medication in the IV to put you to sleep.

After surgery

You will have a bandage on your shoulder, the iceman and a sling. You will be discharged when you are awake, tolerating fluid and able to go the bathroom.

You will be given instructions for home, arthroscopic pictures and a DVD of your surgery.

When you get home have small bland meals that night then advance to your regular diet the next day if feeling well.

Activity after surgery

You may move around as tolerated, but your arm should remain in the sling. Take it easy for the first 2 days, in other words do not make plans to go out to dinner, to a party etc. Increase your activity slowly.  You may walk or ride a stationary bike, you will not be allowed to jog or swim.

You must give your shoulder time to heal. You cannot use pain as a guide on activity in the postop period. If you decide to have surgery, you will need to follow instructions  and guidelines to avoid failure of the surgery. Repairs can be pulled apart if directions are not followed. Please take this into consideration when making plans for after surgery.

Pain medication

You will need pain medication for the first 2-3 days. After that take only as needed.  You will not be pain free. Surgery is painful and you may have pain for several months.

Driving

You should not drive for 1 week or if you are taking narcotic medication. If you are instructed to wear a sling, you may not turn the wheel with this arm.  You must therefore decide if you can safely drive with 1 arm. You will not be able to shift with your surgical arm, if you have a standard transmission you should try to borrow an automatic.  You must decide if you can safely control your vehicle. Please check with your insurance agent about driving with a sling. Practice in a remote area before going onto a main road.