General

What is a Total Shoulder Replacement?

Shoulder replacement surgery is a treatment option for patients whose shoulder arthritis has become so severe that they cannot tolerate the pain and functional impairment they experience. Shoulder replacement surgery is usually recommended only after a patient has tried nonoperative treatments for the shoulder arthritis.

There are many different types of shoulder replacements. The most common shoulder replacement done in America and Europe is called an anatomic total shoulder. This surgery replaces the ball of the shoulder with an artificial ball and resurfaces the socket of the natural socket with an artificial component. Most orthopedic surgeons will use the term “total shoulder” interchangeably with the term “anatomic total shoulder”. This type of total shoulder is dramatically different from reverse shoulder arthroplasty (see second tab) and different from Shoulder Hemiarthroplasty (see third tab).

Total shoulder replacement is a very gratifying operation for patients. Most patients experience a dramatic improvement in their shoulder’s flexibility. They generally notice a profound decrease in shoulder pain.

Improvements in Technology

I don’t believe I saw a shoulder replacement performed when I was in medical school in the 1970s. Shoulder replacement surgery was rare in those days. It was rare for good reason: shoulder replacements didn’t work very well in the early days. Unfortunately, that history has branded total shoulder replacement with an unwarranted reputation. There are some practitioners that still believe that total shoulder replacement does not work very well.

I performed my first total shoulder replacement in 1990. I’m not sure exactly how many I have done, but I think I’ve done between 600 and 800 total shoulder replacements. I am grateful to the practitioners, researchers, companies and local representatives that have worked so hard for so long to refine what is today a predictable, reliable, and worthwhile operation.

Total shoulder replacement is most commonly performed for the diagnosis of osteoarthritis of the shoulder. It is also utilized to treat other forms of arthritis in the shoulder that have reached a point such that nonoperative treatment is unacceptable.

The Surgery

Total shoulder replacement surgery is done in a hospital operating room. The patient is generally anesthetized with a nerve block called a “scalene block” along with a general anesthetic. Once I begin operating, it usually takes me about two hours to do a typical total shoulder replacement. I do the surgery. I’m the only physician present during my surgeries (excluding the anesthesiologist). I do not utilize a nurse practitioner or physician assistant when I perform surgery and I perform the surgery from start to finish. I also help position the patient on the bed before the surgery starts.

When the surgery is completed a patient usually spends about one hour in the recovery room. Then they go to a regular hospital bed. Most will spend two nights in the hospital. It’s very rare for a person not to return to their home after their two-night hospital stay. A few patients will need to go to a rehabilitation facility, but most do not. Unless there is a unique factor that governs the patient’s hemoglobin level, I do not transfuse patients after shoulder replacement surgery. They usually don’t need it.

On the day of surgery most patients are very comfortable. The nerve block used to eliminate pain during surgery generally lasts for the remainder of the day of surgery. Patients may experience the worst pain during the 24-hours after the nerve block wears off. That pain is severe enough to require regular narcotic pain medication. During the second postoperative day, the pain diminishes to a remarkably low level.

Recovery

First Few Weeks

As soon as the arm awakens from the anesthetic, it’s okay to begin using it. A sling is used only if the patient wants to use the sling. A total shoulder replacement is ready for use for many day-to-day tasks from the very beginning of the recovery. Therapy begins the morning after surgery, and after the patient leaves the hospital they do home exercises for the first 2 weeks. Patients are very confident about how to do the exercises as a result of the training they receive while in the hospital. It is not necessary to go to a physical therapist, nor is it necessary for a physical therapist to come to you in most cases during weeks one and two of recovery.

I prescribe narcotic pain medication for the patient to use at their discretion to control pain. Generally a person is able to diminish their narcotic pain medication use very quickly. It is not unusual to have a need for narcotics only at bedtime by the 2nd week postoperative mark.

Within days of their surgery, most patients can bathe themselves, put on and take off their clothes, and tend to all personal hygiene tasks independently. I allow patients to drive when they are free of narcotics. I find that many online references imply that driving cannot take place for months. I have not found that to be a necessary restriction.

I use surgical glue instead of stitches on the skin when I perform shoulder replacement surgery. The surgical glue is waterproof. This diminishes the chance of infection. It eliminates the need for a bandage. From the very beginning, it is okay with me for a patient to shower and bathe as they normally would. Because there is no bandage, you will note a lot of bruising and discoloration around the surgical wound. This is normal.

The entire operated extremity develops swelling after the surgery. A lot of bruising usually appears in the first few days; that bruising will progress down the arm and usually involve part of the forearm. Some of the bruising may be evident for up to weeks after the surgery.

The Two Week Mark

About two weeks after the surgery date, I examine the patient in the office. If all seems appropriate, I then recommend outpatient physical therapy. That therapy is usually prescribed by me at a frequency of about three times per week. There are many fine physical therapy locations in the Greenville area. I have experience with many. I have compiled these facilities into a list that I can provide for you. Everyone on my list of physical therapy locations represents a facility that has rehabbed shoulder patients for me before and has passed my muster. I will send you there with a detailed prescription that outlines what should and should not be done to your new shoulder.

Six Weeks After Surgery

If all is healing well at six weeks, all restrictions on range of motion and exertion of the shoulder are lifted. At this point most patients are very happy with their new shoulder. They’re able to do things that they haven’t been able to do for years. For example, they may be able to reach back and put a belt through a loop in the small of their back. Men are able to put a wallet in their pocket for the first time in a long time. I expect a patient to be able to use her new shoulder to brush the back of her head and hold a hairdryer. It’s a lot of fun to watch a patient’s joy as he regains abilities that he thought were gone forever.

Three Months After Surgery

I find that most patients feel like they are fully recovered three months after surgery. That is not the case, however. The muscles that had been restricted from use for years and years will continue to gain strength until about one year following surgery.

When a patient is fully recovered from surgery, I’ll usually recommend that they follow-up about once a year.

The Life of a Shoulder Replacement

A well cared-for total shoulder should be expected to last about 15 years. There is wide variation in the durability of total shoulders. It would be a mistake for anyone to think that fifteen years is guaranteed; however, many of the total shoulders I did over 20 years ago are still functioning very well. Some of the shoulders I’ve done have failed within the first few years.

If you think you may someday want to have total shoulder surgery performed, I encourage you to explore the FAQs:

What surgery are you suggesting?

I am recommending that you consider replacing your shoulder joint with an artificial shoulder joint. Replacement of both the ball and the socket of the shoulder joint will usually result in a dramatic decrease in one’s pain. Movement will usually improve dramatically too, but it doesn’t return to the movement of a normal shoulder.
Post-op Instructions

Is it done in an operating room?

Yes.

How will I be anesthetized?

One can have this surgery under a general anesthetic. The surgery can also be done with just the shoulder anesthetized and intravenous sedatives. That method involves numbing nerves to the shoulder. It is called an interscalene block. The sedation is such that most patients nap during the procedure. You and your anesthesia professional will decide which anesthetic is best for you.

Do I have to stay in the hospital?

Most patients will remain in the hospital for two nights after their surgery. Some will stay longer if they have significant medical problems that require attention around the time of the surgery.

What are the alternatives to surgery?

It is always an option to simply accept the pain and functional impairment with an arthritic shoulder and do no other intervention. Sometimes injections of cortisone into the shoulder joint will give relief of pain. Medication taken for arthritis by mouth will also give relief to some patients. In most cases, exercises designed to stretch and strengthen the shoulder muscles will lessen pain somewhat.

Is the operation done arthroscopically or through an incision?

The operation is done through an incision along the front of the shoulder. It is usually at least 4 inches long. It leaves a notable scar on the front of the shoulder.

About Your Doctor

How many of these have you done?

I do not have an exact total. I have been performing surgery since 1981. Over several years I have done between 600-700 operations on the shoulder.

I am a Board Certified Orthopaedic Surgeon. I have been in practice at Piedmont Orthopaedics since 1986. I subspecialize in my practice, and most of what I take care of relates to problems of the shoulder.

Risks

What are some of the things that could go wrong?

The anesthesia carries risks with it. The person who evaluates you for your anesthetic will discuss those risks with you. In general, complications from anesthesia are very rare, but they do exist.

How often does infection occur?

Approximately 1 percent of shoulder replacement surgeries will become infected.

What happens if there is infection?

Infection will often require that another operation be done on the shoulder. During the surgery, the infected tissue is washed. Sometimes, surgery involves removing the artificial parts and replacing them in a third operation done weeks after the removal.

Will my shoulder get stiff?

The best results from shoulder replacement occur in a patient that is motivated to do the straight-forward exercises taught to them by their physical therapist after surgery. I will also coach on the proper way to do the exercises. Stiffness can result if a patient does not perform these exercises.

Could I die?

No surgery is absolutely safe. It is possible that one could die from any type of operation. The death rate from shoulder arthroplasty surgery is very low. I would estimate it to be in the range of 1 in 500. Other major events such as heart attack or stroke are extremely rare following shoulder replacement surgery.

Will I need a blood transfusion?

Almost certainly, no. Shoulder replacement does result in moderate blood loss, but it is extremely rare that the loss is significant enough to require blood transfusion. Since transfusion is so rare, I usually do not ask patients to donate the blood ahead of surgery.

Benefits

Will it relieve my pain satisfactorily?

Most patients are thrilled with the amount of pain relief that results from shoulder replacement surgery. Within weeks, many patients say their pain is already less than it was prior to surgery. It continues to get better as the weeks go by. The soreness following surgery is usually perceived by patients as being “different”, and most find that surgical pain is not nearly as bothersome as the arthritic pain. The surgical pain slowly diminishes as time passes.

What are the benefits of surgery?

Most patients notice a significant decrease or elimination of their shoulder pain. Their flexibility and comfortable range of motion increase dramatically. They notice increased use of the arm and perceive that it is stronger, but often the perception of greater strength is simply because the shoulder no longer hurts so much.

Will I have limitation on what I can do after it is healed?

Yes. Controlled movements of the arm such as everyday household tasks are fine, but I would advise against any activity that could result in a broken shoulder. Such activities include rock climbing, motorcycle racing, and aggressive football or soccer. I also do not recommend activities that pound the shoulder with violent movements such as chopping wood or using a sledge hammer.

A Common Sequence of Recovery

What is involved in this type of surgery?

In preparation of surgery, you will be asked to not eat or drink for at least 8 hours prior to surgery. Specific times to stop all food and drink will be given to you by your anesthesia professional. If you are on a drug that causes blood thinning such as Plavix or Coumadin, be sure to mention that to me. It may be important that those drugs be stopped well in advance of surgery. If you have rheumatoid arthritis or lupus and are on certain drugs for those conditions, they too may need to be stopped prior to surgery.

It is okay to eat and drink as soon as you feel like it after surgery. The pain will be controlled by using pain medication pills that I will prescribe for you or medication given through your IV. Neither method will entirely eliminate all of the pain, but it will make it tolerable. The pain can also be helped by the use of ice on the shoulder and sitting in an upright position.

What is the overall recovery from this operation? How long does it take to completely recover?

Six months to a year.

Will I be hurting that long?

No. Generally by one week following surgery the patient feels better, and often by 6 weeks following surgery the patient is using no prescription pain medication at all.

How long will I need prescription pain medication?

Most patients will use it regularly in the first week and periodically until about 3 weeks following surgery. Often by week three, it is only used at night.

When are the sutures removed?

I usually use surgical glue, so there are no sutures to remove.

When can I get it wet?

The glue is waterproof, so it is okay to take a bath or shower from the very first day.

Will I have to wear a sling?

Yes. A sling is provided at the time of surgery and the patient is instructed to use it for the first 6 weeks following surgery. It can be removed in certain environments such as the safety of your home. It is important that you are confident that no one will bump into you and that you will not trip if your sling is off. When the sling is off, it is important not to move the shoulder beyond the safe arc of motion.

Is any other special wound care required?

Your scar will look prettier sooner if you rub vitamin E into the scar.

Reverse Shoulder Arthroplasty

Reverse Shoulder Arthroplasty

A reverse shoulder arthroplasty is a type of shoulder replacement designed for patients with cuff tear arthropathy. It is designed to return function to a shoulder that does not have a functioning rotator cuff tendon.

So what’s not to like about having a reverse shoulder arthroplasty? The complication rate. The complication rate of reverse shoulder arthroplasty is very high compared to many of the joint replacements done by orthopedic surgeons. Those complications include:

  • Infection
  • Axillary nerve injury
  • Periprosthetic fracture
  • Dislocation
  • Painful loosening of components
  • Disappointing range of motion of the new shoulder

Infection

Infection is a complication that commonly results in the need for two additional operations. The first operation is the removal of all artificial components if the infection is severe enough to require such removal. It is common that 6 weeks of intravenous antibiotics are then administered and a third operation is undertaken when clinical evidence of infection is absent. During the third operation a new reverse shoulder arthroplasty is performed. In most published reports of reverse shoulder arthroplasty performed in America or Europe the infection rate is about 4%. This infection rate is about 4x higher than the commonly reported infection rate for traditional total shoulder replacement. There are many theories about why the infection rate is higher, but with today’s methodology, a drastic reduction in chances of infection is unlikely to happen in the near future.

Axillary nerve injury

The axillary nerve is the nerve supply to the deltoid muscle of the shoulder. Injury of the axillary nerve as associated with reverse shoulder arthroplasty covers a spectrum from very mild symptoms to complete loss of function of the nerve. If the axillary nerve does not function at all, most of the benefit of reverse shoulder arthroplasty is lost. The reported incidents of axillary nerve injury varies widely in journal articles. Part of the reason for that is there are many ways to detect axillary nerve injury. Electrophysiologic testing will often detect an injury to the nerve that is often unrecognized by the patient and his physician. That type of mild injury is usually not clinically significant.

Periprosthetic fracture

A fracture may occur around the artificial components. The most common periprosthetic fracture to occur with reverse shoulder arthroplasty is a break of the proximal humerus bone. It is relatively rare that one has a break of the shoulder socket. The treatment of a periprosthetic fracture depends on the characteristics of the fracture. Treatment could be as simple as diminishing stresses on the arm in the first few weeks of healing, to a situation as complex as prolonged surgery to add plates and screws and other fixation aids to a fracture.

Dislocation

Reverse shoulder arthroplasties seem to dislocate more commonly than traditional total shoulder replacements. They often require a return trip to the operating room to solve a dislocation problem. Sometimes a dislocation problem cannot be solved. Such patients will be faced with repeated dislocations throughout their lifetime.

Painful loosening of components

Reverse shoulder arthroplasty was originally introduced in France. The creator of the device advocated that reverse shoulder arthroplasty only be done in patients with 5 years or less of life remaining and in patients with no other reasonable surgical option to deal with their pain and functional impairment.

Reverse shoulder arthroplasties aren’t durable. The components tend to wear out within a few years of use. When they begin to wear out, they usually cause pain. A worn-out reverse shoulder arthroplasty can usually be improved with revision surgery to replace or modify the loose components.

Poor range of motion

Successful reverse shoulder arthroplasty dramatically improves the patient’s range of motion. This is something the patient and doctor both look forward to. A few reverse shoulder arthroplasty patients will never regain good motion of their shoulder. There are many reasons why that might happen. If a patient doesn’t develop good range of motion, the surgery can be a disappointment.

The American Academy of Orthopedic Surgeons has excellent information available at their website under the subcategory Reverse Total Shoulder Replacement.

Reverse Shoulder Arthroplasty FAQs

What surgery are you suggesting?

I am recommending that you consider replacing your shoulder joint with an artificial shoulder joint. Replacement of both the ball and the socket of the shoulder joint will usually result in a dramatic decrease in one’s pain. Movement will usually improve dramatically too, but it doesn’t return to the movement of a normal shoulder.

Pre-op Instructions

Is it done in an operating room?

Yes.

How will I be anesthetized?

One can have this surgery under a general anesthetic. The surgery can also be done with just the shoulder anesthetized and intravenous sedatives. That method involves numbing nerves to the shoulder. It is called an interscalene block. The sedation is such that most patients nap during the procedure. You and your anesthesia professional will decide which anesthetic is best for you.

Do I have to stay in the hospital?

Most patients will remain in the hospital for 2 nights after their surgery. Some will stay longer if they have significant medical problems that require attention around the time of the surgery.

What are the alternatives to surgery?

It is always an option to simply accept the pain and functional impairment with an arthritic shoulder and do no other intervention. Sometimes injections of cortisone into the shoulder joint will give relief of pain. Medication taken for arthritis by mouth will also give relief to some patients. In most cases, exercises designed to stretch and strengthen the shoulder muscles will lessen pain somewhat.

Is the operation done arthroscopically or through an incision?

The operation is done through an incision along the front of the shoulder. It is usually at least 4 inches long. It leaves a notable scar on the front of the shoulder.

About Your Doctor

How many of these have you done?

I have not done many. There are surgeons in Greenville that have done hundreds more than me. If you are a candidate for a Reverse Shoulder Arthroplasty (RSA) you may want to choose a more experienced surgeon to perform the surgery

The main reason I so rarely perform this surgery is because I see how unhappy patients are with their result if they experience one of the many failures of a RSA. I encourage you to ask your surgeon lots of questions before you decide that RSA is for you.

Risks

What are some of the things that could go wrong?

The anesthesia carries risks with it. The person who evaluates you for your anesthetic will discuss those risks with you. In general, complications from anesthesia are very rare, but they do exist.

How often does infection occur?

About 4 percent of shoulder replacement surgeries will become infected.

What happens if there is infection?

Infection will often require that another operation be done on the shoulder. During the surgery, the infected tissue is washed. Sometimes, surgery involves removing the artificial parts and replacing them in a third operation done weeks after the removal.

Will my shoulder get stiff?

The best results from shoulder replacement occur in a patient that is motivated to do the straight-forward exercises taught to them by their physical therapist after surgery. I will also coach on the proper way to do the exercises. Stiffness can result if a patient does not perform these exercises.

Could I die?

No surgery is absolutely safe. It is possible that one could die from any type of operation. The death rate from shoulder arthroplasty surgery is very low. I would estimate it to be in the range of 1 in 1000. Other major events such as heart attack or stroke are extremely rare following shoulder replacement surgery.

Will I need a blood transfusion?

Almost certainly, no. Shoulder replacement does result in moderate blood loss, but it is extremely rare that the loss is significant enough to require blood transfusion. Since transfusion is so rare, I usually do not ask patients to donate the blood ahead of surgery.

Benefits

Will it relieve my pain satisfactorily?

Most patients are thrilled with the amount of pain relief that results from shoulder replacement surgery. Within weeks patients usually say their pain is already less than it was prior to surgery. It continues to get better as the weeks go by. The soreness following surgery is usually perceived by patients as being “different”, and most find that surgical pain is not nearly as bothersome as the arthritic pain. The surgical pain slowly diminishes as time passes.

What are the benefits of surgery?

Most patients notice a significant decrease or elimination of their shoulder pain. Their flexibility and comfortable range of motion increase dramatically. They notice increased use of the arm and perceive that it is stronger, but often the perception of greater strength is simply because the shoulder no longer hurts so much.

Will I have limitation on what I can do after it is healed?

Yes. Controlled movements of the arm such as everyday household tasks are fine, but I would advise against any activity that could result in a broken shoulder. Such activities include rock climbing, motorcycle racing, and aggressive football or soccer. Protection of a RSA requires strict avoidance of certain movements of the arm and shoulder that may seem ordinary and safe.

A Common Sequence of Recovery

What is involved in this type of surgery?

In preparation of surgery, you will be asked to not eat or drink for at least 8 hours prior to surgery. Specific times to stop all food and drink will be given to you by your anesthesia professional. If you are on a drug that causes blood thinning such as Plavix or Coumadin, be sure to mention that to me. It may be important that those drugs be stopped well in advance of surgery. If you have rheumatoid arthritis or lupus and are on certain drugs for those conditions, they too may need to be stopped prior to surgery.

It is okay to eat and drink as soon as you feel like it after surgery. The pain will be controlled by using pain medication pills that I will prescribe for you or medication given through your IV. Neither method will entirely eliminate all of the pain, but it will make it tolerable. The pain can also be helped by the use of ice on the shoulder and sitting in an upright position.

What is the overall recovery from this operation? How long does it take to completely recover?

Six months to a year.

Will I be hurting that long?

No. Generally by one week following surgery the patient feels better, and often by 6 weeks following surgery the patient is using no prescription pain medication at all.

How long will I need prescription pain medication?

Most patients will use it regularly in the first week and periodically until about 3 weeks following surgery. Often by week three, it is only used at night.

When are the sutures removed?

I usually use surgical glue, so there are no sutures to remove.

When can I get it wet?

The glue is waterproof so it is okay to take a bath or shower from the very first day.

Will I have to wear a sling?

Yes. A sling is provided at the time of surgery and the patient is instructed to use it for the first 6 weeks following surgery. It can be removed in certain environments such as the safety of your home. It is important that you are confident that no one will bump into you and that you will not trip if your sling is off. When the sling is off, it is important not to move the shoulder beyond the safe arc of motion.

Further discharge instructions will be given by Dr. Jernigan, as individual needs may vary.

Is any other special wound care required?

Your scar will look prettier sooner if you rub vitamin E into the scar.

Shoulder Hemiarthroplasty

Shoulder Hemiarthroplasty

What surgery are you suggesting?

I am recommending that you consider replacing your shoulder joint with an artificial joint. Replacement of the ball of the shoulder joint will usually result in a dramatic decrease in one’s pain. Movement will usually improve dramatically too, but it doesn’t return to the movement of a normal shoulder.

Pre-op Instructions     Post-op Instructions

Is it done in an operating room?

Yes.

Will I be anesthetized?

This is usually done under a general anesthetic. The surgery can also be done with just the shoulder anesthetized. That method involves numbing nerves to the shoulder. It is called an interscalene block. It is common to be sedated if the surgery is done with an interscalene block. The sedation is such that most patients will take a nap during the procedure. You and your anesthesia professional will decide which anesthetic is best for you.

Do I have to stay in the hospital?

Yes. Most patients will remain in the hospital for two nights after their surgery. Some will stay longer if they have significant medical problems that require attention around the time of surgery.

What are the alternatives to surgery?

It is always an option to accept the pain and functional impairment with an arthritic shoulder and do no other intervention. Sometimes injections of cortisone into the shoulder joint will give relief of pain. Medication taken for arthritis by mouth will also give relief to some patients. Exercises designed to stretch and strengthen the shoulder muscles will lessen pain somewhat.

Is the operation done arthroscopically or through an incision?

The operation is done through an incision along the front of the shoulder. It is usually at least 4 inches long. It leaves a notable scar on the front of the shoulder.

About Your Doctor

How many of these have you done?

I have done 600-800 shoulder replacements of all types. I have probably done less than 50 hemiarthroplasty cases since 1986. I am a Board Certified Orthopaedic Surgeon. I have been in practice at Piedmont Orthopaedics since 1986. I subspecialize in my practice, and most of what I take care of relates to problems of the shoulder. I currently perform about 70 “regular” shoulder replacements per year.

Risks

What are some of the things that could go wrong?

The anesthesia carries risks with it. The person who evaluates you for your anesthetic will discuss those risks with you. In general, complications from anesthesia are very, very rare, but they do exist.

How often does infection occur?

Approximately 1% of replacements of this type will become infected.

What happens if there is a post operative infection?

Infection will often require that another operation be done on the shoulder. During that surgery, the infected tissue is washed. Sometimes, surgery involves removing the artificial parts and replacing them in a third operation done weeks after the removal. Intravenous antibiotics may be necessary for 6 weeks, and long-term oral antibiotics may be necessary.

Will my shoulder get stiff?

The best results from shoulder replacement occur in a patient who is motivated to do the straight-forward exercises taught to them by their physical therapist after surgery. I will also coach on the proper way to do the exercises. Stiffness can result if a patient does not perform these exercises.

Could I die?

No surgery is absolutely safe. It is possible that one could die from any type of operation. The death rate from shoulder arthroplasty surgery is very low. I would estimate it to be in the range of 1 in 500. Other major events such as heart attack or stroke are extremely rare following this type of surgery.

Will I need a blood transfusion?

Almost certainly, no. Shoulder replacement does result in blood loss, but it is extremely rare that the loss is significant enough to require blood transfusion. Since transfusion is so rare, I usually do not ask patients to donate the blood ahead of surgery.

Benefits

Will it relieve my pain satisfactorily?

Most patients are thrilled with the amount of pain relief that results from shoulder replacement surgery. Within weeks patients usually say their pain is already less than it was prior to surgery. It continues to get better as the weeks go by. The soreness following surgery is usually perceived by patients as being “different,” and most find that surgical pain is not nearly as bothersome as the arthritic pain. The surgical pain slowly diminishes as time passes.

What are the benefits of surgery?

Most patients notice a significant decrease of their shoulder pain. Their flexibility and comfortable range of motion increase. They notice increased use of the arm and perceive that it is stronger, but often the perception of greater strength is simply because the shoulder no longer hurts so much. The ability to reach forward and upward (as when reaching into a cabinet) will be significantly less than a normal shoulder but will usually be much better than your shoulder before surgery.

Will I have limitations on what I can do after it is healed?

Yes. Controlled movements of the arm such as everyday household tasks are fine, but I would advise against any activity that could result in a broken shoulder. Such activities include rock climbing, motorcycle racing, aggressive football or soccer. I also do not recommend activities that pound the shoulder with violent movements, such as chopping wood or using a sledge hammer.

What about physical therapy?

It takes a very long time to gain all the strength and flexibility you will gain. You will need to exercise your new shoulder each day for at least six months.

A Common Sequence of Recovery

What is involved in this type of surgery?

In preparation of surgery, you will be asked not to eat or drink for at least 8 hours prior to surgery. Specific times to stop all food and drink will be given to you by your anesthesia professional. If you are on a drug that causes blood thinning such as Plavix or Coumadin, be sure to mention that to me. It may be important that those drugs be stopped well in advance of surgery. If you have rheumatoid arthritis or lupus and are on certain drugs for those conditions, they too may need to be stopped prior to surgery.

It is okay to eat and drink as soon as you feel like it after surgery. The pain will be controlled by using pain medication pills that I will prescribe for you or medication given through your IV. Neither method will entirely eliminate all of the pain, but it will make it tolerable. The pain can also be helped by the use of ice on the shoulder and sitting in an upright position.

What about the overall recovery from this operation? How long does it take to completely recover?

Approximately 1 year is common.

Will I be hurting that long?

No. Generally by one week following surgery the patient feels better, and often by 6 weeks following surgery the patient is using no prescription pain medication at all.

When are the sutures removed?

I use surgical glue. No sutures or staples require removal.

When can I get it wet?

The surgical glue is waterproof, so it is okay to take a bath or a shower from the very first day.

Is any special wound care required?

You will have a prettier scar if you protect it from sunlight for one year. That is easily done with a sunscreen applied along the scar. It is also okay to rub Vitamin E into the scar. The contents of a Vitamin E gel capsule can be expressed onto one’s fingertip, rubbed into the wound twice a day, and continued for about 2 months after surgery.

Will I have to wear a sling?

Yes. A sling is worn much of the day until several weeks from surgery. It can be removed to perform daily exercises and can also be removed when the arm is resting in a safe position while sitting. Whenever there is a risk that you might fall or trip, the sling should be on.