At-Home Tips

At home

There's no place like home — especially when you return from the hospital. You'll want to do all you can to make the transition easier by organizing things in advance. You have scheduled your shoulder surgery, and now it is time to prepare for your discharge before you ever come to the hospital.

Many shoulder surgeries are performed on a person's dominant arm; since that is the arm that we use the most. This surgery will have a significant impact on how you perform your Activities of Daily Living (ADLS). ADL's are the tasks we do daily often without having to think about them. ADL's include dressing, bathing, eating, sleeping, grooming, and working.

There are things you can do to prepare yourself preoperatively for how your surgery will impact your ability to perform these tasks, and we will cover some tips for you to use once you are discharged from the hospital.

Sleeping

Something we all take for granted is getting in and out of bed, normally a simple task. At the hospital, patients have the benefit of side rails to grab onto to assist with bed mobility. We do not always have these at home. Also, depending upon the height of your bed, this simple task might prove difficult once you are discharged to home.

We recommend sleeping on your back with your sling on. You should have a pillow for your head, and a small pillow or folded towel under the elbow.

Always get in and out of bed on your non-surgical side; you should NOT use your surgical arm to help! Many patients have elected to purchase or rent an electric chair lift for when they come home from surgery. The reclining lift chair is a powered recliner that you can sleep in, like any other recliner, but the chair also can lift you to a standing position. This might prove very helpful since you will have only one arm to help get yourself up and down.

Consider using a step stool to get in and out of bed, perhaps even switching sides of the bed for ease of getting in and out on your non-surgical side.

Bathing and toileting

Washing yourself without using your dominant arm is something that will take a little getting used to doing, as will using the toilet. It may seem embarrassing to talk about, but we all clean ourselves as a matter of habit and routine, and that routine will be different when you come home from the hospital. The only way to prepare for this change is to practice using your other hand with your washcloth, as well as your toilet paper. Equipment is available to assist with bathing and toileting if needed.

Dressing and grooming

Dressing yourself will also be a much different process when you come home from the hospital. Prepare outfits for yourself before you come to the hospital that will be easy to get on and off using only one arm. Sweat outfits and slip on shoes will make getting dressed a much easier process. Again, practice putting your clothes on with only one arm to get used to the process.

Remember to dress your surgical arm first, using one size larger shirts with button ups for ease, along with athletic shorts or pants with elastic waist bands for ease in dressing and toileting. For gentleman, we recommend an electric shaver to assist with your personal grooming. By practicing with the nonsurgical arm, shaving, brushing your teeth and your hair, will be much simpler after surgery. Another tip that will make life easier is to use a spray deodorant which will be much easier to work with than a roll on or a deodorant stick.

Eating

Eating will also take some practice since most of us use one hand to hold our fork. If you eat with your surgical arm, practice eating using the other hand. Preparing meals in advance of your surgery that are easy to make and eat with only one hand is recommended. Remember to cut food into portions that you can eat before you store your meals since using a knife and fork together after surgery may not be possible for a short time. Also, we recommend that you look for pop tops for soups and canned goods that will be easy to open without having to use two hands. An electric can opener can also come in handy. For any frozen foods, open the boxes ahead of time for easier access when you get home.

Working

Physical tasks that require two hands will not be permitted in the short term. Many of us do most of our work on the computer. A speech recognition program such as "Dragon Speak" will make operating your computer and typing documents a much easier process. Like all other tips provided, a speech recognition program takes some getting used to using, so practicing beforehand will make for a much smoother transition when you get home from the hospital.

Returning to work is usually directed by your surgeon and depends on the type of job and the type of surgery you have had. Consider other ergonomic equipment like rocker knives for ease cutting one handed.

Precautions

Rotator Cuff Repair, Bankart Surgery, Labral Repair, and Bicep Tenodesis: You will be asked to wear a sling or abduction pillow during the day and at night while lying down. Your physician or therapist will let you know when you no longer need to immobilize your arm. Typically, you will wear the sling for 4-6 weeks. Failure to follow this precaution can disrupt the stitches in your muscle/ tendon/ labrum and lead to a failed surgery.

Total Shoulder Replacement: You will be asked to wear a sling or abduction pillow during the day and at night while lying down. Your surgeon will let you know when you no longer need to immobilize your arm. Typically, you will wear the sling or brace for 3 to 4 weeks.

Pain and swelling control

To control the pain it is necessary to minimize swelling. Try to ice 15-20 minutes approximately every 2 hours. When using ice, you should place a small barrier (pillowcase or towel) between the ice and your skin to protect the skin from damage. If you have been instructed to exercise your shoulder, it is best to ice after the exercise. It is also important to follow the physician's instructions regarding medications.

Positioning

Sleeping position

• Patients without a sling: When sleeping on your back, place a pillow under your head and one pillow under each arm (elbow, forearm, and hand should rest on the pillow).If you choose to sleep on your side, sleep with the surgical side up and rest your arm on a pillow (as if hugging the pillow).You may find it helpful to roll up a small hand towel and gently place it between your arm and the side of your body.
• Patients with a sling: When sleeping on your back, place a pillow under your head and one pillow under each arm (elbow, forearm, and hand should rest on the pillow).We recommend that you do not sleep on your side at this time. If you are unable to sleep in bed, try resting in the recliner with your arm supported.

Sleeping in a semi reclined position in a lounge chair/recliner or propped in the bed with a wedge is helpful the first few nights home as your body starts the healing process and gets used to the sling/brace.

Changing positions

Be careful not to use your surgical arm when moving around or trying to get out of bed.

Sitting position

Sit with a pillow under your arms to take the weight off your shoulder and neck.

Home exercise program (see separate sheet from your surgeon)

It is important to perform all your exercises as instructed to prevent loss of motion and decrease muscle stiffness. Exercises may be mildly uncomfortable, however should not cause significant pain. Stop any exercise that causes excessive or prolonged pain. Your therapist will progress your exercises when you have your post-op physical therapy visit.

Skin care

When your arm is immobilized heat and moisture can become trapped under your arm causing skin irritation or a rash.to help prevent this from happening be sure to keep this area clean and dry.to do this place a soft cloth under your arm and wear clothing that can be easily put on and taken off like a buttoned shirt or a tee shirt that has been cut in the front.to clean under your arm, lean forward to let your arm dangle away from your body. Do not attempt to lift your arm!

Tips for surgical incision care

Your incision may be closed with dissolvable stitches, staples or regular stitches. If you have visible stitches or staples, these will need to be removed in about 14 days after surgery, so be sure to make your follow-up appointment with your surgeon for this to happen.

While at the hospital, you'll wear a dry gauze dressing. Once at home, follow surgeon's instruction if a dressing is needed. Do not apply any ointments or lotions to the incision area while it's healing.

YOU MAY NOT BATHE IN A TUB, SWIM OR USE A HOT TUB UNTIL YOUR INCISION IS FULLY HEALED.

Protect your incision site

• Do not shower until your orthopedic surgeon advises you to
• NO lifting or pushing with the surgical arm anything weighing more than a Kleenex. This includes no pushing up from sidelying.NO weight, no picking up plates or cups, nothing until you are cleared by your surgeon.
• Avoid walking when rushed, distracted, dizzy or tired. Avoid being dizzy by staying hydrated, resting for a moment between position changes and remembering to BREATHE as you get up and down.
• Don't walk on any surface you cannot verify is dry and flat. This means initially avoiding grass, gravel, leaves, mud, snow, ice, and sand.
• Avoid crowds if you can. If not, walk with a friend on your surgical side with their hand in the small of you back. This enables them to protect you from being bumped.
• Look down often but maintain good posture. Have any floor level hazards removed from your home (e.g. kid's toys, cords, small area rugs, clutter)

Driving

Resume only as directed by your surgeon (this is discussed at first postoperative visit).

• Be careful getting in and out of the car.
• Avoid twisting and bending. Instead turn body all at once as a unit.
• No car rides unless approved by surgeon except for after-surgery follow-up visit.
• Never drive while taking opioid pain medications.

Tips to prevent infection

Do:

• Eat a healthy diet and stay hydrated.
• Keep your incision clean, dry and protected.
• Notify your doctor right away of open skin irritations, infections (urinary tract, respiratory) or fevers.
• Practice good hygiene, wipe down cell phones with alcohol, and keep your home clean (linens, bathroom).
• Keep pets clean and away from incision site, and wash hands after contacting pets.

Do not:

• Use lotions or powder on or around your incision
• Touch your incision without washing hands first
• Wear artificial nails
• Swim or get into a hot tub
• Sleep with pets for four weeks after surgery

Be sure to ask your doctor when you can continue with these activities.

Tips for being around pets

• Keep pets clean and away from incision site.
• Always wash hands after contact with pets.
• Do not sleep with pets during the post-op period. Some domestic pets have organisms like MRSA which can be transmitted to humans.

Use of anticoagulants

Your surgeon might prescribe a blood thinner (anticoagulant) to prevent blood clots. This can be an Aspirin or—as necessary—a stronger anticoagulant. While safe when taken as instructed, blood thinners can cause bleeding if you fall or have an injury.

If on blood thinners, call your surgeon immediately if you experience bleeding from anywhere (e.g., urine, surgical site, nose, etc.) Please also notify your surgeon if you have the following:

• Oozing from the surgical site
• Painful swelling in your arm, elbow or hand
• Cold, numbness or tingling of arm (If you've had a nerve block this is normal up to 18 hrs)
• Dizziness or confusion
• Rapid or unusual heartbeat
• Chest pain or shortness of breath
• Vomiting or nausea that persists for more than 24 hrs
• Fever above 101 degrees

Things to avoid while on anticoagulants

Over-the-counter drugs like aspirin-containing compounds, nonsteroidal medications (e.g., ibuprofen or aleve) and vitamins can interact with anticoagulants and cause bleeding. avoid these products while on a blood thinner.

For similar reasons, you should also avoid or postpone the following:

• Drinking alcohol
• Using a straight-edge razor
• Getting a procedure (e.g., dental work)*
• *if it is not possible to postpone a procedure, be sure that your dentist or physician is aware that you are taking anticoagulants and that you have had a recent joint surgery.

Recognizing and preventing potential complications

Infection

While rare, call your surgeon immediately if you notice the following signs of an infection:

• Increased swelling and redness
• Increased drainage or drainage that changes color or has an odor
• Surrounding skin that is hot to the touch
• Increased pain in your incision, not relieved by pain medication and not associated with exercise
• Night sweats or fever greater than 101 degrees

Blood clots

Do not take a "wait and see" approach. Call your surgeon immediately if you experience the following signs of a blood clot:

• Increased swelling in your thigh, calf or ankle that does not go down when your feet are elevated above heart level
• Pain and tenderness in the calf of either leg
• Increased warmth or redness in either leg

Blood clot in lungs (pulmonary embolus or PE)

A pulmonary embolus is a blood clot that has traveled to your lungs.

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