Preparing for Shoulder Surgery

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Before surgery

General questions

Lankenau Medical Center
Kim Hogan, Orthopaedic Program Manager
484.476.8523
hogank@mlhs.org

Bryn Mawr Hospital
Beth Mathews, Orthopaedic Program Manager
484.337.3412
mathewsb@mlhs.org

Paoli Hospital
Donna Levan, Orthopaedic Program Manager
484.565.1537
levand@mlhs.org

Riddle Hospital
Cara Peck, Assistant Nurse Manager/Orthopaedic Program Manager
484.227.2801
peckc@mlhs.org

Pre-surgery preparation questions

Pre-surgery billing/financial counseling (all hospitals): 484.337.1970
Anesthesia billing/insurance inquiries (all hospitals): 1.800.222.1442

Lankenau Medical Center
Preadmissions: 484.476.2530
Day of surgery issues: 484.476.2364

Bryn Mawr Hospital
Preadmissions: 484.337.4541
Day of surgery issues: 484.337.4905

Paoli Hospital
Preadmissions: 484.565.1087

Riddle Hospital
Preadmissions: 484.227.6236, vinceg@mlhs.org

Surgery date change/ill prior to surgery: Call your surgeon's office.

After-surgery billing questions for all hospitals: Call billing customer service, 484.580.4360

Pre-op checklist

  • Choose a coach. Select a family member or friend who can drive you to the hospital on the day of surgery, pick up your prescriptions, drive you home on the day of discharge and drive you to medical appointments during recovery.
  • Be prepared. For those who have a power of attorney or living will document for medical affairs and decisions, a copy of the document is required for your chart.
  • Plan ahead. To make the days following surgery easier, look around your home to make sure it is safe for your recovery.
  • Attend preadmission testing/clearances. Follow your surgeon's instructions for preadmission testing and medical clearance, which includes a physical examination, medical history and lab tests.

An introduction to the anatomy of your shoulder

Anatomical illustration of a shoulder
The shoulder is made up of three bones: the scapula (shoulder blade), clavicle (collar bone) and humerus (upper arm bone). The upper part of the shoulder blade (acromion) projects over the shoulder joint. The collarbone meets the shoulder blade called the acromioclavicular (AC) joint; the other end of the collarbone joins the breastbone (sternum) called the sternoclavicular joint. The joint capsule is a thin sheet of fibers that surrounds the shoulder joint. The capsule allows a wide range of motion yet provides stability. The rotator cuff is a group of muscles and tendons that attach your upper arm to your shoulder blade. The rotator cuff covers the shoulder joint and capsule. The muscles attached to the rotator cuff enable you to lift your arm, reach overhead, and take part in activities such as throwing or swimming. A sac-like membrane (bursa) between the rotator cuff and the shoulder blade cushions and helps lubricate the motion between these two structures. 

Types of surgery

  • Arthroscopic surgery—In this procedure, the surgeon inserts a pencil-thin device with a small lens and lighting system into tiny incisions to look inside the joint. The images from inside the joint are relayed to a TV monitor allowing the doctor to visualize the joint in high definition. Surgical instruments can be inserted to make repairs. This procedure can be done on an outpatient basis with discharge on the day of surgery.
  • Open surgery—This approach is necessary for shoulder replacement and some rotator cuff repairs. Open surgery can be done through small incisions of just a few inches. Recovery and rehab are defined by the type of surgery performed inside the shoulder, rather than the approach.

Shoulder replacement options

Shoulder replacement illustration

  • Primary total shoulder—With this procedure, the head of the humerus is replaced with an implant that includes a stem with a smooth, rounded metal head. The socket is replaced with a plastic cup that fits the head of the ball perfectly.
  • Reverse total shoulder—The normal structure of a total shoulder replacement is reversed. The ball portion is attached to the scapula and the artificial socket is attached to the humeral head. This allows the deltoid muscles of the shoulder to take over the work of moving the shoulder, increasing joint stability. This procedure is often indicated for patients with compromised rotator cuff function.
  • Shoulder resurfacing—The damaged humeral head is sculpted to receive a metal cap that fits on the bone, which then functions as a new smooth articular surface. This procedure is less invasive than a total shoulder replacement.

Arthroscopic surgery

Shoulder replacement surgeries

What to expect:

  • Surgery will last approximately one to two hours
  • You will be in the hospital most of the day
  • You will generally go home the same day, as per your surgeon and insurance

What to expect:

  • Surgery will last approximately two to 2 ½ hours
  • You will be in the hospital one night, as per your surgeon, your procedure, and your insurance

Pre-op arrangements

Start within three days of setting your surgery date:

  • Arrange for a "coach"
  • Avoid dental work, including cleanings and any other invasive procedures, for up to two weeks before surgery
  • Preadmission testing:
  • Complete a living will

During the weeks before your surgery, many people will be asking you about your insurance coverage, medical history and legal arrangements. The following may help:

Arrange for a "coach"

Coaches are relatives or friends who:

  • Help you prepare for surgery
  • Assist with your recovery and rehabilitation
  • Drive you to the hospital for your procedure and back home after discharge
  • Pick up your outpatient pharmacy medications

Your coach will also be a first contact for updates from the healthcare team after surgery.

Manage your medical health

Speak with your primary care doctor about staying healthy for surgery, especially if you smoke, have diabetes or are obese.

Work with your physician to optimize your health reduces the risk of infections and poor wound healing.

If you are a current smoker, we advise you to:

  • Quit smoking and/or using tobacco or nicotine products for at least two weeks before surgery.
  • Avoid smoking cessation products such as Nicorette® gum, nicotine patches, nicotine vaping, and second-hand smoke. Nicotine, in any form, can delay bone fusion and healing.

Please discuss smoking cessation plans with your medical doctor. There are new medications available to help with this. Also, you may use the Main Line Health Contact Center at 1.866.CALL.MLH (225.5654) to find out about other resources or cessation classes.

Dental work

Two weeks before surgery:

  • Avoid dental extractions, periodontal work, and cleanings along with other invasive procedures involving the risk of bleeding.
  • If you require this work, please schedule well in advance of surgery.

Up to 90 days after surgery:

  • Do not schedule dental work (including routine cleanings) or other invasive procedures.

Preadmission testing and nursing assessment

Attend 10-14 days before surgery (if not already completed)

Your surgeon will provide instructions on medical evaluations needed before surgery, such as:

  • Health history and physical exam
  • Blood work, EKG or x-rays
  • Other medical clearances

Your surgeon will provide instructions on medical evaluations needed before surgery, such as medical appointments and medical testing as needed.

You will need to have a COVID test no more than four days prior to your scheduled surgery.

Please have the following information filled out on the Medication Tracker:

  • Allergies and side effects from medications and anesthesia
  • Medications (prescription and over-the-counter) and herbal supplements
  • Dose of each medication in milligrams (mg), milliliters (mL) or units, and when you take the medications (am vs.pm)

Please provide us with a list of dietary restrictions (e.g., vegetarian, gluten-free, kosher).

Finally, please plan to stay about two hours for pre-op clearance at the hospital or your physician's office.

  • Your providers at this appointment will give you instructions and go through your medication list.
  • Your providers at this appointment will also let you know what medication you can take the morning of surgery, if any are allowed.

Legal arrangements

If you have a power of attorney for medical affairs or a living will, you must provide copies of these documents in advance.

Insurance and copay information

For assistance from a financial counselor, call 484.580.4360.

Medical status

If you have any questions about inpatient vs. outpatient status, it's important to discuss this in advance with your surgeon or your surgical coordinator.

For more information about medical status, see our commonly asked questions.

Plan for surgery and recovery

Seven to 14 days prior to surgery

Follow your surgeon's instructions on discontinuing certain medications during this time.These may include certain prescriptions, over the counter pain relievers as well as vitamins and herbal supplements. Those instructions and details may be in your surgeon's pre-op check list; please refer to that list if you received one.

Please note that for pain, you CAN safely take Tylenol over the counter as well as any other medications specifically approved by your surgeon.

If you take blood thinners (e.g., Plavix, Arixtra, Coumadin, Pradaxa, Eliquis or Xarelto), speak with the prescribing physician before stopping any of these medications.

If you are asked to stop taking medications, please do so before surgery as instructed.

If your surgeon indicates that you need to discontinue taking nonsteroidal anti-inflammatory drugs (NSAID), some of these drugs include the following:

  • Ibuprofen (Advil/ Motrin)
  • Naproxen (Aleve/Naprosyn)
  • Meloxicam (Mobic)
  • Celebrex
  • Indocin
  • Voltaren
  • Lodine

You may also be asked to stop taking:

  • Aspirin
  • Osteoporosis medications (like Fosamax, Actonel)
  • Vitamins, especially vitamin E and K and fish oil
  • Over-the-counter herbal supplements
  • Hormone-related medications, like Estrogen

Plan for at-home care after surgery

Ask yourself: While I'm recovering, who will…

  • Help me prepare meals?
  • Take me home from the hospital, to my doctor appointments, and to physical therapy?
  • Have my prescriptions filled upon discharge?
  • Care for my pet while I'm in the hospital?

IMPORTANT: Always wash hands well after contact with pets. Keep pets clean. No sleeping with pets after surgery.

Quick tip: Frequent hand washing and daily skin cleansing promotes good health and hygiene. Daily skin cleansing helps remove microbes (germs) that may cause infections. This is especially important if you are having a surgical procedure.

Modify your home

  • Make entrances to your home and its' rooms as accessible as possible.
  • Cut the grass and tend to your garden or other yard work.
  • Clear away all unnecessary clutter to reduce tripping hazards.
  • Tack down loose carpeting, put small area rugs away and remove electrical cords and other obstructions from walkways.
  • Install nightlights in bathrooms, bedrooms and hallways, and keep pathways clear.
  • Do your laundry and put it away.
  • Clean your house and put fresh linens on your bed.
  • If you are considering installing a grab bar in your bathtub/shower, make arrangements to install it now.
  • Consider using a tub bench or shower chair (not usually covered by insurance) to maximize your safety.
  • Place a rubber mat or nonskid adhesive strips on the bottom of your bathtub or shower stall.
  • Keep often used items at waist height and avoid reaching overhead or below your hips especially if the item is bulky or heavy.
  • Prepare and freeze single served meals and arrange for someone to shop for you.
  • Use a spray deodorant after surgery which will be much easier to work with than a roll-on or a deodorant stick.
  • Purchase handheld items and aids you may need (per therapist's advice during recovery).
  • Arrange to have someone care for your pets or loved ones while you are away from home and in the early recovery period after surgery.
  • If you use a cane or walker already, consider how you will get around only using one arm for stability.

Prior to discharge from the hospital, your therapists will advise you on what home modifications and aids you may need during your recovery.

Sling use

After surgery you may have a sling or immobilizer applied to your arm/shoulder for a period of time to help limit use and movement. This is needed to allow the joint and surrounding area to heal properly.

Note: Not all insurers pay for assistive devices.

Quick tip: How can I gain access to my lab work or care summary after discharge? Sign up for our Patient Portal before your surgery.

Physical therapy (PT) once you're cleared to start: How to plan ahead of time

  • Discuss your PT needs with your surgeon
  • Call your insurance company for therapy coverage and copay information
  • If you need outpatient therapy, choose a PT location that's close to home
  • Plan for transportation to PT until you're cleared to drive

The day before surgery

The day before your surgery, someone will call you between 2:00 pm and 5:00 pm (Lankenau between 3:00 pm and 7:00 pm) with the scheduled time of your surgery and any additional details you might need.

Note: If your surgery is on Monday, you will be called on Friday afternoon.

Evening(s) before surgery

  • Use the recommended pre-op antibacterial soap as directed by your surgeon for joint replacement patients (the next section reviews instructions on how to use this soap).
  • Please refer to Anesthesia directions for fasting guidelines prior to surgery

Plan on bringing to the hospital (if applicable to you):

  • Photo identification, insurance cards and copay
  • Glasses with labeled case (no lenses that day), hearing aids and CPAP or BIPAP machine with mask (write down settings)
  • Power of attorney documentation, advanced directive, living will (if applicable)
  • Your favorite personal hygiene products
  • Shoes with good heel (sneakers, loafers)
  • Loose-fitting pants with elastic waistband (sweat pants, shorts) or opened front/button down shirt to accommodate dressings/bandages
  • Patients can often become confused after surgery; pictures of loved ones can help you avoid this, as can crossword puzzles or a book
  • Cell phone (with charger labeled with your name)

Plan on leaving the following at home:

  • Tight-fitting clothes and flip-flops (safety hazard)
  • Jewelry, credit cards, valuables, large sums of cash
  • Medications, unless told otherwise

Please refer to anesthesia directions for fasting guidelines prior to surgery.

One to two nights before surgery and the morning of surgery:

  • Read instructions provided by your health care provider.

Taking showers just before surgery

If your surgeon recommends, to prepare for surgery wash with a specific antiseptic soap, such as Hibiclens or Bactoshield. Available at local pharmacies (if not given by your surgeon's office or by Pre-Admission Testing), these soaps contain 4% chlorhexidine gluconate. If you're allergic to this or any other ingredients listed on the bottle, do NOT use these products. Talk to your provider about alternatives.

One or two nights before and the morning of surgery, shower or bathe with Bactoshield, Hibiclens or an alternative per surgeon request.

You may shampoo your hair and wash your body with your regular soap including the following areas, rinsing thoroughly to remove residue:

  • Genital area
  • Face
  • Hair

Next, avoiding the 3 areas noted above, apply Hibiclens or Bactoshield to the rest of the body. Use this product as a liquid soap, applying directly to the skin and washing gently. Do not rub or scrub skin. Leave on the skin for two full minutes then rinse thoroughly with warm water.

Do not use Hibiclens or Bactoshield in:

  • Head, face, ears or mouth
  • Genital area
  • After washing with antiseptic soap, do not:
  • Wash with your regular soap
  • Apply lotions, powders or perfumes to areas cleaned with the antiseptic soap
  • Use hair removal products or shave at or near the surgical site 48 hours before your procedure

Do not use hair removal products or shave at or near the surgical site within 48 hours before your procedure.

Continue to your hospital stay