Post-operative Instructions for Rotator Cuff Repair, Biceps tenodesis
Wound Care
- You will have a sterile gauze dressing covered with tape. Please keep the dressing clean and dry. You may take a sponge bath, or shower with plastic wrap over the shoulder (use tape to prevent leaks).
- Remove the dressing 3 days after surgery to inspect the incisions. Leave any steri-strips (white butterfly bandages) in place. If the incisions are dry, you may leave the dressing off. You may get the incision wet in the shower 5 days after surgery, but do not submerge in water.
- You may have some clear, yellowish, or bloody drainage from the incisions; this is normal. Please keep the dressing in place until there is no further drainage.
- Occasionally there is excessive bloody drainage; please change the dressing when it becomes completely saturated. Sterile gauze is available at the pharmacy. If you continue to have saturated dressings beyond the first few dressing changes, please call the office.
- If the incisions are draining pus (opaque, thick, white fluid}, or if there is redness that worsens over the next 1-2 days, call the office immediately. Do not apply any ointments or creams.
- There may be visible sutures, these are non absorbable and will be removed at your follow up appointment.
Activity
- Please wear your sling as much as possible for the first 2 weeks to protect your shoulder (especially when sleeping). You may come out of the sling to shower, dress, or for passive motion (see below).
- You may use your arm for limited activities, such as eating or typing, but please keep your elbow at your side. Do not lift, push, or pull anything heavier than one pound (about a cup of coffee). Please use pain as your guide and avoid any activity that causes severe pain.
- Passive range of motion of the shoulder should be done 3-4 times daily by doing pendulum exercises. Undo your sling and let the arm hang down, bend forward and let the index finger point at the floor. Make small circles with your finger and slowly make the circles larger, alternating directions.
Follow up appointment
If an appointment has not already been scheduled, please call the office at 206-633-8100 and schedule an appointment for 7-10 days after your surgery. During this visit we will examine the surgical incisions, remove sutures if necessary, and progress your activity.
Physical Therapy
Physical therapy should begin as soon as possible after your first post-operative clinic appointment. You will need to choose a therapist and reserve an appointment. Please reserve in advance as they fill up quickly.
You may use our in-house therapists, or any therapist of your choosing. You will receive a prescription with specific therapy instructions during your clinic appointment.
Controlling your pain and inflammation
Some pain, swelling, and bruising is expected after surgery. It is usually most severe for the first 2-3 days. The following strategies are especially important during this time. Try to anticipate an increase in pain when the nerve block wears off, usually within 12-24 hours.
- Rest – Take things easy for the first few days; try resting in a recliner chair or with pillow propping you up.
- Ice – Apply an ice pack (or a cold therapy machine if you have one) to your shoulder. Take care not to put ice directly on the skin. Ice for 30 minutes at a time, and remove for 30 minutes in between sessions. You should continue this for the first 2-3 days or longer if you still have pain and swelling.
- Medication – You may have received a prescription for narcotic and/or anti-inflammatory medication. Please take them as instructed. The medication is most helpful if taken 30-45 minutes prior to any planned activity or exercise. Try to anticipate a return of pain after the nerve block has worn off by taking medication before going to bed.
Returning to work
You may return to work when it is safe to do so within the above activity restrictions. We recommend waiting 1-2 weeks before returning to light duty work However, it will take 3 months or longer for the arm to return to full strength. Keep in mind that your employer may prohibit narcotics while at work Please continue to ice and elevate while at work A doctor’s note or Duty Status form can be provided during your follow up appointment.
Driving
You should avoid driving for the first 2-3 days. Afterwards, you may return to driving when it is comfortable to do so, and you are no longer on narcotics. For some it may take 1-2 weeks depending on your pain level, motion, etc. If you have any concerns, please wait to drive until after your follow up appointment so that we can assess your progress.
Medications and common side effects:
- Narcotics (oxycodone, hydrocodone, etc.)- prescription medication for reducing pain. They may cause drowsiness, confusion, nausea, and constipation. To avoid constipation, increase your intake of fiber, fruits, and vegetables, and stay hydrated. Over the counter laxatives can be taken to treat constipation while on narcotics; please see separate handout or ask your pharmacist.
- Anti-inflammatories (Ibuprofen, Naproxen, etc.) – available over-the-counter to reduce pain and inflammation. Avoid them if you have diagnosed kidney disease or active ulcers. This medication can cause upset stomach; please take them with food. To treat an upset stomach, take an over-the counter antacid or proton-pump inhibitor (ask your pharmacist for assistance).
- Acetaminophen (Tylenol) – Used to reduce pain and decrease fever. Avoid taking this medication if you have liver disease. Taking more than the recommended dose can lead to liver damage. For an adult, it is safe to take up to 3-4,000 milligrams each day (24 hour period). Some prescription narcotics already have acetaminophen in them.
- Antihistamines (e.g., benadryl, hydroxyzine) – Used to treat some side effects from narcotic use, such as itching and nausea. Can cause drowsiness and confusion.
Please call the office if you have the following:
– Fever above 101°, pus draining from wound, worsening redness or rash
– Difficulty breathing
– Continuous bleeding from wound (see “wound care” above)
– Numbness or weakness that is not improving after the nerve block has worn off (1-2 days)
– Intolerable pain when the above strategies for pain control have failed
For questions or concerns not addressed on this form, please call our office at 206-633-8100. The clinic is closed during the evenings, weekends, and holidays. For urgent matters after hours, an on-call provider can be reached at the above number.
