Shoulder Arthroscopy Discharge Instructions

The minimally invasive surgical procedure arthroscopy is used to view and treat problems that occur within a joint or surrounding a joint. Although arthroscopy can be used to look at the spine, hip, ankle, wrist and fingers, it is most often employed to view the knee and shoulder.

Arthroscopic procedures cause little surgical trauma. Post-operatively, patients can return to their homes quickly with discharge instructions on how to care for themselves.

General information

• The surgical procedure is named after the flexible fiber optic piece of equipment that is passed through a small incision in the skin and is used to visualize the surgical field and transmit pictures to a monitor.

  The actual surgery is performed through additional small incisions (portals). The surgeon will use the portals to remove inflamed tissue and repair tears or damage.

  Because the incision is small with an arthroscopic procedure, there is less surgical trauma to the tissues, a relatively short recovery period, and basic discharge instructions for most orthopedic surgeries.

Warnings

• All surgeries carry the risk of complications and are a stress on the body. Call emergency services (in most areas 911) immediately if you experience chest pain, shortness of breath or one-sided weakness.

Cautions

• Post operatively you may encounter some situations in which the physician should be alerted promptly. These situations include a temperature over 100 degrees F (37.7 degrees C), increased drainage, redness, swelling or foul odor at the wound site or the wound starting to pull apart (dehiscence). Additional conditions that would require prompt physician notification include poor circulation of the post-operative arm, as evidenced by numbness, tingling, of arm, hand or fingers or possibly increased swelling of the limb, or color change of the skin or nail beds. Other urgent concerns that the doctor should be notified of are increased or new onset of pain, increased difficulty in moving the shoulder, arm, hand or fingers of the post-operative arm or pain or difficulty urinating.

Pain Control

• Take pain medication as directed. Take pain medication before the pain is severe. By waiting too long to take pain medication, the pain is more difficult to control.

  Use the sling or shoulder immobilizer as directed. Do not remove this unless the physician has instructed you to do so. Using the sling/immobilizer will prevent muscle strain and help limit your pain.

  Use an ice pack in the first 48 hours after the surgery. This will decrease swelling; swelling contributes to pressure in the surgical area and causes additional pain. Place a towel between the ice pack and skin surface. Leave the ice pack on for no longer than 20 minutes and then it needs to be off for 20 minutes. This pattern of having the ice on and off can be continued throughout the day.

  If pain is not controlled, the physician should be notified.

Diet

• Post-operatively, the patient will be started on a clear liquid diet. The diet is advanced according to the patient's tolerance for food. At the time of discharge, most patients are consuming a full liquid diet (milkshakes, cream soups and oatmeal) or their regular diet.

  Nutritious foods which are high in protein, vitamins A and C, calcium and zinc should be consumed to promote wound healing. As narcotics can be constipating, the diet should also be high in fiber.

Shoulder precautions

• Do not perform any exercises with the post-operative arm unless directed by the physician (at time the pendulum exercise may be given to the patient to perform).
  When exercises are prescribed, perform them exactly as directed. Do not perform extra repetitions as overuse may tax the muscles and limit future shoulder mobility.
  Do not use the post-operative arm to push off of a surface; this causes contraction of the muscles. Do not engage in any contact sports or heavy lifting. Activities that utilize the wrist and elbow are permitted.

Pendulum Exercise

• If there are no complications during the shoulder arthroscopy, pain is well controlled, and the incision looks good, the patient may be instructed on pendulum exercise.

  According to the American Academy of Orthopaedic Surgeons, to perform the pendulum exercise you should bend forward 90 degrees at the waist, using a table for support. Then, rock body in a circular pattern to move arm clockwise 10 times, then counterclockwise 10 times. Do 3 sessions a day of this.