Noteworthy information from awarded, world-class surgeon Dr. Ian Lo

Following surgery, most patients will experience a variable amount of pain. This level of pain is dependent on what type of surgery you have had and how your body reacts to surgery. Dr. Lo will give you a prescription for pain medication following surgery to control your pain. 

You may also apply intermittent ice to the shoulder to relieve pain. Icing the area is most helpful in the first 72 hrs. Never apply ice directly over the skin. Wrap it in a towel or cloth. You may apply ice for 30-40 minutes every hour. If you feel you are having an extraordinary amount of pain following surgery despite taking medication, please contact Dr. Lo.

Following shoulder arthroscopy, there will be a significant amount of swelling in the shoulder. This swelling is due to the surgery itself and due to the arthroscopy fluid used to expand the joint. It is not uncommon for the swelling and bruising to travel down the arm into the forearm and hand and the chest and thorax. You should perform simple hand, wrist, and elbow exercises several times a day to help with the swelling. If you feel you have unusual swelling or bruising after your surgery, please contact Dr. Lo.

Shoulder arthroscopy is performed through small 1 cm puncture incisions through the skin. Depending on what procedure is performed, you may have anywhere from 2 to 10 small incisions. Most patients have 3 to 6 small puncture incisions.

Since shoulder arthroscopy is performed by expanding the joint using fluid, this fluid must drain out of the shoulder after surgery. After shoulder arthroscopy, a bulky dressing will cover the wound to soak up this drainage. It is not uncommon for the dressing to become saturated with fluid. This fluid may be slightly blood-tinged but, for the most part, represents drainage of arthroscopy fluid and not blood. If the dressing becomes saturated, it may be reinforced with more gauze or changed. Otherwise, the dressing may be changed 48-72 hours after surgery and usually covered with simple bandages.

There is usually a bulky dressing and gauze, which is first removed. Underneath there are white bandages called ‘all-in-ones,’ which may be left on for 5-6 days post-op. After 5-6 days, you may peel these off. Underneath the ‘all-in-ones’ are small thin white tapes across each puncture wound, called SteriStrips. The SteriStrips help keep the wounds clean and opposed. These will commonly fall off on their own, usually in 1-2 weeks. If they do not, you may peel them off at that time. 

It is not uncommon to have a small amount of drainage from the puncture wounds, covered with a small amount of gauze and tape. It would help if you change your dressing as often as it gets dirty, accidentally wet in the shower, and at least once a day until the wounds appear dry and healed. You can clean the area around the wounds with a clean cloth or alcohol pad. If your bandages are still there after two weeks, you may gently peel them off. If you feel you have an extraordinary amount of drainage or thick blood is draining from your wound, please contact Dr. Lo.

The frequency depends on what type of surgery you have had. In general, if you have had a repair such as a rotator cuff repair, labral repair, or instability repair, then the sling is worn for 3 to 6 weeks. During this time, you should wear your sling 100% of the time (including sleeping) unless you are doing your exercises, taking a shower, or sitting comfortably. For example, if you are sitting comfortably watching TV, you may take your sling off and rest your arm in a comfortable position.  

If you wish to type on a computer or write, you may sit at a desk, take your sling off, rest your arm on the desk or a pillow, and type or write. When you are up and walking, even if in the house, it is safest to use your sling to avoid any inadvertent injury such as a fall or sudden motion.

Suppose you have had only a decompression type procedure (i.e., subacromial decompression, acromioplasty, distal clavicle excision), or a procedure to gain motion (i.e., capsular release for frozen shoulder). In that case, your sling is for comfort only. You may take your sling off as soon as possible and begin moving your shoulder. If you are having trouble wearing your sling, please contact Dr. Lo.

You can gently use your operated arm to eat. It is easiest to slip your arm out of the sling and use your hand to feed yourself by bending at the elbow. Keep your elbow at the side and do not reach or do anything away from your body, such as picking up a plate, cutting tough meat, or lifting anything heavy (i.e., no more than a coffee cup).

Avoid soaking the wound (i.e., taking a bath) until the wound is completely healed, which may take up to 3 weeks. You may shower or sponge bath 48-72 hours after surgery. You may take your arm out of the sling when taking a shower and support the arm and its weight using the opposite arm or a homemade cloth sling.  

For the first 5 days, keep the wounds dry using a garbage bag or taping Saran wrap over the shoulder. Do not scrub the area. After taking a shower, pat the wounds dry with a clean towel and reapply new bandages. It is essential to keep the axilla (aka: armpit) of the operated shoulder clean and dry. To clean the axilla, do not try to lift the arm or elbow away from the body using the shoulder muscles. Instead, it is more comfortable to lean towards the operated side and let the arm gently dangle away from the body supporting the arm. You can then wash and dry the axilla. 

Most shoulders arthroscopies are performed on an outpatient basis. Therefore you will require someone to accompany you to and from surgery. You will not be allowed to leave on your own and must have someone with you the night of surgery. 

Generally speaking, the first 3-5 days following surgery are the most difficult. During this period, it is preferable to have someone who can assist you intermittently through the day with simple daily tasks, such as cleaning, dressing, cooking, and more. During the first 2 weeks, most patients will slowly become more comfortable doing regular day-to-day activities on their own.

Depending on your surgery, Dr. Lo will determine how long you should be protected in your sling. The length of time may be from 3 to 6 weeks. It is unsafe to drive during this time. After discontinuing the use of your sling, it is recommended not to drive a vehicle until your operated arm is consistently and comfortably out of its sling. For some patients, this may be another week or two.

Some patients have difficulty finding a comfortable position to sleep. It is easiest for many patients to sleep in a reclining chair or propped up with pillows in bed. This positioning seems to relax the shoulder for many patients and can be easier to position the sling. If you sleep on your back, it may help to place a small pillow behind the elbow or shoulder to help support the shoulder’s weight. If you sleep on your side (the operated side up), it may help to place a pillow between your arms. When you get in and out of a bed or chair, try not to use your operated arm to push.

Dr. Lo will discuss with you when formal physical therapy will be required. In most cases, formal physical therapy will not begin until after your first follow-up visit. However, Dr. Lo will instruct you on your home exercise program to be performed immediately after surgery. 

Dr. Ian Lo and his team can coordinate your post-operative rehabilitation and physical therapy. These services can be arranged through Gateway Surgery, or your physical therapist of choice.

The timing of your return to work depends on the type of work you do, how much pain you are in, and what kind of surgery you have had. Most patients do not work until they are seen back in the clinic about 2 to 3 weeks after surgery. After 2-3 weeks, most patients can only tolerate single-handed work, such as answering the phone or light deskwork duties.  

Your ability to work and your specific job duties will depend on your type of surgery and your rehabilitation progress. Please remember that it is unsafe to drive during your period of sling immobilization. However, you should contact Dr. Lo to ask specifically about your job and when you can return.

Shoulder surgery is performed to keep people active. However, during the early post-operative period, we must balance the activity level with the shoulder’s protection.  

You are encouraged to stay active and return to some activities when you feel able. You may go for a walk outside, walk on a treadmill, or ride a stationary or recumbent bike. We do not recommend any impact cardiovascular activity such as running or jumping, due to the shoulder’s bouncing. For instance, you can ride a stationary bike, but you should not do a spin class.

You can go to the gym and lightly work your lower-extremities. Light lower extremity machine strength training might include seated leg extensions, seated leg curls, leg press, body-weight lunges, and body-weight squats. You should not use your upper extremity for any weight training or upper extremity stabilization or weight-bearing such as planks. 

 Try your best to take it easy. Surgery will temporarily affect your overall energy level and cardiovascular fitness. 

Although blood clots are not common following shoulder surgery, blood clots are always a risk following any operation. They can even occur spontaneously without surgery or injury. The most considerable risk of a blood clot following surgery is usually within the first 4 weeks after prolonged immobilization. That is why you must stay active and do the exercise program provided to you by your physiotherapist. 

Some factors associated with a higher risk of blood clots include a history of a blood clotting disorder, smoking, oral contraceptive pills, pregnancy, being overweight or obesity, cancer, heart failure, inflammatory bowel disease, age > 60, or those with prolonged travel or immobilization. 

Be aware of any suspicion of blood clots. Contact your doctor or proceed to the nearest emergency department if you experience:  

•     Calf pain
•     Calf swelling
•     Extreme arm swelling
•     Chest pain or discomfort that is worsened with a cough or deep breath
•     Shortness of breath
•     Difficulty breathing
•     Lightheadedness, dizziness, or fainting
•     Rapid pulse 
•     Coughing up blood

Dr. Lo is here to help you. Please contact his office if you have any problems, questions, or concerns.