Shoulder

Video 1: Dr. Trent McKay: Post-Operative Care After Shoulder Surgery 
For those who have had an open shoulder surgery, the incision is a bit larger, and we use a different type of dressing, such as Aquacel. This is a large, occlusive dressing that seals the incision from the environment. The care for this dressing is straightforward—you don’t need to do anything with it. It can tolerate getting a bit wet, but during the first couple of weeks after surgery, it’s best to avoid getting it wet entirely. Showers are fine as long as you keep the operated arm out of the water spray. Avoid soaking the area—no hot tubs, lakes, oceans, or baths. 
 
The stitches we use can be deceptive; some patients try to remove them on their own. Please don’t do that. We place the stitches in a specific way, and if removed incorrectly, half of the stitch could remain in the incision. Typically, these stitches are removed 10 to 14 days post-surgery in the clinic. 
 
When it comes to scar care, avoid applying anything like Vitamin E or Neosporin to the incision while it is healing. After about a month, some scar massage may be beneficial to help release scar tissue. Simply use your finger to rub the skin around the scar, which helps break up deeper scar tissue. 
 
A common issue is how to dress when you’re not supposed to move your arm. The key is to avoid lifting the arm overhead. Start by letting your arm hang down and place the operated arm into the sleeve first, keeping it close to your side. Then use your other arm to guide the sleeve over your shoulder. Button-up shirts can make this easier. 
 
Sleeping comfortably after shoulder surgery is one of the biggest challenges. I don’t have a specific rule on how you should sleep as long as you’re wearing your sling. Most patients find it difficult to sleep flat on their back, so many opt to sleep in a recliner or with pillows propped up in bed. As time goes by, you can slowly recline further back until you’re able to lie flat again. 
 
One important exercise post-surgery is the pendulum exercise. A common mistake is using the arm muscles to move the arm. Instead, let gravity hold your arm down and use your hips and feet to create a swinging motion, keeping the muscles relaxed. 
 
Another major concern after shoulder surgery is falling. A recently operated shoulder won’t do well in a fall, so be very careful. Make sure your home is free of tripping hazards, and consider using a cane if you have balance issues. Also, be mindful that post-surgery medications and anesthesia can affect your balance and coordination. 
 
To help with recovery, it’s best to stop smoking, as nicotine can negatively affect tissue healing. Maintaining a good diet with plenty of protein, calcium, and vitamin D is also recommended. If you experience a fever over 101.5°F, redness around the incision, fluid discharge, or a sudden increase in pain, contact your physician immediately. 
 
Video 2: Dr. Trent McKay: Tutorial On Using a Sling After Shoulder Surgery 
Hi, I’m Dr. Trent McKay, a board-certified orthopedic surgeon specializing in shoulder surgery at Olympia Orthopaedics in Olympia, Washington. Today, I want to share some tips on using a sling after shoulder surgery, which can be crucial for recovery. 
 
Slings are often used after shoulder surgeries such as rotator cuff repair, labral repair, shoulder instability surgery, and shoulder fractures. The purpose is to immobilize the shoulder to aid in proper healing. 
 
A typical sling has a cradle for the arm, a pillow for support, and a strap system. Unlike traditional slings, this one is designed to prevent pressure on the neck by placing the strap under the armpit. Your arm goes into the cradle, the straps go over the shoulder like a backpack, and there are clips for easy removal. 
 
To remove the sling, use the clips rather than undoing the Velcro straps. Once adjusted for your size, there’s no need to mess with the Velcro again. 
 
Another common feature is a small strap for resting your thumb, which helps keep the arm in place. However, be careful not to use this strap when your arm is still numb from a nerve block, as it could compress a nerve and cause prolonged numbness. 
 
You may also notice a ball attached to the sling. This is not a toy; it’s meant to help reduce swelling. By squeezing the ball, you activate your forearm muscles, which helps pump fluid back into your body and prevents swelling. 
 
Another helpful tool is an ice machine. These devices provide continuous cold therapy, which can be a significant part of pain relief. However, remember to have a layer of clothing between your skin and the device to prevent frostbite, especially if your arm is numb from a nerve block. 
 
When positioning the arm in the sling, keep it close to the body to protect the delicate repairs. The sling should also be worn while sleeping to prevent accidental arm movements. 
 
The sling is essential for protecting the surgical repair while tissues heal and integrate properly. Think of it as a way to ensure the new tissue connections remain undisturbed during the early healing phase. 
 
If you have trouble fitting the sling or need adjustments, please contact our office. We’re here to help ensure a comfortable and effective recovery. 
 
Video 3: Dr. Trent McKay: Managing Medication After Shoulder Surgery 
I’d like to discuss how to manage medications after shoulder surgery. This varies for everyone, but I generally prescribe two types of pain medications. One is a narcotic like Percocet or Norco, which contains Tylenol to enhance pain relief. However, too much Tylenol can be toxic, so I also provide a “rescue medication,” usually a standalone narcotic like Oxycodone, for in-between doses. 
 
Most surgeries use a nerve block to numb the arm, which can last from 12 to 36 hours. I recommend taking a pain pill before bed the first night, as the block could wear off unpredictably. 
 
The duration for taking pain medication also varies. Smaller surgeries may require a shorter period, while more extensive procedures may need longer use. It’s essential to use the minimum amount necessary, as narcotics are highly addictive. 
 
Common side effects of surgery and narcotics include constipation, which can be managed with stool softeners like Colace or Miralax. Nausea is another common issue, and I typically provide medication for this as well. Some patients also experience itching, which can be relieved with over-the-counter Benadryl. 
 
Regarding anti-inflammatory medications like ibuprofen or Aleve, these can sometimes interfere with healing. I generally advise against taking them for about a month after a major repair, but you should discuss this with your doctor. 
 
A frequently asked question is about driving post-surgery. You cannot drive while on narcotics, as it is considered driving under the influence. You must also be able to safely operate the vehicle. If you get into an accident while driving in a sling, you could be held liable. 
 
Lastly, patients often ask how much they can lift after surgery. A good rule of thumb is to keep it very light—no more than a cup of coffee—while in a sling. Remember, any weight lifted goes through the shoulder, so even small movements can stress the healing tissue. 
 
Before surgery, we recommend using benzoyl peroxide wash to reduce skin bacteria and a Hibiclens wash to disinfect the area, both of which help minimize infection risk. 
 
Post-surgery, the bulky dressings should be left on for two days. After that, you can remove them and switch to a simple band-aid to protect the incision sites.