Total Shoulder Replacement Surgery Guidebook
Table of Contents 3 Your Guide to a Successful Recovery 4 Pre-Operative Care Focus On You Focus On Your Home Focus On Your Upcoming Surgery Preparing Your Skin for Surgery What to Bring to the Hospital
9 Hospital Care/Discharge Planning Day of Surgery The Plan for Your Pain Criteria for Discharge Coach’s Discharge Checklist Know your zone. Preventing Surgical-Site Infections
14 Post-Operative Home Care What You Can Do at Home Controlling Your Discomfort Body Changes Total Shoulder Replacement (TSA) Blood Clots in Legs or Arms (DVT) Blood Clots in Lungs Decreasing Your Risk of Falls Post-Operative Exercises and Goals
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Total Shoulder Replacement Surgery Guidebook
17 Appendix A: How to Move After Surgery After-Surgery Shoulder Precautions Applying and Removing Your Sling Transferring In and Out of Bed Getting Dressed Putting On and Removing Your Bra Showering After Your Total Shoulder Replacement
21 Appendix B: Medications Anesthesia Blood Thinners
22 Appendix C: Nutrition 23 Our Health Equity Promise
Your Guide to a Successful Recovery Preparation, education and a pre-planned discharge are very important for joint replacement surgery. This guidebook was made to help you understand: • What to expect through every step of your surgery process • What you will need to do before and after surgery • How to care for your new joint Remember, this is just a guide. Your care navigator, physician, physician’s assistant, nurses or therapists may add to or make changes to any of the suggested care plans. Always use their recommendations first and ask questions if you are unsure of any information. Keep your guide as a handy reference for at least the first year after your surgery.
The Orthopedic Care Navigator An orthopedic care navigator is a specially trained, registered nurse who provides expert clinical assistance and support to patients who are receiving care at AdventHealth. This confidential service is free of charge and available to all orthopedic patients. Your care navigator is dedicated to guiding you through your journey to orthopedic health — ensuring you receive the care you need when you need it. Our whole-person approach to care is designed to help you heal in body, mind and spirit. Your care navigator provides the following services tailored to your individual needs. • Serves as the clinical liaison between you and your health care team • Acts as a patient advocate through the surgical process and hospitalization • Educates you on your diagnosis and treatment options • Oversees the entire care process to help answer questions and ease your concerns after surgery • Provides education about the surgical and expected recovery processes that will be discussed in the pre-surgical joint replacement class
You’re not alone. We’re here to help.
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Pre-Operative Care Focus On You Stop nicotine products. • All nicotine products should be stopped before surgery. This includes cigarettes, nicotine gum, patches, vaporizers and smokeless tobacco. • Nicotine makes it harder to get oxygen to your new joint. Oxygen is needed for healing. Now is the time to stop in order to aid in recovery after surgery. • The American Heart Association provides many tips and resources to help you quit smoking. Call 1-800-AHA-USA1 or visit Heart.org/Smoking. • If you need help quitting smoking, contact your care navigator.
Exercise. • For exercises, goals and activity guidelines, see Activity Guidelines in this guidebook. • Under the guidance of your surgeon, it may be recommended that you perform pre-operative exercises or attend physical therapy. • Do not do any exercises that cause extreme pain or are not within your current range of movement.
Eat right. • See Appendix C for guidelines on eating healthy and preparing for surgery. • Practice good dental hygiene before and after surgery.
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Total Shoulder Replacement Surgery Guidebook
Focus On Your Home Prepare your home by doing things in advance. Cook meals and freeze them for after surgery
Clean, do laundry and put laundry away, including bed linens.
Cut the grass and/or do any yard work.
Install night lights in bathrooms, bedrooms and hallways.
Make arrangements. Arrange for someone to collect your mail and help with your trash.
Arrange for someone to care for your pets.
Arrange for someone to help with heavy housework cleaning.
Arrange for someone to do your grocery shopping.
Check your home for obstacles. Remove throw rugs and tack down any loose carpet in your home.
Remove electrical cords and other obstructions from walkways.
If you have more than one step, consider having a rail installed.
Your seats should be firm and should not have wheels or swivels. Arms are helpful for mobility.
Is your bed too high or low? Is there enough space to use the walker?
Will the space around your toilet fit the 3 in 1? (Approximately 19” x 28”)
Your shower chair should also fit flatly in the interior of your shower or tub.
Check if your bathroom needs grab bars. DO NOT USE SUCTION BARS.
Pre-Operative Care
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Focus On Your Upcoming Surgery Survey Your health care team would like you to complete a quick survey about your pain, mobility and whole quality of life. We’ll send you a link via text or email so you can answer the questions electronically. We may also ask you to respond in person or over the phone.
Pre-Admission Testing You must pre-register before your testing appointment
You will complete any lab work or tests ordered and review your medication list.
Pre-Operative Visit to Surgeon You may be scheduled for an appointment in your surgeon’s office before your surgery. This will serve as a final check-up and a time to ask any questions that you might have.
Stop medications that increase bleeding. Stop all anti-inflammatory medications, including aspirin, Motrin, Naproxen, vitamin E, fish oil, etc., as your doctor instructs. These medications may cause an increased risk of bleeding.
If you are taking a blood thinner, you will need special instructions for stopping the medication by the prescribing physician.
You can access your AdventHealth patient portal (also called MyChart) by scanning this QR code.
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Total Shoulder Replacement Surgery Guidebook
Preparing Your Skin for Surgery Instructions for Pre-Operative Showers With a Chlorhexidine Prep Solution Evidence shows that pre-operative showers with an antiseptic solution can reduce the risk of infection at the surgical site. • These showers decrease the number of normal bacteria on your skin, thus reducing the risk of infection. • You will perform these showers as instructed by your surgeon.
Take a shower and wash your entire body in the following manner. 1.
For the first shower, wash and rinse your hair first using your normal shampoo. Make sure you completely rinse the shampoo from your hair and body.
2. Do not wash your hair. Wash your face with your regular soap or cleanser and rinse completely. Then, turn off the shower. 3. Apply the antiseptic solution to a wet, clean washcloth and lather your entire body from the neck down. 4. Never use the antiseptic solution near your eyes or ears. DO NOT apply to your face, hair or groin area. 5. Gently wash your body, and focus on the areas where the incision(s) will be located for three minutes. Avoid hard scrubbing. 6. Once you have completed the scrub, wait three minutes. This wait time allows for the soap to kill the bacteria. 7.
Turn the shower on and rinse the antiseptic solution off your body completely. DO NOT wash with regular soap or shampoo after using the antiseptic solution.
8. Pat yourself dry with a clean, freshly washed towel. After the last shower before surgery, DO NOT apply powders, deodorants, lotions or perfumes. 9. Dress in freshly washed clothes. Sleep in freshly washed sheets and linens the night before surgery. Chlorhexidine 4.0% Prep Solution can be purchased from retail pharmacies, Amazon and your local AdventHealth Pharmacy.
Special Instructions You will be instructed by your physician about skin care and showering before surgery. Do not shave your leg or groin within 48 hours of surgery on the surgical leg.
Do not use any lotions, powder or deodorant on surgery day.
Please take medications the morning of surgery only as directed by your physician or nurse. Use chlorhexidine soap for showers. See more above.
Arrive on time. A late arrival can move or even cancel your planned surgery.
DO NOT TAKE MEDICATION FOR DIABETES ON THE DAY OF SURGERY.
Pre-Operative Care
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What to Bring to the Hospital Pack a suitcase for the hospital. • Loose clothing is preferred
• CPAP if you use one
• Sturdy shoes for walking
• DO NOT BRING any valuables
You can bring an electronic device to pass the time. Staff is not responsible for valuables during your stay.
Bring any assistive devices (walker) so we may inspect them for safety and adjust them to fit your height.
Bring a copy of your Advance Directives or Power of Attorney.
Bring your insurance card, prescription card, driver’s license or photo I.D., and any co-payment.
Bring a list of any medications you have taken in the last 30 days.
The morning of surgery, only clear liquids (coffee or tea with nothing added, or water) are allowed up until 1 hour before leaving home.
Note: Please leave your suitcase, tote bag and/or personal belongings in the car. Your family/friend can retrieve these once you are done with your surgery.
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Total Shoulder Replacement Surgery Guidebook
Hospital Care/Discharge Planning Day of Surgery Before Surgery, in the Pre-Op Unit You will be asked to put on a hospital gown and your clothes and shoes will be placed in a belongings bag. We will check your temperature, blood pressure, heart rate and breathing rate, as well as conduct safety checks including verifying your site of surgery and evaluating your risk for falls. You may be provided additional skin preparation. For information about the different types of anesthesia and what to expect before, during and after your surgery, please refer to Pre-Operative Care.
Immediately After Surgery You will be taken to a recovery area (PACU – Post Anesthesia Care Unit). During this time, pain control is typically established, and your vital signs are monitored. You can expect to have the following equipment: • Sequential compression devices (SCD) - used to prevent blood clots
• Incentive spirometer/coughing and deep breathing - used to prevent pneumonia • Cold therapy - used to prevent swelling
Family visitation is limited in the recovery room, but the recovery team will keep your family updated on your progress. The recovery time can vary for every patient. During this time, your surgeon will speak to your family member to update them on your surgery.
After Surgery • You should take a small walk in the hospital or at home with help the afternoon after surgery. • You will be receiving medication for pain, as needed.
• It's very important you begin ankle pumps as soon as you are able. You should do 10 reps every hour you are awake. This will help prevent blood clots from forming in your legs.
Ankle pumps: Point toes. Flex Foot. Repeat.
Hospital Care /Discharge Planning
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The Plan for Your Pain Having pain is normal when recovering from surgery. Your dedicated health care team is here to control your pain so you can actively participate in your recovery through breathing exercises, getting out of bed and physical exercise. Everyone feels pain differently. Your nurses will ask you to rate your pain on a scale from zero to 10, with zero being no pain and 10 being the worst pain you can imagine. Your nurse will also ask you to identify a tolerable goal for pain for you to participate in your recovery and daily activities like bathing, eating and talking with your family and friends. Remember, some pain is normal during recovery; zero is not an achievable goal. Your nurses and care team are very dedicated to keeping you comfortable and controlling your pain during your stay.
Numbing Medicines
Alternative Pain Measures
A local numbing medicine may be used by your doctor during surgery. This will reduce your pain and ensure that you are able to do your exercises. The effects of this numbing medicine can last from 24 to 72 hours after surgery. During this time, you may not be able to use or feel your arm. This is normal.
The pain after your surgery will lessen as you recover. Additional therapies may be used to help control your pain:
Type of Pain Medication
• Providing distractions like soothing music, prayer, deep breathing or relaxation.
• Cold therapy is used to lessen pain and also decrease swelling. • Positioning you for comfort.
You may receive a combination of medications that work together to provide maximum pain relief. Your nurses will describe any new medications to you, including what they are for and any side effects you may experience. Tell your nurse if you experience any side effects from your medications.
Your nurses can assist you in using these therapies to reach maximum comfort. You may also choose a “face” that matches how you are feeling. Important: You must let your nurse know early if you are having pain so they can intervene early to provide you the best relief.
Oral medication is medicine given in pill form. Your surgeon may prescribe pain pills on a scheduled basis around the clock or they may be prescribed as needed. Constipation can occur as a result of pain medications. Constipation lasting longer than three days should be reported to your physician.
Pain Scale 0
No Pain
10
1
2
Mild Pain
3
4
Moderate Pain
Total Shoulder Replacement Surgery Guidebook
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6
Serious Pain
7
8
Severe Pain
9
10
Worst Pain Possible
Criteria for Discharge Patients are discharged once medically and surgically ready. Please make sure that your coach is available to provide transportation home. You will be able to go home when you are able to walk and urinate, you have received instructions on sling use and pendulum hangs by the post-operative care team, your pain is managed and you have been cleared by your medical doctor and orthopedic team.
Coach’s Discharge Checklist Coaches, are you ready for discharge day? Before patient discharge, we want to make sure you know how to help the person you are coaching. Check if you feel comfortable with the following. £ What blood thinner is your loved one going home on? Does it need monitoring? If so, when and where? (See Appendix B) £ Is there a surgical dressing? If so, when does it need to be changed? £ What are the signs and symptoms of infection? £ How should you assist the patient in and out of bed? £ Do I know how to help the patient with pendulum hangs that should begin the day of surgery? £ How should you assist the patient up and down stairs? £ Do I understand how to help with the patient's sling? If you have any questions or concerns, please do not hesitate to ask a member of the Joint Care Team prior to discharge.
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Know your zone. Recovery From Orthopedic Surgery
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DAILY CHECK • Do not smoke. other assistive devices as instructed by a physician or physical therapist. • Keep dressing clean, dry and intact if you have one. • Follow your physician’s prescribed activity • Continue to take your medications as prescribed. precautions including elevation and bracing if • Eat a balanced diet. applicable • Do your exercises as prescribed by your provider. • Continue doing your breathing exercises. • Apply ice as ordered by your physician. • Walk several times a day using a walker, cane or
GREEN ZONE Your symptoms are under control if: • Your incision or dressing is clean, and there is little to no drainage • You have mild pain that can be controlled with medications • You can do exercises and activities of daily living
• You are not having shortness of breath, chest pain or fever • You have regular frequency in bowel movements • You are following your provider’s instructions for exercise and weight-bearing
YELLOW ZONE Call your health care provider if: • You notice lots of bruising or bleeding • You are having nose bleeds • You are bleeding from the gums or see blood in your urine or stool • It’s hard to urinate or you are unable to have a bowel movement for three days in a row or longer Call your surgeon/orthopedic doctor’s office if: • You have new numbness or tingling • You have issues with cast/splint or sling • You have more swelling or pain than normal since surgery (It is not unusual to have swelling for up
to six months after surgery.) • You have a fever greater than 101°F for more than 24 hours • You have drainage, redness or odor at the incision site • You feel calf tenderness, swelling or warmth in either leg • For hip and knee surgeries: You are unable to walk or put weight on your leg • You are not able to move your impacted extremity • You had shoulder surgery, and you have uncontrolled pain in your arm, deformity in the shoulder and/or lengthening of the arm
RED ZONE | Call 911 immediately. DO NOT DRIVE YOURSELF TO THE EMERGENCY DEPARTMENT. Call 911 if: • You have stroke symptoms including: loss of • You have pale, gray or blue nail, lip or skin color balance, blurred vision, face drooping on one • You are coughing up blood side, arm and/or leg weakness or speech difficulty. • You have a rapid heart rate • You have severe headache • You have severe shortness of breath • You have chest pain • You experience sudden wheezing
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Total Shoulder Replacement Surgery Guidebook
Preventing Surgical-Site Infections What is a surgical-site infection (SSI)? A surgical-site infection is an infection in the part of the body where the surgery took place. Most patients do not develop an infection. However, about one-to-three out of every 100 patients who have surgery do develop infections. Some of the common signs of a surgical site infection are: • Redness and pain around the area where you had surgery • Drainage of cloudy fluid from your surgical wound • Fever
PREVENTION IS THE KEY.
How do I prevent a SSI? Before your surgery:
Wound Healing Well
Infected Wound (Redness and Puss)
• Tell your doctor about other medical problems you may have. • Consider removing acrylic nails or trimming long natural nails. They are full of bacteria. Sometimes patients itch near the site, without washing hands. The mindless itching can pass the bacteria from the nails to the wound. • Quit smoking. Patients who smoke get more infections. Talk to your doctor about how you can quit before surgery. • Do not shave near where you will have surgery. Shaving with a razor can irritate your skin and make it easier to develop an infection. • Use Hibiclens or CHG soap the night before and morning of surgery to cleanse skin of ALL bacteria, as directed by your surgeon. • The day of surgery, you may also have povidone iodine or mupirocin applied to nostrils. This will reduce the chance of bacteria from your nose spreading to your surgical wound. At the time of your surgery: • Ask if you will get antibiotics before surgery. • Make sure that your health care providers clean their hands before examining you, either with soap and water or an alcohol-based hand rub. If you don’t see your providers clean their hands, ask them to.
What should I do when I go home? • Your doctor or nurse should explain what you need to know about taking care of your wound. Make sure you understand how to care for your wound before you leave the hospital. • Always wash your hands before and after caring for your wound. • If you have any symptoms of an infection, call your doctor immediately. • If you don’t see your providers clean their hands, ask them to. • No one should touch the surgical wound or dressings, including you. • Anyone who visits should clean their hands with soap and water or an alcohol-based hand rub. If you do not see them clean their hands, ask them to. • Do not let your incision get wet or dirty. No hot tubs, pool or ocean swimming. • Cleanliness at home should include freshly laundered towels and clothes after a daily shower. Clean linens on your bed.
Hospital Care/Discharge Planning
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Post-Operative Home Care When you go home, there are a variety of things you need to know for your safety, recovery and comfort.
What You Can Do at Home • Ankle pumps. • Deep breathing with an incentive spirometer — you will take this home. • You should continue taking a stool softener (i.e. Senokot S, Colace) until you are no longer on prescription pain medication. It is important to maintain a good bowel program since constipation can occur. • See Appendix A for information and examples on proper body positioning when sitting down, standing up and lying down.
Controlling Your Discomfort • Take your medications as prescribed by your physician. • Change your position every 45 minutes throughout the day. • Use ice for pain control after exercises, including home, physical and occupational therapy. • Take short walks daily.
Body Changes • Your appetite may be poor. Drink plenty of fluids to keep from getting dehydrated. Your desire for solid food will return. • You may have difficulty sleeping, which is normal. Do not sleep or nap too much during the day. • Your energy level will be lower than normal for at least the first month. • Narcotic pain medication can cause constipation. Use stool softeners or laxatives if necessary.
Total Shoulder Replacement (TSA) • Ice should be used after activity, exercise or physical therapy. In addition, it may be used at any other time to assist in reducing pain and swelling.
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Total Shoulder Replacement Surgery Guidebook
Blood Clots in Legs or Arms (DVT) Surgery may cause the blood to slow and thicken in the veins, creating a blood clot in a condition called deep vein thrombosis or DVT. This is why blood thinners are prescribed after surgery. (See Appendix B for more information about blood thinners.)
Signs of Blood Clots in Legs or Arms • Swelling in thigh, calf, ankle or arm that does not go down when raised above heart level
• Pain, heat and tenderness in calf, back of the knee or groin area (Note: Blood clots can form in arms or legs.)
How to Prevent Blood Clots • Ankle pumps (right and left sides)
• Compression stockings
• Walking
• Blood thinners
Blood Clots in Lungs An unrecognized blood clot could break away from the vein in the leg and travel to the lungs and is called a pulmonary embolus. This is an emergency and you should CALL 911 if suspected.
Signs of Pulmonary Embolus (PE) • Sudden chest pain
• Sweating
• Difficult and/or rapid breathing
• Confusion
• Shortness of breath
How to Prevent Pulmonary Embolus • Prevent blood clot in legs • Recognize a blood clot in the leg and call physician promptly
Decreasing Your Risk of Falls Falls are a leading cause of injury for older adults. These falls usually happen on a level surface from a standing or sitting position. Often the fall results in a fracture. Please closely review these fall prevention strategies: • Have regular medical physical exams. • Review your medications each time you visit your medical doctor. Some medications or combinations of medications can cause one to be lightheaded, dizzy and weak - all potential risks for falling. • Have routine eye exams. You may be wearing
incorrect glasses or develop cataracts without realizing it. • Physical therapy for fall prevention, core strengthening and gait training before and/or after surgery may be helpful. • See the section on preparing your home for additional tips.
Post-Operative/Home Care
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Post-Operative Excercises and Goals Activity Guidelines Exercising is important to obtain the best results from total shoulder surgery. You may receive additional exercises from a therapist or your surgeon as you progress through your recovery. For the first few weeks after surgery, it is very important to allow your shoulder to rest. This allows the soft tissue around your shoulder to heal. It is important to wear your sling, and only do the exercises prescribed to you by your surgeon. You may be instructed to wear your shoulder sling or immobilizer up to four to six weeks after surgery. It will help protect your shoulder from any unexpected movements, especially while sleeping. Your surgeon may instruct you to wear it less or more than this time period. Always go by the instruction given to you by your surgeon. It is very helpful to start practicing only using your non-operative arm before surgery so you get used to using only one arm for activities. Many people are able to do simple activities after surgery like eating, dressing, brushing teeth and showering. Driving will not be allowed until you are cleared by your surgeon and are not taking pain medications. You will most likely be discharged to home and instructed to follow the exercises discussed with your surgeon and therapist. Outpatient therapy typically will not start until after your follow-up appointment with your surgeon after surgery. Until instructed by your surgeon, do not bear any weight through your operative arm. This includes using it to assist you out of bed and when rising out of a chair. Do not attempt to lift anything heavier than a glass of water with that arm. Although your surgeon may give you some light exercises to do during this period, never force any shoulder motions such as reaching behind your back, reaching out to the side or reaching across your body. Do not allow a family member to assist you in extreme motions of your arm past your level of comfort. By leaning forward and performing a pendulum hang, you can wash under your arm and put a shirt sleeve on. Shirt sleeves should go on the operative arm first and be taken off the operative arm last.
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Total Shoulder Replacement Surgery Guidebook
Appendix A: How to Move After Surgery After Surgery Shoulder Precautions
DO
DO NOT û
DO NOT put any weight on or lift any weight with your surgical arm.
ü
DO have someone available to assist you whenever possible.
When in bed, DO NOT allow your elbow to fall any further back than your body when in bed. DO place a pillow under arm when laying down.
û
DO NOT put any weight on or lift any weight with surgical arm. Example: don't lean on your arm when pushing up from sitting.
ü
û
When forearm is facing straight out in front of your body with elbow bent, DO NOT allow forearm to move any further out to the side. Example: like closing a sliding door
ü
û
û
DO NOT actively move your shoulder. Example: Reaching with operative arm to get items from a high shelf
DO NOT reach behind your back. Example: Reaching back with operative arm for personal hygiene
DO always use your sling, except while exercising, getting dressed or showering, until your surgeon tells you to stop. You may be able to use your hand, fingers, elbow and wrist if your surgeon allows.
ü
DO sit in a chair with armrests, a high seat height and a firm seat when possible. Do push up with your non-operative arm on the chair armrests when getting up.
Appendix A– How to Move After Surgery
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Applying and Removing Your Sling
Transferring In and Out of Bed
Putting On Your Sling
When Getting Into Bed
1. Begin by making sure the tag is on the outside. Place your hand through the open end of the sling.
After surgery, you may feel more comfortable sleeping in a recliner chair instead of a bed. Make sure your arm is supported with pillows in the recliner chair.
2. Fit the sling on your arm so your elbow is back in the pocket as far as it can go and your wrist/ hand is well supported.
1. Make sure you have multiple pillows available to help support your head, neck and arm in bed. Placing a pillow behind the operative shoulder blade will give a sense of security and comfort.
3. The long strap of the sling should go from the back of your surgical arm, across your back to your other shoulder and down your chest. (You may also attach the strap to the fastener and then lift strap over your head to the opposite shoulder.) 4. Thread the long strap through the loop on the sling near your wrist. 5. Make sure to adjust the sling so that the forearm is parallel to the floor. The elbow, wrist and forearm should all be at the same level to reduce swelling. 6. Be sure your elbow is positioned in front of you so you can see your elbow when you are looking straight ahead. 7. You may need to adjust the pad on the shoulder strap near your neck so it feels comfortable. If your sling does not have a pad you may need to add soft material to your sling so it does not rub against your neck.
3. When your arm is out of the sling, just let it hang by your side. Do not use it until you have been told you can by your surgeon.
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Total Shoulder Replacement Surgery Guidebook
4. Scoot your hips around so you are facing the foot of the bed and lift your legs into bed. 5. Slowly lower your head onto the bed. Do not use your operative arm to assist.
When Getting Out of Bed
Remember to regularly release the sling to exercise and move your elbow, wrist and hand to prevent stiffness of these joints as directed by your surgeon. 2. Gently remove the sling from the operative arm; limit movement of your shoulder while removing the sling.
3. Reaching back with non-operative arm, sit down on the edge of the bed and then scoot back toward the center of the mattress.
6. You may feel more comfortable with your head slightly elevated in bed with pillows.
Taking Off Your Sling
1. Loosen the fastener and take the strap out.
2. Back up to the center of the bed, halfway between the head and foot of the bed, until you feel it on the back of your legs. You may need a step stool beside the bed to do this. Sleep with your operative arm toward the outside of the bed to help with getting in and out of bed.
1. Scoot your hips to the edge of the bed. 2. Sit up while lowering your legs to the floor. 3. Scoot to the edge of the bed. 4. Use non-operative arm to push yourself off of the bed. Having your non-operative arm in the center of the bed when you sleep will make this easier. Make sure to not use your operative arm to help during this process.
Appendix A: How to Move After Surgery
Getting Dressed ave someone assist you whenever possible. A very large and loose fitting loose t-shirt or button-down shirt H will be easiest. 1. Remove sling with minimal movement of arm. 2. Allow operative arm to dangle at side, close to body. Doing a pendulum hang while donning the shirt is helpful. Always put the operative arm in the sleeve first. Gather sleeve for operative arm in opposite hand. Slowly slide sleeve up operative extremity all the way to armpit. Go around or over the head, then put the non-operative arm in last. When removing the shirt, make sure to remove the non-operative arm from the shirt sleeve first. This is very important. 3. Make sure you use the non-operative arm to do all the work. The operative arm should just be dangling at your side or resting in your lap. 4. Reach back and use non-operative arm to bring garment across your back. 5. Put non-operative arm into sleeve. 6. Place both legs into clothing, put on underwear and pants/shorts before you stand up to pull on pants. Pull pants/underwear up past knees; be sure to pull up pants from under feet. Helpful tip: Elastic-waste pants or shorts are easier to get on and off. 7. Stand up, making sure you have your balance first. Use your non-operative arm to do the pulling. The surgery arm should only help slightly. The operative arm can be used for light tasks, such as zippering or fastening buttons.
Appendix AppendixBA: — How to Move After Surgery
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Putting On and Removing Your Bra Putting It On 1. To put on a bra, fasten it in front, using both hands. 2. Turn the bra around your body using your nonoperative arm. A larger sports bra is another option: 1. Step into it. 2. Pull it up over your chest and place your operative arm in first.
Taking It Off 1. Use your nonoperative arm to remove strap on same side and then remove operative arm strap. 2. Turn bra around to front using nonoperative arm. 3. Use both hands to unfasten without moving operative shoulder, or follow same method as removing sports bra. For removing sports bra: 1. Use your nonopertive arm to remove strap on same side and then remove operative arm strap. 2. Slide the bra down towards feet and remove with nonoperative arm.
Showering After Your Total Shoulder Replacement You may need a shower seat, particularly if you had trouble getting in and out of your shower before surgery. If you have a bathtub, a seat without arms is recommended; if you have a walk-in shower, you may use any type of shower seat. Make sure your seat is nonskid. Place your soap, shampoo or other items needed to shower in an easy to reach place. If you have any other or specific questions regarding showering, please ask your nurse or therapist during your stay in the hospital.
Getting Out of the Shower or Tub Using a Shower Chair 1. Scoot yourself to the edge of the bench by lifting your legs over the edge of the tub as you scoot around. 2. Push up with non-operative hand on back of seat and balance yourself before walking away.
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Appendix A: How to Move After Surgery
Appendix B: Medications Anesthesia What types of anesthesia are available? Decisions regarding your anesthesia are tailored to your personal needs. The types available to you are listed below. • General anesthesia provides loss of consciousness. • Regional anesthesia involves the injection of a local anesthetic to provide numbness, loss of pain, or loss of sensation to a large region of the body. Regional anesthetic techniques include interscalene and other blocks.
Will I have any side effects? Your anesthesiologist will discuss the risks and benefits associated with the different anesthetic options as well as any complications or side effects that can occur. Nausea or vomiting may be related to anesthesia or the type of surgical procedure. Medications to treat nausea and vomiting will be given if needed. The amount of pain you feel will depend on several factors, especially the type of surgery. Your pain should be minimal, but do not expect to be totally pain-free. You can expect your arm to be numb and not to function normally or at all for up to three days after surgery. This is normal.
What will happen before my surgery? You will meet your anesthesiologist immediately before your surgery. Your anesthesiologist will review all information needed to evaluate your general health. This will include your medical history, laboratory test results, allergies and current medications. With this information, the anesthesiologist will determine the type of anesthesia that is best suited for you. If a regional anesthetic is to be used, it will be administered in the pre-operative area. Your anesthesiologist will also answer any questions you may have.
What happens during surgery/anesthesia? Anesthesia will be provided by an anesthesia care team. An anesthesiologist with a Certified Registered Nurse Anesthetist (CRNA) will provide your care while in the operating room. They will monitor your vital signs (blood pressure, heart rate and oxygen level) during surgery and administer any medications necessary to provide you a safe surgical procedure.
What can I expect after the operation? After surgery, you will be taken to the Post Anesthesia Care Unit (PACU) where specially trained nurses will watch you closely.
Blood Thinners The surgeon will place you on an anticoagulant, also called a blood thinner, in order to help prevent blood clots. Most patients will go home on a blood thinner. The specific medication will be decided on by your surgeon based on your medical history.
Blood Thinner Medication Examples: Generic (Brand) Injectable • Enoxparin (Lovenox®) • Fondaparinux (Arixtra®) • Heparin
Oral blood thinners • Aspirin • Rivaroxaban (Xarelto®)
Most Common Side Effects of Blood Thinners • Risk of bleeding • Upset stomach • Bruising
• Burning at injection site • Decrease in platelets
• Tell your nurse or doctor if you notice any bleeding or black colored stools.
Appendix B: Medications
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Appendix C: Nutrition Your body needs to be well-nourished to heal bones, muscles and skin that are affected by surgery. Healthy nutrition is important before and after surgery. Your doctor will determine the appropriate diet for you after discharge based on your medical history. Some nutritional considerations are included below. More information on healthy nutrition can be found at ChooseMyPlate.gov.
Protein It is normal for your appetite to be decreased after surgery. Eat a small amount of protein at each snack and meal. Protein contains all the essential amino acids to aid in wound healing and keeps your immune system strong. Protein is not just for muscle building. It is a key nutrient in bone building. Aim for two to three servings of protein-rich foods.
Protein-rich food: Eggs, red and white meat, turkey, chicken, fish, cheese, low/nonfat milk, beans, nuts/seeds, soy protein
Iron Iron is an important mineral for your body to make hemoglobin. Hemoglobin is a part of the blood that carries oxygen.
Iron-rich food: Red meat, egg yolks, dark green leafy vegetables, iron-rich cereals, beans, lentils, dried fruit, liver, watermelon, baked potato, dark meat turkey
Calcium and Vitamin D Calcium and Vitamin D are nutrients associated with healthy bones.
Calcium- & Vitamin D-rich food: Low-fat dairy, like milk and yogurt
Fiber Fiber-rich foods can help avoid constipation. It is important to increase your fiber intake slowly, along with adequate fluid intake, to avoid gas, bloating and constipation.
Fiber-rich food: Whole grains, bran, fruits, vegetables, beans, lentils
Water Adequate hydration will prevent constipation and promote healing. Unless your physician is restricting the amount of fluids you drink, the focus should be on drinking six to eight glasses of water a day.
Vitamin C Vitamin C is needed to make a protein called collagen and is needed for repairing tendons, ligaments and healing surgical wounds.
Vitamin C-rich food: Citrus fruits, strawberries, kiwi, baked potatoes, broccoli, bell peppers
Zinc Zinc is important for wound healing. Zinc is a mineral found mostly in animal foods. It is better to get zinc from foods than supplements.
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Appendix C: Nutrition
Zinc-rich food: Meat, fish, poultry, dairy, wholegrain foods, breads, cereals, nuts
Our Health Equity Promise Patient Protection and Affordable Care Act: Section 1557
The statements below direct people whose primary language is not English to translation assistance: ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al número siguiente. CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi theo số điện thoại dưới đây.
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AdventHealth provides free aid and services to people with disabilities to communicate effectively with us, such as: • Qualified sign language interpreters • Written information in other formats (large print, audio, accessible electronic formats, other formats) AdventHealth provides free language services to people whose primary language is not English, such as: • Qualified interpreters • Information written in other languages
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407-303-5600
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