Preparing for Elective Shoulder Surgery
Most shoulder surgeries are elective, including operations for arthritis, rotator cuff problems, and dislocation. This gives patients the opportunity to bring their best, most healthy, and most prepared self to the operating room. Here are some recommendations for you to consider. Please discuss them with your surgeon and primary provider.
A. Get Comfortable with the Surgery and Recovery
Discuss with your surgeon:
1. The planned procedure, including likely benefits and possible risks
2. Surgical and non-operative treatment options
3. The recovery process, including post-surgery dos and don'ts
4. Need for special equipment after surgery
5. Timing and frequency of postoperative visits, including timing of bandage change and suture removal.
6. Need for physical therapy
7. If you need other surgical procedures, such as those on your hands, feet, knees or hips, discuss with your surgeon the ideal order of these procedures.
B. Assemble Your Support Team
Ensure you have support in place for your recovery period. Check with your surgeon to learn what type of support will be needed and for how long. For example, how long after surgery will you be able to drive a car?
C. Confirm Insurance Authorization
Make sure the procedure is authorized by your insurance company and that both the hospital and surgeon fees will be covered.
D. Complete Pre-Surgery Requirements
Finish all required tests, imaging, and consultations well in advance.
E. Understand Medication Management
Learn from both your surgeon and your primary care provider which medications to discontinue before surgery and when.
F. Know Pre-Surgery Fasting Requirements
Understand when to stop (1) eating and (2) drinking clear liquids before surgery. In some practices, clear liquids are allowed up to 2 hours before surgery.
G. Discuss Pain Management
Review postoperative pain management plans and confirm who will manage your pain medications.
H. Assess Mobility Needs
Discuss how your surgery will affect your ability to get out of bed and chair, get yourself dressed, and use your walking aids. Learn what type of clothing will be best suited for you after surgery and when you will be able to put on shoes and socks.
I. Optimize Your Health
1. Your weight: The BMI is a useful indicator of a person’s height/weight balance. It is calculated by dividing your weight in pounds by your height in inches squared and multiplying the result by 703. A BMI below 19 may indicate malnutrition while a BMI of 40 and above may indicate morbid obesity, each of which can be associated with increased surgical risk.
2. Diet:
o Aim for balanced nutrition with adequate protein, fruits, and vegetables. To help healing after surgery a daily protein intake of 0.5 gram per pound of body weight is often recommended. Confirm what is best for you with your primary provider.
o Discuss vitamin D and C supplements with your provider; these vitamins are important for healing and many individuals are deficient in them.
o Stay hydrated. A commonly used guideline is 0.5 to 1 ounce per pound of body weight per day.
3. Habits:
o Reduce or eliminate alcohol consumption, it increases the risks of surgery and complicates pain management. In most cases, drinking alcohol should stop two weeks before surgery.
o Stop smoking and using nicotine products at least one month prior to surgery. Smoking dramatically increases the risks of surgery and the rate of complications.
o Reduce or eliminate narcotic medication use two weeks before surgery, it complicates postoperative pain management.
4. Fall Prevention: Remove hazards, practice balance, optimize vision, install handrails on stairs.
5. Exercise: Regular cardio, strength training, and flexibility exercises. One half hour of exercise per day is a useful guideline.
6. Manage Chronic Conditions: Optimize blood sugar, blood pressure, lung function, and bone health. For those individuals with diabetes or prediabetes an A1C below 7 is often recommended.
7. Medication Management: Continue regular medications until advised to stop
8. Rest: Get adequate sleep and rest
9. Skin Health: Address any skin issues. Poor skin health or open sores may result in postponement of surgery until healing is complete.
10.Dental Health: Manage dental conditions proactively. Root canal surgery, necessary gum surgery, and infections need to be managed prior to surgery.
These general guidelines can optimize your recovery from surgery and the safety of the procedure. Please discuss them with your surgeon and primary provider.
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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link)
Shoulder rehabilitation exercises (see this link).
