After Surgery

The immediate postoperative period

This is the period of time within the first week after surgery. The surgical anesthesia will either have been local, sedative, general, or regional. This can affect the immediate postoperative course. Those without general anesthesia can potentially have less nausea and vomiting and can begin to tolerate eating and drinking sooner. In addition, if there is regional and/or local anesthesia, the first six or eight hours may be relatively free of sharp pain. As time goes on, there is potential for sharper, deeper pain. Utilizing adequate ice, rest, positioning, and pain medication can help make the first week after surgery more tolerable. Cold therapy should be applied quite often to the operated shoulder with a bag of ice or cryotherapeutic device. There are several benefits to ice and cryotherapeutic devices. The ice pack or bag of frozen veggies may not get close enough to the shoulder joint to actually cool it down. The use of appropriate cryotherapy can actually cool the joint fluid down, which will diminish the inflammatory mediators in the joint. This, in turn, will lessen the amount of postoperative swelling in the joint and allows patients to feel better faster and with less narcotic usage.

Doctors have different philosophies about how often people should use ice. This is something to discuss with your surgeon. Anti-inflammatory and narcotic medications are also at the discretion of the physician. At times these medications come with unwelcome side effects.

A sling or immobilization device is sometimes utilized after shoulder surgery. The type of surgery performed and the doctor's philosophy will determine how long the sling is used, what type of sling is used, and how often it can be removed.

An overview of physical therapy after surgery

Diminishing swelling and pain, regaining range of motion, regaining strength, regaining endurance, and performing sports-specific exercises are the steps to full recovery. We define full recovery as the ability to do whatever you want with your shoulder without reserve, pain, or fear. Postoperatively, some people reach levels of function that are lower than others, depending on their goals and lifestyles. A person's overall function after shoulder surgery depends on many factors: the amount of trauma found and treated during the surgery, the body's reaction to the surgery, the body's inherent (genetic) potential to heal, the quality of the tissue within the joint, the quality of the repair during the surgery, the person's tolerance of pain, the motivation of the physical therapist and patient, and the home exercises performed by the patient. At times, patients will stop getting better before gaining a level of function that permits participation in sporting events or before reaching their pre-injury joint function. Physical therapists utilize their knowledge of the human body, their hands, and modalities (electronic, ultra-sonographic, continuous passive motion, etc.) to facilitate blood flow to the area, to encourage fluid reabsorption in the area to diminish swelling, and to help with pain relief. They help educate the patient about exercises and activities that can be done to increase function and to decrease pain.

As a general rule of thumb, prior to a home exercise program and physical therapy sessions, warming the shoulder makes tissues more pliable and flexible. This is an activity to help alleviate stiffness. The warmth increases blood flow to the area and will help soften up some scar tissue formations as well as allow the patient to perform the exercise programs.

There may be bleeding or increased fluid in the area after the movements of therapy or home exercises. In addition, at therapy or during home exercises the joint may reach places it has not been in quite some time. After the exercise program is finished, one can utilize ice to help cool down the stretched-out tissues and diminish the pain and the swelling that may ensue if small scar tissue bands have been broken during the exercise.