What to Expect on the Day of Arthroscopic Shoulder Surgery and Recovery
So you're getting shoulder surgery...
I wrote this article to provide a patient's perspective on what it is like to get arthroscopic shoulder surgery. Not every injury, surgeon, or patient is alike—but I hope this article will nonetheless be useful as you mentally prepare yourself for the big day.
My experience goes like this: as a baseball pitcher, I had a torn labrum, rotator cuff, and biceps tendinitis from my years of play. After over a year of trying non-surgical alternatives, we opted to repair all of these injuries.
Most people who choose arthroscopic shoulder surgery will be getting one or more of these three injuries repaired. Other reasons for undergoing this surgery may include general shoulder instability, arthritis inflammation, or bone spurs.
This article is not intended diagnose or cure any of these illnesses; it is just one person's experience, along with anecdotes from others. If you find the following information to be useful, or even if you don't, please let me know in the comments section, below. Maybe I can add information to make things more accurate.
Note: I will not be addressing total shoulder replacements, or injuries so severe that they require "open surgery," because I haven't experienced those procedures.
Read on if you are interested in how the days before, during, and after your surgery will go.
What is arthroscopic surgery?
The arthroscope is the instrument used to see inside your shoulder without literally peeling back the muscle to look. The benefit of using the arthroscope is that quite a bit of repair can be done via one or more small incisions which reduces infection risk and decreases recovery time. Your surgeon will be trained to know how to interpret what is seen on the camera, which will be fairly hard to understand for a novice.
In rotator cuff and labral repairs, the surgeon will first clean up the area with suction. The tear often ends up with a fair amount of fraying, which itself can cause pain. The surgeon will clean out these loose parts, which sometimes is all that has to be done. This is called debridement. If the tear is significant enough that the surgeon believes debridement is not enough, he or she will then suture the tear. They will basically sew the tear back together.
Biceps tendonesis, a common part of labral repairs, involves detaching your biceps tendon from the labrum. Sometimes it has begun to detach already and other times it is the underlying cause of labrum injury. They will quite literally cut it off and reattach to your humerus bone, instead.
I won't attempt to cover other, less common injuries here, but they will all have similar procedures in terms of how the surgeon will look at your injury. Anything that is arthroscopic will be minimally invasive, relative to open surgery.
Below is a "highlight" tape of sorts of an arthroscopic labrum repair. Be warned though: it is a look at the inside of a shoulder as well as some shots of what the surgeon is doing from the outside. Some folks would be put off by this, but I found it very interesting and informative.
The day before your surgery...
Most surgeons will not give you an exact time of day for your surgery. If this is the case, they will call you on the day before your surgery to tell you exactly when to come. Expect it to be in the morning.
There are not too many special directions before your surgery. The most important thing, though, is that you cannot eat or drink anything starting at midnight before your surgery! This shouldn't be too hard since you probably will be going to sleep by then anyway, but you cannot eat the next morning either. Even water can be a problem. The anesthesia will make you vomit, a lot, if there is anything left in your stomach. That is the last thing you want to be doing after your surgery.
Your doctor will also probably ask you to shower once or twice with Hibiclens. This is more to prevent you from bringing infections into the hospital than anything else. Don't put it near your face, hair, or genitals because it is fairly harsh.
Other than that, just try to have a good day!
Time for surgery!
This will actually be one of the simplest times of the process. Since you can't eat or drink, there's no use in getting up extra early that day. Do arrive in time, though. You will have to do a little paperwork and put on gowns, which I think is a little confusing. Do not be afraid to ask questions, though, and make sure you answer all of their questions.
They will ask you which shoulder is being operated on a lot. Don't get annoyed! They don't want to screw up. They'll ask you your information a few times too for the same reasons.
You won't have much to do before anesthesia begins. First, you'll get an IV. They will probably put this in your off-hand and they will put a mild sedative in first. This should calm you down, but not knock you out. While you are awake, they will put in the "nerve block." This is a local anesthetic that will leave your arm without feeling for the next 6-12 hours. Seriously, no feeling at all! You might feel a little silly as this is all going on because of that sedative. With that said, I thought the nerve block was the most painful thing I felt all day; it still wasn't too bad, though. They will put a long-ish needle in near your collarbone and release the anesthetic several different times while they use an ultrasound to make sure the needle is where it belongs.
You may be left to sit for a few minutes while this sets in. The only sensation you will have left is in the top of your hand and even your thumb and pointer finger will remain numb for most of the rest of the day. Biology and stuff.
Soon, you will be wheeled into the operating room. It will be cold. I know I asked someone why, but I can't remember the answer. You may or may not remember them giving you an oxygen mask, but soon...
...you're in the recovery room.
Just like that, surgery is over. It may have taken a couple of hours, but it's all a blink of an eye to you.
You will probably feel SUPER groggy at first. You are by no means required to wake up right away. If you still feel out of it, just lay back and nap. My first reaction was to try to get out of bed like a lunatic, but you don't want to do that. They will take care of you. You should not have any pain because of the nerve block.
At this point, if you are going to have a negative response to the anesthetic, you'll know it. Nausea is definitely possible and you'll be feeling it now. Most people do not get it or do not get it much, though. Usually you'll be given an anti-nausea patch before surgery and an anti-nausea shot during surgery. My main issue at this stage was dry mouth, which is a side effect of the anti-nausea patch.
Depending on the hospital, your loved ones may be there with you when you wake up. At others, they will let you wake up in a recovery room before wheeling you to a different room with privacy to see your loved ones and get a little more personalized attention from an RN.
Once you feel able, you'll be able to leave. You will have the challenges of putting on your clothes and standing on your feet to overcome. Obviously, you can't drive. Putting on your shirt will be hard to do as you leave, but with the nerve block it shouldn't hurt. I was recommended to bring a button up shirt, but in the end a t-shirt would have been fine. Most doctors will also give you a very cool ice machine to take home.
You can eat, drink, and do whatever else you feel like on the way home. You may or may not feel groggy. Be mindful that you can hurt yourself while the nerve block is still on though and you will want to start your painkillers before the nerve block wears off!
The days afterward
Eventually, probably before you go to sleep the day of surgery, the nerve block will wear off. It is both very sensitive and probably not quite as bad as you might have imagined. You will want your sling on basically all the time and putting on clothes won't be something to look forward to. You can't get your stitches wet, so you may not want to bother with showering and changing clothes if you can help it.
You should be told to "stay ahead" with your painkillers. This is true. Don't wait for pain to set in to use them. Don't overuse them, but try to use them in such a way that you don't have any pain when you're just sitting. It will of course hurt if you move it, but it should not hurt when you are stationary. They can help you sleep, too.
Your sling will be very neat. It will have a pad to keep your arm a little further from your body, a nice padded strap for over your shoulder, a ball for your hand to squeeze, and another strap around your waist to really keep the arm from moving unintentionally. Use this absolutely as directed or else you will have a lot of pain.
Most doctors will give an ice machine with a fitted attachment that goes over your shoulder. For the first two days, ice an hour on/hour off whenever you are awake or able. You will obviously need a friend to help set this up. Be careful when the nerve block is still on, because you can get frostbite.
You shouldn't have a bad time in the first few days so long as you have reacted okay to the anesthetic and you use the painkillers properly.
These may vary some depending on your injury, but you will be given a set of a few home exercises to do in the very early days of your recovery, usually starting two days post-surgery. These are very easy to do, usually some combination of letting your arm hang straight down and using your off-hand to assist you in simple movements. You won't feel like doing them, but they turn out to not be so bad and you will feel better after doing them.
These are very important for your recovery! It gets the blood flowing and gets the process of making your shoulder normal again started.
These must be used with caution. Many people use these with no event, but these can be addictive. Don't use these longer than needed and don't give them to anyone else. If you have side effects or think you're having trouble discontinuing use, talk to your doctor. Each doctor will have a different preference for narcotic, so I won't comment on dosing for now. With that said, they will probably make you not very productive while you use them. You may find yourself dozing off with little warning while you use them. Do not drive or do anything important while you're on these. You shouldn't need them longer than two weeks, if that long.
You may also be given another once/day pain pill, go ahead and take that but be aware it will make you drowsy too. I ended up taking it at nighttime. Tramadol, which is another narcotic, is what I'm thinking of here; it will be an extended release version. Discontinue this at the same time that you quit your primary narcotic pinkillers.
If you need extra pain support, take ibuprofen or aspirin. Extra acetaminophen (Tylenol) will put your liver at risk.
Changing your dressing, stitch removal
After a couple of days, you will need to remove the original bandaging you received after your surgery. You can try to clean with just water, but it probably won't be easy to do and you don't really need it to look nice. Do not use alcohol or any ointments on the area!
You will expect it to be gory, but it isn't much. I attached a picture of what a normal post-surgery shoulder looks like.
You need not apply so much gauze like the surgeon did, because you should be done bleeding. If there is pus, a lot of swelling or bruising, or anything else that concerns you, call your doctor.
After a week to two weeks, you'll need your stitches removed. Either your surgeon or your primary care physician can do this. He or she will give you further directions about dressing the wound after that. You'll be starting physical therapy after the stitches are removed.
Most surgeries have positive outlook and are completely done within a year, with much of the hard part done far sooner than that. I won't even try to guess how yours will be, so I'll leave that to the doctor.
If you have questions or feedback, I'd be happy to respond in the comments. I hope this helps alleviate any fears or anxieties about your surgery. While it is super inconvenient, it's really not that bad. You should never feel a ton of pain, and you're asleep for the worst part of it. Hopefully yours goes as smoothly as most!