Before you consider having surgery, there are several ways you can resume an active lifestyle. This first section will explain:
Arthritis
Nonsurgical options available
When you should consider having surgery
The risks of total shoulder replacement surgery
What is arthritis?
Did you know there are over 100 different types of arthritis?
Arthritis is inflammation of the joints that can take several forms:
Osteoarthritis is the most common type. It is the "wear and tear" and breakdown of the cartilage within the joint.
Rheumatoidarthritis is an autoimmune disorder that targets the lining of the joints.
Gout arthritis is caused by too much uric acid in the blood and can cause pain, stiffness, and swelling of a joint.
Psoriatic arthritis is an inflammatory arthritis that can affect people with psoriasis.
Arthritis can also be caused by a prior injury, especially breaks in the bones of a joint, or it could have developed based on how your joints formed during childhood.
Symptoms of arthritis can include:
Joint pain
Joint stiffness
Decreased motion
Swelling in the joint
Difficulty with shoulder motion that impacts your ability to do activities that you enjoy, and routine activities such as bathing and dressing
Nonsurgical options
Explore nonsurgical ways to reduce your pain. Your pain can be dramatically decreased in several ways before you decide to have surgery. Discuss each nonsurgical option with your primary care doctor to determine which are best for your specific needs.
Medication
There are a number of medications that can help with your pain. Discuss the risks and benefits of each pain medication with your doctor to determine which one is best for you.
Acetaminophen:
Tylenol, which is also called Acetaminophen, is generally a safe medication (unless you have liver disease)
Dosing should be limited to 3 grams or 3,000 milligrams per day, which is up to 6 extra strength Tylenol per day or 4 Extended Release Tylenol per day
If you have any questions about the dosing, speak with your doctor or pharmacist
Anti-inflammatories:
Advil, Motrin, Ibuprofen, Aleve, Naprosyn, Celebrex, Mobic, and many others
These medications relieve inflammation and pain in an injured shoulder and can be very effective
Can be taken on a regular basis or occasionally, as needed
Risks can include: stomach upset, bleeding in your stomach or bowels, kidney injury, and elevation in blood pressure
Take these medications only as prescribed and do not increase the dose without speaking to your doctor
If you are on these medications for several months, ask your doctor about checking your blood work to monitor your kidney function
Injections
Your doctor may recommend injections directly into your shoulder. The purpose of an injection is to reduce irritation and inflammation caused by your injury.
Corticosteroid Injections:
About half to two-thirds of patients find these injections relieve their pain
Pain relief will last anywhere from several weeks to 6 months or more
Some patients will not have any improvement after an injection
Corticosteroid injections should be given at least 4 months apart
Injections are typically performed in the office and do not interfere with your ability to drive home
Physical therapy
Physical therapy is often the first option for treatment. It can help improve the flexibility and strength in your shoulder.
Lifestyle changes
To have the best outcome or results from your surgery, it is important that you are as healthy as possible. There are several lifestyle changes that will help.
If you smoke or use any tobacco products, please quit.
Achieve a healthy weight. Being a healthy weight will benefit you in many ways, both in your daily living and related to your surgery.
Smoking cessation
The American Academy of Orthopaedic Surgeons (AAOS) lists these positive changes when you stop using tobacco products:
Decrease your risk of a heart attack and stroke
Reduce your risk of pneumonia
Improve your body’s ability to heal your wounds and decrease your risk of postoperative infection
Improve your body's ability to heal the tendon repair
How to get started:
Talk to your family doctor and check your health insurance benefits. They can help with aids and counseling
Talk with family members and friends. If they know how important this is to you, they can help provide support and assistance.
Along with program support provided by your health insurance, check for assistance from your employer.
Penn State Health Milton S. Hershey Medical Center 1-800-243-1455
Weight loss
Being a healthy weight will benefit you in many ways, both in your daily living and related to your surgery.
Being overweight increases your risk for:
Skin healing problems
Infection
Blood clots in your legs or to your lungs
Heart problems
Weight loss can be difficult and takes both healthy eating and increased activity, which can be as easy as increasing the amount of walking that you do daily.
To get started:
Let your family and friends know you are working on eating healthy and increasing your activity. They can help partner with you.
Contact your family doctor for help.
Check your health insurance benefits. Many health plans pay for sessions with a nutritionist, diet teaching/support groups, or gym memberships.
Remember, safe weight loss is a slow, gradual process, of 1 to 1 ½ pounds of weight loss a week and takes changing long time habits and your lifestyle. It can be an up and down process but will be worth it as you begin to feel better and become more active.
When should I consider having surgery?
The decision to have surgery is typically made based on your answers to the following questions:
Have you exhausted all nonsurgical treatment options?
How much is the arthritis and decreased motion interfering with your lifestyle?
How much pain is it causing?
Do you have any other medical conditions?
Understanding the risks
As with any surgical procedure, there are risks and complications. Your surgeon will discuss each potential complication of shoulder replacement surgery in detail.
Infection
Although uncommon, infections are one of the most severe complications. This can occur around the time of surgery or later in your recovery. The treatment is complex, but the incidence is quite low.
Nerve Injury
Nerve injuries to the shoulder, arm, and hand are uncommon. This injury is usually temporary but can be permanent.
Blood Clots
Blood clots are also known as deep vein thrombosis (DVT) and pulmonary embolism (PE). The formation of a blood clot is uncommon. Some patients are instructed to take medications (such as aspirin or a blood thinner) around the time of their surgery to decrease this risk. Your surgeon will let you know if this is necessary.
Stiffness and weakness
Stiffness can be a problem after your rotator cuff repair surgery. This can be minimized by fully participating in therapy after surgery.
Dislocation
Dislocation is when the bone joint comes out of the socket. Typically this does not require an incision or an extensive surgical procedure to correct. However, if a dislocation occurs multiple times, additional surgery may be required. The risk of dislocation can be minimized by wearing your sling as directed and following therapy exercises as instructed.
Prosthesis wearing or loosening
Over time your shoulder prosthesis can wear down or the components may loosen. This is rare but can be caused by infection, poor bone quality, or wear over time. Excessive wear or loosening may require additional surgery.
Discuss with your doctor if surgery is right for you.
Once you have chosen surgery
If you and your doctor choose surgical repair, review this section to:
Meet your surgical team
Learn what will happen during your surgery
Understand how your pain will be controlled
Learn when you can go home after surgery
Meet your surgical team
You are in good hands.
All of our surgeons are board certified and have completed orthopaedic subspecialty fellowships in the area of shoulder and elbow surgery.
We work as a team.
An integrated, multidisciplinary approach combines a team of dedicated physicians, advance practice providers, orthopaedic nurses, clinical case managers, anesthesia teams, residents and medical students, and physical and occupational therapists dedicated to providing our patients with the highest quality care.
This team is led by your surgeon and also includes advance practice providers. They communicate daily about your progress both before and after surgery. During your preoperative and postoperative period, our advance practice providers, which consist of physician assistants (PA) and/or nurse practitioners (NP), will be involved in your care. They are licensed by the state and engage in ongoing education in the specialty of orthopaedics. They have advanced academic and clinical training that allows them to provide health care services including:
Taking a patient's medical history, performing a physical exam, and ordering laboratory tests and procedures
Diagnosing, treating, and managing diseases
Writing prescriptions and coordinating referrals
Providing education on disease prevention and healthy lifestyles
Performing certain procedures, such as joint injections
What will happen during your total shoulder replacement surgery?
Joint replacement surgery, also called arthroplasty, is surgery performed to relieve pain and restore your range of motion by realigning or reconstructing a joint.
I wanted to talk to you about what it means to have a total shoulder replacement. So, we’re going to talk about an anatomic total replacement, and what that means is we are replacing the ball and the socket of your shoulder because of your arthritis. So this is what it looks like on an x-ray. This is a typical picture for osteoarthritis (gestures to x-ray images on the computer screen). Your should is made up of a ball as well as a socket. In arthritis, you lose the cartilage between the ball and the socket. So we normally should see a space between these two and as you can see they’re riding bone-on-bone. That’s what’s causing your pain. So when it’s time to have the should replacement, what we do is replace that ball and socket. This is what it looks like. (Holds up a metal ball replacement piece and plastic socket replacement piece.) The two of them together make your new joint, and they articulate so that you don’t have that pain anymore. You don’t have the bone-on-bone. And then this is what it looks like when it’s in your shoulder. (Holds up a model of the pieces set in bone.) So now the ball is in the bone, and the plastic-looking piece is deep inside there, resurfacing the socket. Essentially, you have a new joint, and you shouldn’t have your pain anymore.
What happens during reverse shoulder replacement surgery?
I’d like to tell you about a reverse ball and socket implant. Typically, we do this implant for someone who has a massive rotator cuff tear as well as arthritis. So I’m going to go over some x-rays (gestures toward the computer).
The shoulder is made up of a ball (gestures in a circular motion on the x-ray image of a shoulder joint), as well as a socket (gestures in a curved motion to the right of the ball area on x-ray). When someone has a massive rotator cuff tear as well as arthritis we start seeing that the ball rides high on this socket here (pointing to the x-ray). So normally, the ball should be down here, but you can see in this picture that the ball has ridden up and is riding high. And so what we get is cartilage loss at the top of the ball as well as the socket, and we also get cartilage loss where it articulates with the acromion. That’s the bone on the top of your shoulder. So what happens in a normal should is the ball rides and is contained within the socket normally, because you have normal tendons that hold it there. But in a massive cuff tear what we start to see is that the ball starts to ride high on the socket and we get edge loading on that socket which creates arthritis, and then you get that new articulation with that bone on the top of your shoulder.
So for the implant, what we do is we put a ball on the socket and a socket on the ball. What that allows us to do is to bring this ball all the way back down so that it’s in its normal position. It also allows the deltoid to start moving the shoulder. So this is the big muscle on the outside part of the shoulder you can feel so we don’t have to rely on the internal tendons anymore in the shoulder. So for the implant, this is what it looks like. So this is the socket that we put on the ball, and this is the ball we put in the socket. We bring that back down and you have a new articulation in your shoulder. This is what it looks like at the time of surgery in the bone. So you can see here that we’ve got a new ball in the socket and the socket is now in that previous ball. That creates the new joint and you don’t have pain anymore.
How your pain will be controlled
Pain control is one of the most important considerations for our patients around the time of surgery.
We will do everything that we can to help manage your pain in an acceptable manner.
Patients who are on regular narcotic pain medications prior to surgery have a much more difficult time managing their pain after surgery.
We use a multi-modal approach to pain management.
Right before the surgery, you may receive several medications by mouth to help with pain control during your surgery.
During surgery, you may receive pain medications through your IV from the anesthesia team. We also typically provide an injection around the joint at the time of surgery to provide pain relief for 12-18 hours.
After surgery, you will receive several pain medications to help control your pain. Our team will make adjustments as needed so that your pain is manageable.
To help reduce swelling and decrease pain, apply ice to your surgical site several times a day.
You will be asked frequently during your hospital stay what your pain level is as a way of monitoring the effectiveness of the pain control.
When can I go home after surgery?
Patients that are in good health with good strength and have a strong support system at home may be eligible for outpatient shoulder replacement surgery. This means that the patient can expect to return to their home the same day as surgery. Some patients do stay overnight in the hospital. Discuss this option with your surgeon to see if you are a candidate.
Pain Medication
You will receive a prescription for pain medication for you to have at home after your surgery.
Medication for Constipation
Constipation is a side effect of pain medication. Use the medications you typically use to help prevent constipation (fiber, Metamucil, stool softeners such as Colace or Senokot, and Milk of Magnesia). If you have not had a bowel movement after 4 days following your surgery, contact the Bone and Joint Institute.
How to prepare for your surgery
Once you have made the decision to proceed with surgery, there is still much to do. Please review the following sections in detail.
Preoperative Checklist
What to Bring the Day of Your Surgery
What to Expect the Day Before Your Surgery
What to Expect the Day of Your Surgery
Preoperative checklist
Medical Optimization/Surgical Risk Assessment
Your surgeon will let you know if you need a surgical risk assessment from your family doctor and/or specialist.
If needed, schedule an appointment 30 or more days before your surgery
You will be given a surgical risk assessment form to take to your doctor for completion
When scheduling these appointments, please tell your physician's office that you need a "preoperative exam/optimization appointment"
Schedule other exams and procedures
Dental exams
Good dental health is very important prior to surgery
Schedule a dental exam 6 months prior to your surgery to be sure you are infection free and to complete any necessary dental work you may need
Invasive procedures
If you have any procedures scheduled or that need to be done, please call our team
Some procedures will need to be coordinated with the scheduling of your shoulder surgery
Vaccines
Should be completed at least two weeks prior to surgery
Please make sure these are given in your nonoperative arm
Preoperative appointments
Plan on spending 2-4 hours at the Milton S. Hershey Medical Center for your preoperative appointments.
Ask a family member or friend to accompany you during your preoperative appointments
Your appointments may be scheduled in different areas of the Hershey Campus
There is a shuttle bus to transport you if needed
The following will occur during the preoperative appointment with your surgeon and their team:
Review details, risks, and benefits of the surgery
You will be asked to sign a surgical consent form
Receive your Shoulder Replacement Guidebook
You will be fitted for your shoulder sling, which you will need after surgery
Have questions about your surgery and recovery answered
Not all patients will require an appointment with the anesthesia clinic, however, if necessary, the following will occur during this appointment:
Discuss your anesthesia options
Perform a physical examination to be sure that there are no other medical issues of concern with regard to the anesthesia
Receive directions regarding how to take your daily medications immediately before and after your surgery
Prepare your home for recovery
Prior to surgery, it is recommended that you make the following preparations:
Remove throw rugs and any other items that could cause trips or falls
Place night-lights in your bedroom and bathroom
Consider putting safety bars beside your toilet and in your shower
Consider how to rearrange your home for your postoperative period when you will be unable to use your operative arm
Be sure lamps are positioned where you can reach them with your nonoperative arm
We recommend that you spend time doing your routine activities in your home without using your operative arm. This will help you plan for your recovery period.
Pick up medications
You will want to have your medications on hand before having surgery:
Pick up any medications at your pharmacy that have been prescribed by your surgical team
Pick up a stool softener, such as Colace or Senokot, and a laxative as pain medication often causes constipation
Arrange for care and transportation
Discharge usually occurs the same day as your surgery.
Make arrangements for someone to stay with you for a few days after your surgery
You will need transportation to all clinic and therapy appointments
Arrange for someone to be available to transport you if any unplanned appointments or needs arise.
Physical therapy
When you start therapy will depend on what your physician finds during your surgery. Do not begin formal therapy until you are instructed to do so by your surgical team.
Before your surgery, select a therapy practice and check with them to see if they accept your health insurance
When it is time for you to begin therapy, you will be given a prescription and protocol to take to your therapy practice. This will help guide your therapist and provide our contact information
If you would like to have your physical therapy at the Milton S. Hershey Medical Center, it can be arranged by the Bone and Joint Institute staff
Shoulder Replacement Guidebook
Read your Shoulder Replacement Guidebook and contact our team with any questions.
What to bring the day of surgery
Bring the following with you to the hospital:
Advance directives
Inhalers
A list of your medications including the dosage and the time you take each one
Loose-fitting shirt, t-shirt, or sweatshirt that can easily be put on after surgery for your trip home
CPAP machine, if applicable
Cell phone + charger
Do not bring:
Jewelry
Large amounts of money
Other electronic devices
The day before your surgery
In the afternoon
An admissions nurse will call and tell you:
What time to arrive the day of surgery
When to stop eating and drinking
In the evening
It is important to prepare your skin before surgery to reduce the risk of infection at the surgical site. It is also crucial to follow proper diet restrictions. Please be sure to do the following the evening before your surgery:
Shower
Dress in clean night clothes
Follow dietary and tobacco restrictions
Dietary restrictions:
You may eat freely up until midnight
You may drink clear liquids (see below) up to 4 hours prior to your arrival at the hospital, and we encourage you to do so
Clear liquids include:
Water
Apple juice
Kool-Aid
Crystal Light
Soda
Black coffee (with or without sugar or sweetener) DO NOT add milk, cream, or non-dairy creamer
Tea (with or without sugar or sweetener) DO NOT add milk, cream, or non-dairy creamer
Clear liquids are NOT:
Milk
Orange juice
Broth
Tomato juice
Jello
Gum or candy (with or without nicotine)
Tobacco restrictions (after midnight)
NO smoking of any substance
NO chewing tobacco
NO vaping or e-cigarettes
NO marijuana
The morning of your surgery
Report to the Admissions Department at the main entrance of the hospital
You will be taken from there to the preoperative area where the nurses will prepare you for surgery
Your family can accompany you to the preoperative area
Your family can wait in the surgical waiting area while you proceed to the operating room
In the operating room
The anesthesia team will prepare you for surgery and administer general anesthesia
Your surgical team will inject numbing medication around your joint that will help substantially with your pain relief after surgery
Once your surgery is complete, your surgeon will speak with your family and review the procedure.
In the recovery room - Post Anesthesia Care Unit (PACU)
After surgery, you will be transported to the recovery room where your vital signs, pain control, and surgical wound will be monitored frequently. You will then be moved to a room or discharged home.
Orthopaedic unit
Your nurses will provide you with pain medications, monitor your progress, provide eating instructions, and address any other needs you may have
An orthopaedic team member will monitor the progress of patients in the hospital and help with discharge planning
Recovery after surgery
Rehabilitation begins almost immediately after shoulder replacement surgery and there are certain things you need to watch out for. This section will discuss:
When you should call the doctor
Do's and don'ts after surgery
When and how to wear your sling
Bathing instructions
Dressing instructions
Exercises
When should I call the doctor?
Go to the nearest Emergency Room or call 911 if you experience chest pain or shortness of breath.
Some patients do have complications after surgery. Call us if you experience any of the following:
Increasing redness or swelling at your incision area
New drainage from your incision that is yellow, tan, or milky in color
Pain that suddenly increases or is unmanageable and prevents you from sleeping
Pain, redness and/or swelling in your calves
Monday through Friday (8:00 a.m. - 4:30 p.m.) Call your surgeons' team at 717-531-5638
After Hours / Weekends Call the hospital operator at 717-531-8521 Ask to speak to the orthopaedic resident on call.
What are the do's and don'ts after your surgery?
You have an important role in caring for your “new” shoulder. To have the best surgical outcome, follow the Do's and Don'ts listed below:
DO
Wear your sling at all times except for bathing, dressing, and exercising
Check your incision daily and watch for signs of infection or poor healing
Follow your home exercises as directed by your surgeon and therapist
Take stool softeners while you are taking your narcotic pain medications
As you increase your activity, be careful to prevent falls that could injure your shoulder
Certain movements place stress on your new shoulder and should be avoided until your surgeon instructs you to do otherwise.
DON'T
Do not use your operative arm to lift anything heavier than paper and pencil
Do not push yourself up with your operative arm
Do not pull anything with your operative arm
Do not drive while you are wearing your sling
Do not bathe in a tub, get in a hot tub, pool, lake, or ocean until your doctor gives you permission
Do not lift anything heavy with your nonoperative arm
When and how to wear your sling
You must wear your sling at all times, including night time (6 to 8 weeks in the sling depending on the type of replacement surgery you have had). The only times you may take it off are:
Dressing, bathing, and exercising your hand, wrist, and elbow
Performing therapy exercises after you have begun formal therapy
While sitting (and awake), with your forearm supported by pillows
There are two ways you can learn to put on and take off the sling:
Option 1:
Place the sling on a high table or countertop with the trough open.
Place your surgery arm into the trough and fasten the two trough straps to secure your arm in trough
Fasten the waist belt.
Reach behind with nonsurgical arm and move arm through loop in the remaining strap. (This will be a similar motion to putting on a backpack).
Fasten the buckle in front to secure the strap.
Fasten the thumb strap.
Ensure the sling is positioning the operative arm directly in front of you.
When removing the sling, be sure to just release the quick-clip buckles at the waist and shoulder straps and the short straps over the trough and thumb - Do not remove the Velcro from the long straps.
Option 2:
Place the sling on a high table or countertop with the trough open.
Insert your non-operative arm through the only “loop” in the straps
Rotate your body to allow you to place your surgery arm into the trough of the sling.
Use the hand of the non-operative side to fasten the two straps over trough, and fasten the waist and shoulder buckles. Fasten the thumb strap.
Ensure the sling is positioning the operative arm directly in front of you
When removing the sling, be sure to just release the quick-clip buckles at the waist and shoulder straps and the short straps over the trough and thumb - Do not remove the Velcro from the long straps.
Bathing instructions
You may take the neutral wedge brace off once a day to bathe. Please make sure you have someone to assist you with transfers into the shower or tub. If you feel unsteady, a shower seat for bathing will increase safety. When bathing your upper body try leaning forward, allowing some space between your body and operated arm to wash under your armpit and upper arm. The operated arm should only be extended out by 10-15 degrees. Dry yourself in this position. Drying under your armpit is important to prevent skin breakdown or rash.
How to dress
Wear a loose t-shirt or button-down shirt.
T-shirt
Put your operated arm into your sleeve.
Pull your t-shirt up as far as possible to your upper arm without moving your elbow away from your body. You may need assistance with positioning your operated arm away from your body by bending toward your operated side or forward, making sure you do not put weight on your operated arm. The operated arm should only be extended out by 10-15 degrees to assist with putting your arm into your sleeve.
Position your t-shirt so that you can put your non-operated arm into your sleeve.
Put your head through the opening for your neck.
Put the sling on as per the instructions in the guidebook or from your therapist.
Button-Down Shirt
Insert your operated arm into your sleeve.
You will need to walk the collar over to your non-operated arm.
Put your non-operated arm through your sleeve.
You may need assistance with your buttons.
Adjust your shirt at the back and front with your non-operated arm.
Put on your sling as per the instructions in the guidebook or from your therapist.
Pants
Wear pants or shorts with an elastic waist. To dress while wearing the sling, follow these instructions:
While sitting on a chair or the edge of a bed, use your non-operated arm to hold the waistband of your pants.
Place your leg into your pants by crossing your leg and bringing your ankle up to knee height.
Pull your pants up to upper thigh height.
Using your non-operated arm, push up from your chair/bed and pull your pants up.
Socks
While sitting on a chair or the edge of a bed, cross your leg and bring your ankle up to knee height.
Bend slightly forward with the sock in your non-operated hand, and place the sock over your toes.
Pull up your sock while bending your knee toward you.
Shoes
Try to wear slip-on shoes or use elastic shoelaces or velcro closures so you do not have to tie your shoes.
While sitting in a chair, slip your feet into your shoes.
Use your non-operated hand to secure the velcro closures, if applicable.
Exercises to do after surgery
It is important to do the exercises recommended by your therapist after your shoulder replacement surgery.
You can begin with hand, wrist, and elbow exercises immediately after surgery. Your therapist, as directed by your surgeon, will instruct you on which exercises to do, and when to begin, as you progress after surgery.
Click each image for a video demonstration of the exercise.
Exercises to be done immediately after surgery:
Exercises to perform only when directed by your surgeon, with instructions from your physical therapist:
Thank you for visiting
Thank you for taking the time to view this resource! We hope you, your family, and your caregivers find this resource convenient and helpful in making informed decisions about your course of care.
If you have other questions or would like to discuss shoulder replacement surgery further, we would be happy to meet with you.
Best wishes from the Shoulder and Elbow Division at Penn State Health!
