The Sling
If you have a shoulder operation you will almost certainly wake up in a sling. The sling may be needed for anything from 1 to 6 weeks depending on the type of operation you have had. Most patients will need to wear the sling for 6 weeks.
The sling is there to remind you not to move your shoulder and to support the weight of the elbow. Unless I tell you otherwise it must be worn at night as well and only removed for showering. You can make small adjustments the sling as often as you like – please make sure that it supports the weight of the arm and is comfortable. The body strap is not meant to be very tight against your body.
What to wear after shoulder surgery
You are able to wear your sling over your clothes. It is easiest to dress in loose clothing as this will require less arm movement on your part when you are getting dressed. Easiest of all are shirts with buttons down the front but a loose T shirt or singlet with large sleeves will work. Small buttons and zips can be challenging but Velcro fastening is a good option.
Wearing a bra may be uncomfortable initially but will become easier with time. Some patients prefer a strapless or front fastening bra. Pants with elastic waists are easy to take on and off. Doing up buttons, zippers and belts with one hand is quite a challenge. The same applies to shoe laces so sandals, thongs or slip-on and easy fitting shoes are advised.
Undressing
The first time you do this will be time consuming but it gets easier with each repetition. The reverse of getting dressed is required:
- Undo the strap which goes around your waist.
- Undo the strap which goes around your neck and move the sling downwards off your arm. Do not lift the sling over your head with the strap still in place as this may move your shoulder the wrong way.
- To undress you take the good arm out of the sling first. If it is a button up shirt you just slide the shirt downwards off the operated arm. If it is a T-Shirt you will take your head out next and the operated arm out last.
Taking your pants off is achieved by pulling the pants down past your hips and then sitting down. You can now use your hands or your feet to get them all the way down to your ankles and off. Do not use your operated arm to help.
Once you are undressed you can shower with the waterproof dressings in place. Do not lift the arm forward to wash the armpit. Instead lean forward and let gravity take the arm away from the body. When you stand up the arm will come back against the body. The same applies when drying the armpit. Once you are dressed you may wish to put a cotton cloth in the armpit to absorb any moisture there. This is more important if you are wearing your clothing over the sling.
Dressing
Putting pants on can be done standing or sitting. There will be some hip wiggling involved but do not use your operated arm. Putting a shirt on is the reverse of undressing. Keep the operated arm still and gently thread the sleeve onto the arm. Take the shirt as far up to the shoulder as possible, keeping the arm still and leaning forward rather than lifting the arm away from the body.
If you are wearing a T-shirt do the head hole next and the other arm last. Once the shirt is on and the buttons done up you can put the sling on as shown in the video above.
After the operation
Your shoulder may be swollen after the operation. You will have a bulky dressing on the shoulder to absorb any of the fluid which may leak out overnight. This will be changed to waterproof dressings before you leave hospital.
As part of your anaesthetic the anaesthetist will discuss with you the option of having a nerve block in your neck to help control the pain after the operation. Some time during the night or the next morning the block will start to wear off and you will be able to move your hand and will start to feel your shoulder. There may not be any pain at that stage but this is the time to get some pain killers into your system. This will allow the pain killers to be working when the block wears off and you feel the pain from the operation. If the pain becomes severe it is much harder to get back under control than if you control it well in the first place. Before you go to sleep on the first night I suggest taking some pain killers to get a better nights sleep.
Remember that pain killers generally cause constipation so make sure you have something like normacol or movicol to keep your bowel motions regular.
When you leave hospital you will typically take with you various medications. These may include and antibiotic, some Vitamin C (helps nerve and tissue healing), an anti-inflammatory tablet and different strength pain killers. I generally suggest people use Panadol regularly as background pain relief and then add the stronger pain killers as needed. Take the pain killers regularly for the first 2 days and then work out if you need to continue taking them. Sometimes the pain returns after a few days and this is not unusual and is nothing to worry about. Simply start to take the pain killers again until it is controlled. Using a combination of different drugs is more effective than using any one of them alone. Contact me if there is any confusion about how to take your medications.
Pain is a very variable experience. Some people are taking Panadol only by day 2 after the surgery and some people are still using strong pain killers 6 weeks later. Please read the Pain Medication sheet in the next section.
PATIENT INFORMATION Handouts
FAQs
The only change to your usual routine in the week leading up to the operation should be using a chlorhexidine based skin wash when you shower. Do NOT shave the shoulder or apply creams to remove hair from you shoulder. Be careful not to get sunburned or scratch the area. If it is necessary we will clip the hairs from your skin or armpit immediately before the operation.
In most cases the sling is there to protect the repair that has been performed. It should be removed for showers only and worn while sleeping. Even sitting watching TV you should wear the sling to protect you from any reflex movements such as reaching for a falling remote control. I will inform you if it is OK to remove the sling for any length of time.
Some operations require early movement but some time resting in the sling and if this is the case I will give you instructions about how much you can be out of the sling.
Sleep can be challenging for the first 3 weeks after surgery. It tends to improve after that. Some patients do have difficulty finding a comfortable position to sleep. It is common for people to need to move from the bed to the couch to find a comfortable sleeping position. If you are sleeping on your back you may find it helpful to place a small pillow behind the elbow or shoulder to help support the weight of the shoulder. You are allowed to sleep on your side with the operated arm up but do not sleep on the operated arm unless I give you permission to do so. When you are getting in and out of bed or a chair, DO NOT use your operated arm to push down as this may damage the repair.
I do not believe that it is safe to drive one handed. I therefore suggest that you not attempt to drive until you are out of your sling. You should also be off strong pain killers and feel confident that you are in control of the vehicle you are driving. This is usually about 6 weeks after the operation. Please click here for more information
If your dressings remain sealed then please do not change them. Only change them if they are peeling off and allowing water to get to the wounds. This is rarely necessary. Your dressings will be changed the morning after the operation and should last until I see you about a week later.
This will depend on what work you do. As an office worker you may be able to return to work one handed after only a few days. If you need both hands for work you will need to be out of the sling to return to work. As a manual labourer or tradie you will need to wait for the repair to be strong enough to handle the load of what you are doing. This may vary from weeks for an acromioplasty to 6 months for a stabilisation procedure to 12 months for a rotator cuff repair. I will let you know when it safe to lift again.
Swelling and bruising are normal after any operation. This will be very variable depending on the size of the operation you have had and your response to the surgery. In some patients the bruising will travel down the arm and chest and sometimes as far as the forearm and hand. Please do not put any jewellery on the hand of the operated arm for a week or so after the operation. If you are concerned about the amount of swelling or bruising following surgery, please contact me immediately.