Go to Surgery Guidance for more information.

1. Do not drive, operate machinery, or consume alcohol or tranquilizers for 24 hours or for as long as you are taking narcotic pain medicine.  Do not make important personal or business decisions or sign legal documents for 24 hours.
2. Rest today and not do anything too strenuous - you may feel tired from the anesthesia and pain medicine. Be in the care of a responsible adult.
3. Begin with clear liquids and light foods to eat, then progress your diet as tolerated. It is usually best to avoid heavy, greasy, or spicy food the day of surgery. Narcotics cause constipation, so increase the amount of fluid (especially water), fiber, and fruit in your diet. Examples of over-the-counter medications to prevent constipation or for constipation are Metamucil, Citrucel, Colace, or Docusate Sodium (DSS). In the event that you are constipated after surgery, over-the-counter liquid magnesium citrate, taken as directed, can be used.
4. It is important to eat some food every time you take narcotic painkillers (even in the middle of the night), otherwise, you are more likely to get nauseated. Usually a few crackers, applesauce, or banana will suffice.
5. Some anesthetics can cause urinary retention. If you are having trouble emptying your bladder or haven't urinated for eight hours after an anesthetic, be sure to call your doctor's office - no matter what time of day or night. 
6. YOU CAN ALWAYS REACH DR. JUREK (OR THE DOCTOR ON CALL) BY PHONING 206.386.2600. AFTER BUSINESS HOURS, AN ANSWERING SERVICE WILL CALL THE DOCTOR FOR YOU.

1. 1. You can be as active as desired during the postoperative phase excluding the use of the surgical arm. Avoid any activities that could put you at risk of falling. During your recovery, your major focus will be to get your strength and function back.  Plan your activities to be spread throughout the day and include rest times. Increase your activity (for example, walking) slowly and steadily.
   2. Keep your operated shoulder/arm in a shoulder immobilizer/sling as instructed for immobilization, support, and comfort. (Refer to the information at seattleshoulderdoc.com for how to properly take it on and off.)
   3. Keep your operated arm elevated at or above the level of your heart when sitting or lying by using a pillow or wedge under it to reduce pain and swelling.
   4. Make sure you remove/loosen your sling a couple of times per day to flex and fully extend your elbow to avoid elbow stiffness.
   5. DO NOT actively lift the operated arm away from the side of your body unless instructed to do so.  Don’t externally rotate your shoulder beyond neutral (it is okay to have your forearm straight ahead or internally rotated against your stomach). It is okay to use your hand for writing/typing activities at the waist level. Slight elevation to wash under your arm is okay. Do not reach behind and push yourself up with your operated arm.
   6. Avoid lifting, pushing, or pulling with the operated arm/hand.  You may use your hand and wrist for simple activities and remove the sling to flex and extend your elbow. If you want to reach your hand to your face, keep your elbow pinned against your side and flex your elbow.
   7. You may passively move your arm and shoulder gently with your other arm as soon as you are comfortable to help prevent stiffness and swelling.
   8. Elevation of the operative area also will help reduce pain and help with sleep.  Don’t lay flat; elevate your head and shoulders with pillows.  You may apply an ice pack to your operative site every hour for about 20 minutes to help reduce pain and swelling (not necessary during the night while sleeping). If you have an ice machine, you may use this as much as necessary to help with pain and inflammation.
   9. Leave the surgical dressing in place until your first follow-up visit with Dr. Jurek if possible. If the dressing is irritating and you want to remove it, please wait at least three days after surgery to do so. If present, leave the steri-strips (skin tape) in place. If the incision is closed and dry, you can leave it uncovered without a dressing or bandage. You can cover the incision with a sterile dressing if this is more comfortable for you. If the dressing becomes soaked with blood, you may change the dressing before 3 days.
      • Prevent infection by washing your hands or using a hand sanitizer gel often.
      • Avoid touching your incision with your hands.
      • Do not apply lotion, cream, or ointment to the incision.
      • After you remove the dressing, check your incision daily for bleeding, change or increase in drainage, redness, or swelling. You can expect that any drainage that you have will gradually diminish over a few days and then stop completely. Report significant increases in drainage to your doctor’s office.
      • Leave the steri-strips in place. It is okay if they fall off on their own.
      • If your incision is draining, keep it covered with a dry dressing and change it daily or when it becomes wet with drainage.
      • To change your dressing (have someone assist if available):
        • Wash your hands with soap and water; dry them well with a clean towel.
        • Remove the old dressing (leave the steri-strips in place).
        • Cover the incision with a new dressing. Be careful not to touch your incision area or the part of the dressing that touches the incision.
   10. You may go home with a small drainage tube in your shoulder. You can remove this 2 days after surgery by gently pulling the tube away from your shoulder. If you had a drainage tube that you removed, there will be a separate, small opening near the top of your incision. If this site is draining (leaking fluid), follow the same dressing change instructions as for your incision and change daily.  Report any changes in this drainage to your doctor’s office.
   11. You may take a shower after surgery when you feel ready and safe to do so. The dressing covering your surgical incision is waterproof and may be left in place until your first postoperative follow-up visit. It is OK to get the dressing wet in the shower. If it inadvertently becomes saturated in the shower, finish showering with the dressing on, remove it once you are out of the shower, allow your skin to air dry, and replace it with dry, sterile dressings.
   12. DO NOT soak in a bathtub or hot tub.

1. Oral narcotic pain medication has been prescribed for the first few days.  Use only as directed. Do not combine these medications with alcoholic beverages.  We recommend that you take your pain medications routinely for the first 24-72 hours. Mild dizziness is not unusual with these medications. Be careful when walking and climbing stairs. Do not drive while taking narcotic pain medications. Narcotic pain medications can be dangerously addictive; try to reduce your intake and wean off of them as soon as reasonably possible.
   • Taking strong pain medicine when not needed/necessary can result in dangerous over-sedation. Signs and symptoms of over-sedation from taking too much pain medicine (e.g. when your pain level is still tolerable or acceptable) include drowsiness, excessive sleepiness, slow breathing, slurred speech, impaired thinking, confusion, and impaired motor coordination. If any of these symptoms develop, stop taking the pain medicine and call your doctor.
2. In addition to the narcotic pain medication, it is strongly recommended that you also take Tylenol (Acetaminophen) at the same time to optimize your pain control and reduce the need for narcotic pain medication. You may take a maximum of 3000mg of Tylenol total over 24 hours (1000mg of Tylenol every 8 hours). If your narcotic pain medication also contains acetaminophen, make sure you calculate this into your daily total. Do not take Tylenol if you have been told by your primary care physician not to or have liver disease.
3. It is usually okay to mix anti-inflammatories with narcotic painkillers. If you are able to take these drugs, this may be beneficial for pain control.  DO NOT TAKE ANTI-INFLAMMATORY DRUGS IF YOU HAVE ULCERS, A HISTORY OF BLEEDING, OR KIDNEY FUNCTION PROBLEMS. Choose only one type of anti-inflammatory drug listed: Ibuprofen (Advil, Motrin, Midol) 600mg three times a day until not needed OR Naprosyn (Aleve) 500mg twice a day until not needed.  Do not take these if you are currently taking Celebrex or any other type of anti-inflammatory drugs.
4. You may restart your Aspirin if you normally take it as an anticoagulant.  Otherwise, take Aspirin as directed by your doctor after surgery (usually once a day for five days).
5. Please note if you are currently taking birth control pills and starting an antibiotic, your birth control may not be as effective.  While taking any antibiotics, and for one month after completing your antibiotic prescription, we recommend using a back-up method of birth control.
6. *Refills will only be given during normal business hours per your doctor’s approval. By law, all narcotic prescriptions must be hand-signed by your doctor and cannot be called into a pharmacy.

1. FOR DIFFICULTY BREATHING, CONFUSION, COUGHING UP BLOOD, OR SUDDEN CHEST PAIN CALL 911.
2. Significantly increased pain, warmth, and tenderness in your arm or shoulder.
3. A significant increase in bleeding, redness, swelling, or drainage from your incisional area.
4. Excessive drainage or bleeding from your incision not stopped by 20 minutes of direct pressure.
5. Excessive swelling not relieved by rest, elevation, and ice.
6. Feelings of flu-like symptoms (nausea, general body aches, or temps over 101.5 degrees for >24 hours).
7. Any sign of infection to your incision (increased redness, heat, hardness around your operative site, or pus-like drainage).
8. Intolerable pain (unable to sleep or concentrate on a conversation) not relieved by pain medication, cold therapy, and rest.
9. Continued nausea and vomiting.
10. Any rash, welts, or hives (many people itch with narcotic usage and an antihistamine such as Benadryl will usually make this stop - itching by itself is not an allergy.  Itching with hives or a rash is an allergy).
11. Significant swelling, pain, warmth, or tenderness in the calf of either leg that you have not had before surgery.
12. Any progressive numbness or decreased sensation in the operated extremity not relieved by immobilization and rest. Note: if you had a nerve block to help with postoperative pain, it is usual to have numbness and tingling in your arm, hand, and fingers until this wears off.

If your follow-up appointment has not already been scheduled, please call Dr. Jurek’s office on the next business day to schedule your appointment to be seen approximately 7-10 days following surgery.

Answers to many postoperative questions may be found under Surgery Guidance. A video showing how to adjust the shoulder immobilizer is located in the Brace Information section.

In the future, any time when you have surgery, dental work, or develop an infection of any kind (e.g. bladder, tooth, ear, respiratory) you MUST notify your surgeon, dentist, or doctor that you have had an artificial shoulder joint replacement. In these situations, antibiotics are often used to prevent an infection in the artificial shoulder joint. Call your doctor’s office if you have any further questions or concerns.