Ice

• You will be provided with ice packs on the day of your surgery. We recommend that you use ice on a consistent basis for the first 2-3 days to reduce post-op swelling. After that, use as necessary.
• Use a cloth between the ice and your skin- DO NOT place ice directly on skin. Do not leave ice wrap or cold therapy on for more than 20 minutes without checking your skin.
• Breg Polar Cubes are available for purchase. Please contact 513-354-3710 or 859-905-1006 for details.
• You may consider purchasing other commercially available ice and compression devices available online (e.g. amazon.com). Some options include a NICE Machine, Game Ready machine or Cryocuff. These devices are not always covered by insurance; we advise you contact your insurance company for cost details. If desired, we can write you a prescription for these devices.

Sling & Weight bearing status

• With an upper extremity manipulation, you will NOT be placed in a sling. A sling encourages the shoulder capsule to re-scar.
• There is no sling. Begin gentle active and passive shoulder motion immediately (day 1) and use the arm for light functional activities, per Dr. Pettit.
• You may use your arm for light functional daily activities as tolerated; avoid heavy lifting until instructed by your surgeon.
• If your sling came with a squeeze ball, please use the squeeze ball regularly while making a fist, as this will help reduce pain, swelling and bruising. If your sling did not come with a squeeze ball, please use a pair of socks and squeeze frequently.

Physical Therapy

• Formal physical therapy typically starts immediately after surgery. You will be given exercises to do on your own and formal physical therapy will be discussed at your first post-operative appointment.

Until you begin working with a therapist, you can do some exercises at home, such as: pendulum exercises (see pictures below). You should also bend and straighten your elbow and move your wrist so they will not get stiff. You are encouraged to begin gentle active shoulder motion and use your arm for light activities right away, as directed by your surgeon.

Pendulum Exercises: Perform 3 times daily for 5 minutes at a time. Gradually increase the size of the circle.

Pain Control and Medications

You have been given a regional anesthetic block prior to your operation. This will wear off in the evening following your surgery. You may find it beneficial to sleep in a recliner after surgery.

1. Pain Medication: Tylenol 1000mg every 8 hours and, unless discussed otherwise, you have been prescribed a narcotic pain medication (Oxycodone 5mg) to take every 4-6 hours as needed.
• DO NOT drive/use any heavy machinery, drink alcohol, make any life-changing or legal decisions (i.e. sign a will), or participate in activities that require a lot of physical skill, as narcotics may change your mental acuity. On rare occasions they may cause confusion or disorientation, we advise you to discontinue this medication should that occur.
• Narcotics can be addictive. Dispose of any excess medication at a police/fire station.
• Take a stool softener (e.g. Colace) while taking narcotic medication, as narcotics may cause constipation.  If this does not help alleviate your constipation, you can try adding miralax or milk of magnesia. Please call our office if this regimen does not alleviate your constipation.
• If you have any questions or concerns about narcotic strength medications, please contact us.
• Journavx (suzetrigine): If Journavx has been prescribed, take it in place of the Oxycodone. Start with a loading dose of 100 mg (two 50 mg tablets), then take one 50 mg tablet twice a day (every 12 hours) for two weeks. If you are not getting adequate pain control with Journavx, you may take Oxycodone instead. Do not take Journavx and Oxycodone at the same time, and avoid grapefruit while taking Journavx.
2. Anti-nausea: Zofran (Ondansetron): Take as prescribed if needed for nausea, esp. with narcotics.
3. Anti-Inflammatory: Unless contraindicated due to other health reasons, you have been prescribed a non-steroidal anti-inflammatory drug (Ibuprofen 800mg) for use postoperatively. Anti-inflammatories and analgesia may be used as directed to control pain and allow aggressive early motion. If you have no personal history of adverse response to anti-inflammatories (NSAIDs), take as prescribed every 8 hours with food to help reduce swelling and pain. Do not take other NSAIDs (Advil, Aleve, etc) with Ibuprofen.
4. Muscle Relaxer: Cyclobenzaprine (Flexeril) will be prescribed for patients <70yo for muscle spasms as needed. You may take 5-10mg of Flexeril every 8 hours for muscle spasm as needed.

Tylenol and Ibuprofen are the foundation for your pain control regimen

Example dosing: 1000mg Tylenol then 4 hours later 800mg Ibuprofen then 4 hours later repeat- every 4 hours alternate between Tylenol and Ibuprofen. Oxycodone as needed for breakthrough pain.

*You should not exceed 3,000mg of Tylenol or 3,200mg of Ibuprofen in 24 hours.

Driving

• Driving may resume when you are 4 weeks post operatively, and able to remove your sling. You may not return to driving while still taking narcotics. You must feel safe to operate a vehicle. We recommend you practice driving in an open parking lot before returning to the road. If you have to drive for long periods of time within 2-4 weeks after surgery, we recommend taking frequent breaks to walk and stretch, to decrease the risk of a blood clot.

Return to Work

• You may return to work as soon as you are comfortable. This is dependent on your job type. You will not be able to return to work with heavy lifting until 4-6 months post-op. Return to work notes can be obtained at your first post-op appointment.

Follow-up Appointment

• Your first post-operative appointment will be scheduled 7-10 days following your surgical procedure. If you do not have a post-operative appointment scheduled when you leave following surgery, please call 513-441-5639 to make the appointment.

****Signs & Symptoms to Immediately Report****

Call 911 and go to the nearest hospital if you are having chest pain or trouble breathing