home recovery program - kaiser permanente

Home Recovery ProgramSame Day Shoulder Replacement

Orange County Orthopedic Surgery

DS-1145 (09-20)

Welcome

Having surgery to replace a shoulder joint is a big decision. This booklet covers the most important facts to help you prepare for surgery. Most shoulder replacements can be performed as an outpatient procedure where you can recover at home later that same day.

What should you do first? Read this booklet and complete all items on the preparation checklists. It will help you and your family know what to do.

If you haven’t already, register to access your online medical record at kp.org. You can get information about your surgery, view your appointments, and communicate with your care team. If you are already registered, download the Kaiser Permanente app to your smartphone or tablet.

Your care team will answer any questions you have.

Important Phone Numbers

Orthopedics Clinic:Anaheim: 3460 E. La Palma Ave., Anaheim, 92806

Irvine: 6670 Alton Parkway, Irvine, 92618

Total Joint Coordinator:Brenda Rosales, RN Teamleader

714-644-2333

Appointment Call Center:1-888-988-2800

Surgery Scheduler:714-572-7030

Hospital Admitting Department:Anaheim: 714-644-2800

Irvine: 949-932-6830

Member Service Contact Center:1-800-464-4000 (TTY 711)

After-Hours Nurse Advice:1-888-574-2273 (TTY 711)

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Contents Shoulder Replacement Surgery & Recovery ..........................................................................................1

What Is Total Shoulder Arthroplasty Surgery? ..................................................................................1Anatomy of the Shoulder ....................................................................................................................1Kaiser Permanente’s Shoulder Replacement Program ....................................................................2Your Total Shoulder Replacement Team ...........................................................................................3

Your Surgery Date & Clinic Appointments .............................................................................................4Surgery ..................................................................................................................................................4Appointments Before Surgery ...........................................................................................................4Appointments After Surgery ...............................................................................................................4

Your Preparation Checklist ........................................................................................................................5Before Surgery ......................................................................................................................................5Day Before and Morning of Surgery ..................................................................................................6After Surgery .........................................................................................................................................6

Before Surgery ...........................................................................................................................................7Day of Surgery ............................................................................................................................................7After Surgery ..............................................................................................................................................7Leaving the Hospital ..................................................................................................................................7Recovering at Home ..................................................................................................................................7

Daily Care for Your Shoulder ..............................................................................................................7Keeping a Positive Mindset .................................................................................................................8Pain.........................................................................................................................................................8Swelling .................................................................................................................................................8Constipation .........................................................................................................................................8Sleeping ................................................................................................................................................9Outpatient Physical Therapy ...............................................................................................................9

When and How to Contact Us ..................................................................................................................10When to Contact Us .............................................................................................................................10How to Contact Us ...............................................................................................................................10

Answers to Common Questions ..............................................................................................................11APPENDIX A: Medication .........................................................................................................................13APPENDIX B: Get Your Skin Ready ..........................................................................................................15APPENDIX C: Anesthesia and Nerve Blocks ..........................................................................................17APPENDIX D: Constipation ......................................................................................................................19APPENDIX E: Sling and Ice Pack…………… ...........................................................................................20

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Shoulder Replacement Surgery & Recovery

What Is Total Shoulder Arthroplasty Surgery?Shoulder joint replacement, or shoulder arthroplasty, is a common procedure done to treat many painful shoulder conditions.

Anatomy of the ShoulderThe shoulder is made up of three bones:

• Humerus (bone in your arm)• Scapula (shoulder blade)

These bones connect to create two joints: • The glenohumeral (shoulder) joint is the main component of your shoulder joint. It’s where

the top of the humerus, called the humeral head or ball, joins the shallow socket in the shoulder blade called the glenoid.

All joints are usually lined by a smooth layer of tissue called articular cartilage. Cartilage is a smooth substance that allows the bones to easily glide against one another without friction. Cells within the cartilage also produce fluids that lubricate the joint, further allowing friction-free smooth motion of the joints.

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The rotator cuff is a group of four muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) that originate from the shoulder blade. They attach to specific locations on the humeral head or ball. When the muscles contract, the tendons pull on the bones to move the shoulder. Overall, they work together to keep the ball centered in the socket during shoulder motion. One of the tendons may be detached to insert the replacement implant and then re-attached at the end of the procedure.

Most people who need a shoulder replacement have damage to the rotator cuff tendons associated with pain and limited motion, ball and socket joint arthritis, and/or shoulder instability (ball slides out of the socket).

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Kaiser Permanente’s Shoulder Replacement ProgramOur program is designed around evidence-based practices that will help you recover safely and quickly. It includes educating you and your family, making sure you are healthy before surgery, and a return to a normal diet and daily activities on the day of surgery. You can expect to:

• Eat a light meal soon after surgery• Stand up and walk soon after surgery• Walk and move a little more every day• Have improved pain control with fewer narcotics

Your Total Shoulder Replacement TeamIt takes a team to give you the best care before and after surgery. These are some of the team members you will meet.

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Team Member Role

Surgeon Does your surgery and directs your care team

AnesthesiologistGives anesthesia (pain medication) during the surgery and may give you an Interscalene Nerve Block to help your pain after surgery

Physician Assistant (PA) and Nurse Practitioner (NP)

A licensed and experienced health care provider, our PA helps the surgeon take care of you before, during, and after surgery

Perioperative Team Cares for you right before surgery, in the operating room, and after surgery in the post-anesthesia care unit

Orthopedics Clinic Includes our nursing and medical assistant staff who provides care before and after surgery

Surgery Scheduler Schedules your surgery, preoperative class, and preoperative appointments

After-Hours Advice Nurse

Available after hours, weekends, and holidays to answer your questions over the phone as needed

Home Health Nurse and Outpatient PhysicalTherapist

Gives you exercises and guidance to help your recovery in the hospital, in your home, and in the clinic

Your Surgery Date & Clinic Appointments

Once your surgery is scheduled, your care team will schedule several appointments for you. Use this area to make note of these important dates. You can also find this information in your online health record on kp.org.

SURGERY

Date: _______________________________________ Check-in time: ______________________________

Address & location: _______________________________________________________________________

APPOINTMENTS BEFORE SURGERYPreoperative evaluation with Orthopedics. A team member from the Orthopedics Department will meet with you to prepare you for surgery.

Date: _______________________________________ Appointment time: _________________________


Perioperative Medicine clinic. A medical doctor may review your health history and determine which anesthesia and medications are best for you before surgery.



APPOINTMENTS AFTER SURGERYPostoperative Wound Check. You will meet with a member of the Orthopedics team to check your wound and make sure it’s healing properly.



Surgeon follow-up visit. You will meet with your surgeon to check on your recovery progress and discuss next steps.



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Your Preparation Checklist Use this area to plan what you need to do for a healthy recovery. Check off the box as you complete each item.

Before Surgery

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o Register to access your online medical record at kp.org. Download the Kaiser Permanente app to your smartphone or tablet.

8 Weeks Before Surgery - Be Your Healthiest

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NO TOBACCO. If you use tobacco, quit. If you smoke, your surgery may be postponed. Quitting tobacco now is the most important thing you can do to enhance your recovery and prevent an infection in your new joint. Kaiser Permanente Wellness Coaching by Phone can help you quit. Call 1-866-862-4295 to schedule an appointment or visit kp.org/centerforhealthyliving for more information.

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Be active now so it will be easier to move around after surgery. Practice gentle range of motion exercises using pain as a guide.

If you have diabetes, control your blood sugar levels. Work with your doctor or other health care professional.

Complete all necessary dental work 1 month before surgery. After surgery, antibiotics before dental work will be required. Please talk with your surgeon about when you may have dental work after surgery.

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Find a helper (family or friend) who will drive you home and stay with you for the first 1 to 2 days after you return home. Some people prefer around-the-clock help for 1 to 2 weeks after returning home.

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Find someone who will be able to help you with daily activities (like driving to appointments) for 3 to 4 weeks after surgery.

2 Weeks Before Surgery - Stay Healthy and Get Your Home Ready

Prepare and freeze meals, buy frozen or easy-to-prepare meals, or arrange for meals to be provided after surgery.

Prepare the home where you will recover.

• Remove safety hazards that may trip you, such as throw rugs and loose cords. • Place common kitchen and other items in easy-access locations, and set up the

bathroom/bedroom for maximum comfort.• Consider a reclining semi-upright position (reclining chair or back pillow support

or automated bed) when sleeping after the surgery for comfort.

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https://kp.org/centerforhealthyliving

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2 Weeks Before Surgery - Stay Healthy and Get Your Home Ready (continued)

Make care arrangements for pets who may knock you down after surgery. Avoid direct contact with pets near the incision site for 2 weeks after surgery.

Consider getting a weekly pill dispenser to organize medications.

Day Before and Morning of Surgery

Day Before and Morning of Surgery

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Prepare your skin as instructed. This may include wiping your shoulder the night before and morning of surgery.

Do NOT use lotions, moisturizers, or cosmetics.

Wear clothing that is easy to put on such as a large oversized shirt with snap on buttons in the front.

o Arrive at the check-in address by the requested time.

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After Surgery

When You Return Home From the Hospital

Start taking pain medication as instructed and as soon as you start feeling discomfort. Pain is easier to control if you stay ahead of it.

Keep your bandages clean and dry, as directed by your surgeon. If it gets wet, come to the hospital or orthopedic clinic cast room for a dressing change.

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Before Surgery Refer to “Your Preparation Checklist” to make sure that you complete all the items you need to do before surgery.

Make sure you have family or friends who can help you recover after the surgery.

A pre-operative Kaiser Permanente shoulder replacement education class is available for you and your support team to attend. For information, please contact our office.

Day of Surgery Refer to “Your Preparation Checklist” to make sure that you complete all the items you need to do on the day of surgery.

Wash your shoulder and arm the night before and morning of surgery as instructed.

Have your family or friend available to help drive you home from the hospital and assist with basic daily living activities.

After Surgery

Right after surgery, you will wake up in the recovery area. We will work with you to control any discomfort. Your nurse or physical therapist will help you sit up and get out of bed soon after surgery. Moving is one of the most important steps to healing.

Leaving the HospitalYou will be cleared by your care team to go home when you can, with help, transfer to a chair, and use the bathroom. Your helper needs to be able to help with this. Safety is the key. The majority of shoulder surgery patients are able to go home the same day of surgery in order for a comfortable home recovery to start.

When you leave the hospital, you will be in a sling. You will be unable to bear weight with your operative arm for an amount of time determined by your surgeon.

Recovering at HomeWhen you return home, you will likely feel tired. It is normal to have some pain and swelling in your shoulder after surgery. Pain does not equal harm. It will improve as you move and heal.

Daily Care for Your ShoulderKeep your dressings dry and clean until your post-operative clinic visit.

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Following are helpful tips that can help you speed up the recovery process.

Keep a Positive Mindset

After surgery, your physical recovery is of greatest importance. However, part of your recovery also needs to focus on keeping a positive mindset. Remember that pain can be affected by emotions and stress. Fearful feelings and concerns are normal. Some of these include:

• “Why is my shoulder swollen?”• “Why is there still pain?”• “My shoulder is going to hurt more if I stretch it.”

These are common thoughts after surgery. Stay positive as your body heals!

PainIt’s normal to feel more pain after surgery as the medications you had during surgery wear off. The interscalene nerve block can help for 1 or 2 days after surgery.

To avoid the onset of pain, start your pain medications as prescribed as soon as you get home. Don’t wait until your pain becomes unbearable. To reduce or avoid pain, follow the advice for daily care of your shoulder.

Some pain may continue for 2 to 3 months but will get better with time. Slowly increase your activities. If you overdo it with activity, you’ll feel more pain temporarily. SwellingIt’s normal to have swelling, bruising, or a change in skin color anywhere on your arm after surgery. Your incision may feel numb or warm and you may hear occasional painless clicking from the shoulder.

You will likely have more swelling and bruising 3 to 5 days after surgery, which is normal. To reduce swelling:

• Ice your shoulder for 15 to 20 minutes, 6 or more times a day with an ice pack or cooling machine.

• Your hand may swell up because of its dependent position. It’s important to practice making a full fist to prevent stiffness and reduce the swelling.

ConstipationConstipation means it is very hard to pass a stool. This is a common side effect of taking narcotic pain medication after surgery. It’s normal to have some constipation when you take pain medications.

Prevent constipation by walking for a few minutes every hour, eating high-fiber foods, drinking plenty of water, and taking the laxatives and stool softeners that your doctor prescribes.

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SleepingIt’s normal to have some trouble sleeping for a few months after surgery. Avoid naps to sleep better at night. Try to keep near-normal awake and sleep times. Some people find it more comfortable to sleep in a recliner chair, propped up on pillows for the first several weeks after surgery.

Outpatient Physical TherapyGenerally, about 2 weeks after surgery (it may be later based on your specific surgery), you should be able to, with help, get into and out of the shower, exit your home safely, get into and out of a car, and get into the clinic.

The timing of physical therapy will be determined by your surgeon based on the procedure.

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How and When to Contact Us

Contact a member of your care team if you have a question or concern. Call us at one of the phone numbers in the front of this booklet or email through kp.org. It may take a couple of days to reply to email messages, so please call if your question is urgent.

When to Contact Us• You have increasing severe pain that does not get better with resting, pain

medication, ice, and elevation. • You have not passed a stool for more than 72 hours and you have tried the laxatives

and stool softeners as advised. • You have worsening redness.• There is drainage from the incision or bleeding after 5 days.• You have chills or a fever higher than 101°F.

How to Contact Us• First, contact the Orthopedics Department using the phone numbers in the front of

this booklet if it is during day-time weekday hours.• Second, call the After-Hours Nurse Advice line. They can answer your questions and

help you decide if you need to go to Urgent Care, go to the Emergency Department, or wait until the Orthopedics Clinic is open.

• Urgent Care is available evenings and weekends when Orthopedics is closed. Call your appointment call center to find out when your nearest Urgent Care is open.

• Go to the Emergency Department if you need immediate medical care.

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Answers to Common Questions

1. What is the average recovery time? On average, the recovery time is between 4-6 months.

2. How long will I need to stay in the hospital? Most of these surgeries are done as an outpatient and you should be home within a few

hours.

3. When can I resume driving after surgery? You shouldn’t drive while you are in a sling or taking narcotic pain medications. Most people

are in a sling between 3 to 6 weeks after surgery. Ideally, you should be weaning off your medications between 7 to 10 days.

4. When can I resume traveling? There may be a higher risk of blood clots if you travel immediately after surgery and it is

recommended to wait at least a few weeks before long trips.

5. Will I set off metal detectors in security with my shoulder replacement? You may set off metal detectors in security based on the sensitivity. If you do, just notify them

that you had shoulder replacement surgery. You do not need a card or letter from your surgeon.

6. Will I need to take antibiotics for dental procedures following surgery? You can return to the Dentist for cleanings/procedures 3 months after your shoulder surgery.

You will need to take prophylactic antibiotics 1 hour prior to any dental procedures for your lifetime after your joint replacement. This prescription can come from you Surgeon, Primary Care Doctor, or your Dentist.

7. When can I resume drinking alcohol? You can resume alcohol use once you discontinued the use of all narcotic pain medications.

Although it is recommended to try and abstain from alcohol use during your recovery.

8. How long will I need to wear my sling? The average sling time after surgery is between 3 and 6 weeks. Your surgeon will notify you

the recommended length of time to protect your surgery site.

9. What is the best position for sleeping after surgery? Most patients find sleeping in a semi-upright position is the most comfortable. You can either

sleep in a recliner chair or prop yourself up in bed with pillows. This is usually needed for the first 2-4 weeks on average.

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10. When can I resume showering? You should keep your incisional dressing dry and clean until your first post-operative

appointment. This is usually around 2 weeks after surgery. Until then, most patients will keepthe surgical site covered and sponge bathe.

11. When can I start moving my arm? Your surgeon will review with you when you will start physical therapy and when you can

move your arm. This may vary based on your surgery. You can usually remove the sling to move your elbow, wrist and fingers early into your recovery process.

12. What can I do for the pain and swelling? You will be given multiple medications which will help reduce your pain after surgery. These

will not totally eliminate your pain. An interscalene nerve block may be given from the Anesthesiologist which can reduce your pain for 1-2 days after surgery. You will go home with a cold therapy machine that will reduce your pain and swelling as well.

13. Is it normal to have bruising after surgery? Some bruising after surgery is normal. This is not uncommon to see on the inside of your arm

down to your elbow. This also may occur on part of the chest wall as well. This will resolve with time.

14. How long will I need to take Opiods (narcotic pain medication)? This may vary from patient to patient. Ideally we would like you wean off your pain

medications after 7 to 10 days.

15. Is constipation normal with taking pain medications? Constipation is very common especially while taking opioid pain medications. Medications

can be prescribed to help with these symptoms.

16. When can I start lifting and strengthening after surgery? Your surgeon will review with you when you may start strengthening. Usually this starts

around 3 months after surgery.

17. When should I call my surgeon? If you have any concerns about your surgical site, our team is available to provide advice and

direction. The contact numbers will be provided.

18. What does smoking affect? The chemicals inhaled are toxic compounds and can cause impaired tissue healing and

recovery. They may also increase the risk of complications during and after your surgery. It is recommended to stop smoking to optimize your potential outcome and recovery.

19. How long do I have to quit smoking? Ideally, you should stop smoking as soon as possible.

APPENDIX A: Medication

Total Joint Medication Guide

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Day Medications Notes For Tracking Your Medications

The Day You Come Home Gabapentin 300 mg before bedtime (if needed).

Roxicodone® 5 mg as needed for pain not controlled by the other medications.

Take 1 tablet. Wait 30 minutes.If you still have pain, take a second tablet. Wait 30 minutes.If you still have pain, take a third tablet. Wait 30 minutes. If you still have pain, take a fourth tablet.Maximum 4 tablets per 4 hour period.

Tylenol 1000 mg (2 tablets of 500 mg) for pain every 8 hours.

1 Day After Discharge Gabapentin 300 mg before your normal bedtime, if needed.

Roxicodone® 5 mg as needed for pain as described above.

Tylenol® 1000 mg (2 tablets of 500 mg) for pain every 8 hours.Aspirin 81 mg for blood thinning (if not on other blood thinners).

Zofran for nausea, if needed.

Docusate 250 mg for constipation at bedtime.

2 Days After Discharge Gabapentin 300 mg before your normal bedtime, if needed.

Tylenol® 1000 mg (2 tablets of 500 mg) for pain every 8 hours.


Aspirin 81 mg (if not on other blood thinners).



Total Joint Medication Guide

Day Medications Notes For Tracking Your Medications

3 Days After Discharge Tylenol® 1000 mg (2 tablets of 500 mg) for pain every 8 hours.


Aspirin 81 mg (if not on other blood thinners).



Gabapentin 300 mg 45 minutes before your normal bedtime. Wean off.

4 Days Through 6 Weeks After Discharge

Begin Meloxicam 15 mg, 45 minutes before your normal bedtime, if you are allowed to take anti-inflammatory medications. Tylenol® 1000 mg (2 tablets of 500 mg) for pain every 8 hours.


Docusate 250 mg for constipation at bedtime (continue as long as you are on pain medication.

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APPENDIX B: Get Your Skin Ready Your care team will tell you which cleansing solution is best for you.

Chlorhexidine Wipes

The Night Before Surgery and Morning of SurgeryPrepare your skin using the cleansing solution your care team advised for you.

If you were told to use chlorhexidine wipes:• Shower or bathe, washing your face, hair, and genitals with your normal soap and

shampoo. Rinse thoroughly.• Completely dry your skin using a clean towel.• Open one package.• Use one clean cloth to prep the shoulder area. Wipe areas 1, 2, and 3 only as shown

in the image. Wipe each area thoroughly. You may need help. Use all cloths in the package.

• Do not use this product above your neck. Do not allow it to come in contact with your face, including your mouth and ears. Do not use it on your genitals.

• Do not rinse or use any lotions, moisturizers, perfumes, or make-up.• Discard cloths in a trach can.• Allow your skin to air dry. Wear clean pajamas. Sleep on clean sheets.

Wipe your skin in this order:1. Wipe your neck, upper back, and shoulder blade.2. Wipe both arms, starting each with the shoulder and ending at the fingertips. 3. Thoroughly wipe the armpit areas.

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APPENDIX C: Anesthesia and Nerve Blocks

Anesthesia Patients usually have two types of anesthesia for this surgery. The first is general anesthesia, which means you are asleep. The second type is a nerve block. Your arm will be numb and will feel very strange. The nerve block will last about 1 to 3 days. The anesthesiologist will speak to you on the day of surgery about the nerve block.

Interscalene Block Patient InformationWhat is an interscalene block (ISB)? Interscalene blocks are used for pain during and after surgery on the shoulder. An ISB is the injection of a numbing medicine (local anesthetic) around a group of nerves in the neck area. This nerve block in the neck stops you from feeling pain in the shoulder and arm so shoulder surgery can be done with or without general anesthesia.

How is an ISB done?• You will lie flat on your back with your neck turned away from the surgical side. You

may be given medication through an IV to help you relax. • Your neck will be cleaned to reduce the risk for infection.• The doctor may use an ultrasound to help find the exact location of the nerve.• Once the location is found, the doctor will numb the skin with local anesthetic.• The doctor will use a nerve stimulator to guide the needle to numb the correct

nerves. The nerve stimulator will pass a small amount of current down your arm that will make your shoulder/arm twitch.

• The needle will then be removed and the ISB procedure is complete.

What are the benefits of an ISB?• Removes or reduces pain. • Reduces risk of nausea, vomiting, and sedation from general anesthesia.• Allows you to eat and drink earlier.• Provides faster recovery and earlier discharge from the hospital.

Pain Control• Numbness from the local anesthetic may last 8 to 36 hours. The result varies with

each patient.• After leaving the hospital, it’s very important to take pain medication at the

prescribed times from the moment the block begins to wear off.

Management of the Numb Arm• Be careful not to come in contact with very hot or cold items as they can injure the

skin. To prevent skin burns, do not leave ice on your skin for longer than 30 minutes at a time.

• Carry the numb arm in a sling until normal sensation and motor function return and/or until your doctor tells you to stop wearing the immobilizer.

What are the side effects of an ISB?Most of the side effects are related to the numbing of the nerves that supply the shoulder and arm. Any or all of these can occur, but they will resolve as the effects of the local anesthetic wears off:

• Shortness of breath. The numbness of the nerves controlling the diaphragm may make you feel like you are not taking as deep a breath as you did before the ISB.

• Blurred vision seen as a drooping eyelid and slightly blurred vision on the side of the nerve block.

• Hoarseness. Local anesthetic may numb the nerves supplying the voice box.• Difficulty swallowing from numbness of the throat and nerves supplying the voice

box.

What are the risks of an ISB?ISB is considered a safe procedure. However, like many other medical procedures, there are risks, such as a failed block (no numbness to the nerves), bleeding, infection, and reaction to the local anesthetic, including seizure and cardiac arrest, spinal block, epidural block, collapsed lung, nerve injury, or continual tingling sensation.

This handout is designed to inform you about the ISB procedure. Please share any concerns you have with your anesthesiologist on the day of surgery. The information provided here is not a substitute for having a discussion with your anesthesiologist.

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APPENDIX D: Constipation

Prevent constipation by walking for a few minutes every hour, eating high-fiber foods, drinking plenty of water, and taking the laxatives and stool softeners that your doctor has prescribes:

• Colace (docusate) is a stool softener. You will take 250 mg every evening.• MiraLAX is a laxative. Drink a 17-gram packet mixed with juice per the

directions every morning. Increase to 3 times a day if you have not had a bowel movement for more than 24 hours or if you have bloating/discomfort.

• If you have not passed a stool for 3 days, drink an entire 8-ounce bottle of magnesium citrate. If you still haven’t had a bowel movement after 8 hours, you may drink one additional 8-ounce bottle of magnesium citrate. Do not drink more than two bottles. Contact us if you have not had a bowel movement after the second bottle.

• Drink 3 cups of prune juice a day. Stop if your stool is watery or you are not

constipated. • Take 2 Senokot tablets at bedtime if needed.• Take Smooth Move tea (available at drugstores) once a day.

APPENDIX E: Sling and Ice Pack Remember, always follow your doctor’s orders. The affected arm should not perform any active movements. Make sure your affected arm is in a neutral position with your arm at your side and elbow bent 90 degrees.

Bathing• Keep your dressing dry and clean.• The affected arm should not perform any movements. • Sitting on a shower chair or tub transfer bench may be safer.• Do NOT soak the shoulder under water.

Sleeping• Remember, always follow your doctor’s orders.• Wearing a sling while sleeping is recommended to keep your shoulder in the proper position. • Sleeping in a reclined position can be more comfortable than lying flat on your back.• Use pillows to support the affected arm while sleeping.• You may need help to properly position the pillows around the affected arm when sitting

in a reclined position.• The affected arm should not perform any active movements.

Using pillows:• Pillow positioning helps make sure the affected arm remains properly positioned and

does not move during the night.

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Weblink to application of sling:https://www.breg.com/wp-content/uploads/2017/01/universal-abduction-sling-ifu.pdf

Ice Pack Unit:You will also receive an Ice Pack Cooling Unit to help reduce swelling and pain after shoulder surgery. The recovery room nurse will instruct you on application and use of it. Make sure a dry towel or cloth is under the ice pack pad. Check periodically to make sure that the pad remains dry when in use.

Here is a link to its application and using it. Website: https://www.breg.com/wp-content/uploads/2017/01/polar-pad-ifu.pdfVideo: https://youtu.be/md8UJveZr-Q

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https://www.breg.com/wp-content/uploads/2017/01/polar-pad-ifu.pdf

https://youtu.be/md8UJveZr-Q

https://www.breg.com/wp-content/uploads/2017/01/universal-abduction-sling-ifu.pdf

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