Post-Operative and Recovery Guide for Your Right Shoulder Arthroscopy

Your Pain Medicine Plan (Most Important First 2 Weeks)

Take paracetamol (1000mg, 4 times daily) and ibuprofen (400mg, 3 times daily) regularly for the first 2 weeks—set phone alarms so you don't forget. 1 This combination works better than either alone and reduces your need for stronger opioid painkillers. Take ibuprofen with food to protect your stomach.

Pain Medicine Checklist (Tick Each Dose):

Paracetamol: 8am ☐ 2pm ☐ 8pm ☐ Bedtime ☐
Ibuprofen: 8am ☐ 2pm ☐ 8pm ☐ (with food/milk)
Stronger painkillers (if prescribed): Only use if pain is still bad after taking the above

Why this matters: Your surgeon likely gave you a nerve block during surgery that will wear off within 12-24 hours. When it wears off, pain will increase suddenly—this is normal. Starting regular pain medicine before the block wears off prevents severe pain 1.

First 24 Hours After Surgery

What's Normal:

Your arm will be in a sling
Shoulder feels numb then gradually more painful as nerve block wears off
Feeling tired, foggy, or emotional from anaesthesia
Mild nausea

Specific Tasks (Do These):

Hour 1-6 (Still at hospital/home):

Eat something light before leaving hospital (toast, biscuit)
Take first dose of paracetamol and ibuprofen before nerve block wears off
Have someone drive you home—you cannot drive

Hour 6-24:

Keep your arm in the sling at all times (even sleeping)
Sleep propped up with 2-3 pillows—lying flat hurts more
Put a pillow under your right elbow for comfort
Ice your shoulder: 15 minutes on, 45 minutes off (use frozen peas in tea towel, not directly on skin)
Keep your dressing dry—no shower yet

Cat Care Adaptations:

Do not lift cat litter bags (too heavy)
Ask someone else to change litter for 6 weeks
Feed cat with your left hand only
If cat jumps on you, gently push away with left hand—protect your right shoulder

Week 1: The Hardest Week

Daily Routine (Specific Times Help ADHD):

Morning (8am):

Take paracetamol + ibuprofen with breakfast
Wash face with left hand only
Sponge bath (avoid right shoulder dressing)
Dress in loose button-front shirt or zip-up hoodie

Midday (12-2pm):

Take paracetamol (2pm)
Ice shoulder (15 minutes)
Do pendulum exercises (see below)

Evening (6-8pm):

Take ibuprofen with dinner (8pm)
Ice shoulder (15 minutes)
Do pendulum exercises

Bedtime:

Take paracetamol
Sleep propped up with pillows
Keep sling on while sleeping

Pendulum Exercises (Start Day 2-3):

Do 3 times daily, 10 repetitions each direction:

Lean forward, rest left hand on table
Let right arm hang down (still in sling, just loosen it)
Gently swing arm: forward-back, side-to-side, small circles
Do not lift arm yourself—just let gravity move it
Takes 5 minutes total

Why: Prevents shoulder stiffness without stressing repair 2

What You Cannot Do (Week 1):

❌ Drive (illegal and dangerous—nerve block affects reflexes)
❌ Lift anything heavier than a mobile phone with right hand
❌ Reach behind your back
❌ Lift arm away from body
❌ Remove sling except for exercises and washing
❌ Get dressing wet

Week 2: Dressing Removal and First Follow-Up

Day 7-10: Dressing Comes Off

Your GP practice nurse or surgeon will remove dressing
You can now shower (let water run over shoulder, don't scrub)
Pat dry gently with towel
Small sticky strips (Steri-Strips) may still be on—leave them, they'll fall off naturally

Driving Assessment (Week 2):

You can drive when ALL of these are true:

Not taking opioid painkillers for 48 hours
Can fasten seatbelt with right hand without pain
Can turn steering wheel quickly in emergency stop
Can check blind spot by turning body without severe pain

Test this in parked car first—if you cannot do all of these comfortably, wait another week. Most people can drive at 2-3 weeks 3.

Weeks 3-6: Gradual Movement Phase

Sling Use:

Week 3-4: Wear sling outside home, can remove at home for gentle activities
Week 5-6: Wean off sling—use only if shoulder feels tired or painful

Exercises Progress (Add These Gradually):

Week 3-4: Add Active-Assisted Range of Motion

Continue pendulum exercises
Table slide: Sit at table, place right hand on tea towel, slide arm forward on table (left hand helps), hold 5 seconds, slide back. Do 10 times, 3x daily
Wall walk: Face wall, walk fingers up wall like spider, go as high as comfortable (no pain), walk back down. Do 10 times, 2x daily

Week 5-6: Add Gentle Strengthening

Continue above exercises
Resistance band exercises (if physiotherapist provides)—very light resistance only
Can start using right hand for light activities: holding cup of tea, using computer mouse, brushing teeth

Daily Living Activities Timeline:

Week 3:

✓ Dress yourself (loose clothing)
✓ Make simple meals (one-handed mostly)
✓ Light housework with left hand
✓ Short walks outside (good for mood and healing)

Week 4:

✓ Shower normally
✓ Wash hair (may still need help)
✓ Light cooking (nothing heavy)
✓ Computer work at desk

Week 5-6:

✓ Most daily activities with right hand
✓ Light shopping (carry bags with left hand or trolley)
✓ Gentle housework
❌ Still no heavy lifting, pushing, pulling

Cat Care (Weeks 3-6):

Week 3-4: Still no litter bag lifting
Week 5-6: Can scoop litter with right hand (light scooping only)
Can pet cat normally by week 4

Weeks 7-12: Building Strength Phase

What to Expect:

Pain should be minimal (occasional ache with weather changes is normal)
Shoulder feels stiff in morning—improves with movement
Fatigue in shoulder after activities—this is normal, rest when needed

Physiotherapy:

Usually starts week 6-8
Attend all appointments (set phone reminders)
Do home exercises daily—consistency matters more than intensity
Progress is gradual—expect 3-6 months for full recovery 2, 3

Activity Progression:

Week 7-8:

✓ Driving longer distances
✓ Most household tasks
✓ Light gardening (no digging)
✓ Carrying shopping bags (start with 2-3kg, gradually increase)

Week 9-12:

✓ Overhead reaching (cupboards, hanging washing)
✓ Pushing vacuum cleaner
✓ Lifting cat litter bags (if under 5kg)
✓ Most pre-surgery activities

Still avoid until 3-4 months:

❌ Heavy lifting (over 5kg)
❌ Pushing/pulling heavy objects
❌ Contact sports or activities with fall risk
❌ Repetitive overhead work

Pain and Recovery Expectations (Realistic Timeline)

Pain Levels (0-10 scale):

Week 1: 6-8 (worst week)
Week 2: 4-6
Week 3-4: 3-5
Week 6: 2-3
Week 12: 0-2 (occasional ache)

This is for calcific tendinitis specifically—your recovery may be faster than rotator cuff tear repairs because the tendon wasn't torn, just inflamed from calcium deposits 4, 3.

Function Recovery:

6 weeks: 50% of normal function
3 months: 75% of normal function
6 months: 90-95% of normal function
12 months: Maximum improvement reached

Most people (90%) have excellent results after arthroscopic removal of calcium deposits 4, 3.

Warning Signs—Contact Your Surgeon or GP Immediately If:

Infection Signs:

Increasing redness around wounds (spreading beyond 2cm)
Wound feels hot to touch
Yellow/green discharge from wounds
Fever over 38°C
Increasing pain after week 2 (should be improving, not worsening)

Nerve/Circulation Problems:

Numbness or tingling in hand that's getting worse (mild tingling first few days is normal from nerve block)
Hand turning blue or very pale
Cannot move fingers

Other Concerns:

Sudden severe pain with "pop" feeling (possible re-injury)
Chest pain or difficulty breathing (rare complication)

ADHD-Specific Strategies for Recovery Success

Memory and Organization:

Phone alarms: Set recurring alarms for medicines, exercises, appointments
Visual checklist: Print this guide, tick off tasks daily
Medicine organizer: Use weekly pill box, fill on Sundays
Exercise log: Simple tick-box chart on fridge
Appointment cards: Stick on fridge immediately when received

Managing Boredom/Restlessness:

Week 1-2: Audiobooks, podcasts, TV (you'll be tired anyway)
Week 3+: Short walks increase gradually (good for dopamine and healing)
Fidget tools: Use with left hand during rest periods
Break exercises into smaller chunks: 3 minutes, 3 times daily easier than 10 minutes once

Avoiding Impulsive Movements:

Pause before reaching: Count "1-2-3" before using right arm
"Left hand first" rule: Try with left hand before using right
Remove temptations: Put heavy objects out of reach for first 6 weeks

Hyperfocus Risk:

Set timer when doing activities—stop and rest shoulder every 20-30 minutes
Don't overdo exercises thinking "more is better"—this delays healing

Weight and Healing Considerations

Being slightly overweight does not significantly affect shoulder healing but does increase anaesthetic risks (already managed during surgery). Focus on:

Protein intake: 80-100g daily helps tendon healing (eggs, chicken, fish, beans, Greek yoghurt)
Hydration: 2 litres water daily
Avoid weight gain from inactivity: Adjust portions since you're less active
Gentle walking: Start week 2, build to 20-30 minutes daily by week 6

Living Alone Adaptations

Prepare Before Surgery (If Reading This Pre-Op):

Cook and freeze meals in single portions
Stock easy foods: ready meals, cereal, bread, cheese
Move commonly used items to waist height
Arrange help for first week (friend/family/neighbour)

One-Handed Living Hacks:

Dressing: Button-front shirts, slip-on shoes, elastic-waist trousers
Eating: Pre-cut food, use fork only, one-pot meals
Opening jars: Use rubber grip or ask neighbour to pre-open
Carrying: Use backpack on left shoulder, not handbag
Cleaning: Robot vacuum if possible, or minimal cleaning first 3 weeks

Getting Help:

Week 1: Need someone checking on you daily
Week 2-3: Help with shopping, heavy tasks
Week 4+: Mostly independent

Expected Recovery Milestones (Tick When Achieved)

☐ Day 1: Nerve block worn off, pain controlled with medicines
☐ Day 3: Can do pendulum exercises
☐ Week 2: Dressing removed, can shower
☐ Week 2-3: Driving again
☐ Week 4: Off sling completely
☐ Week 6: Minimal pain, doing most daily activities
☐ Week 8: Started physiotherapy
☐ Week 12: Back to normal activities (except heavy lifting)
☐ Month 6: Full recovery

Questions to Ask at Follow-Up Appointments

Week 2 appointment:

"Is my wound healing normally?"
"When can I start physiotherapy?"
"Can I drive now?"

Week 6 appointment:

"What's my range of motion compared to normal?"
"When can I lift heavier objects?"
"Do I need more physiotherapy sessions?"

Key Takeaway Messages

Pain medicine works best when taken regularly, not waiting until pain is severe
Sling protects your repair—wear it as instructed for full 4-6 weeks
Exercises prevent stiffness but must be gentle—no forcing movements
Recovery is slow and gradual—expect 3-6 months, not weeks
Most people (90%) have excellent results after this surgery 4
Set up systems (alarms, checklists) to help your ADHD brain remember tasks
Ask for help—living alone doesn't mean doing everything yourself while healing

Your surgeon's contact number: ________________

GP surgery number: ________________

Physiotherapy department: ________________

Emergency (999): For severe bleeding, chest pain, difficulty breathing

NHS 111: For urgent concerns outside GP hours

What postoperative and recovery instructions should be included in a neurodiverse‑friendly British English patient leaflet for a slightly obese, non‑sport‑active, cat‑owning woman with ADHD (possible AuDHD) after arthroscopic treatment of calcific tendinitis of her dominant right shoulder?

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