What to Expect: Your Surgery Journey

This guide walks you through what usually happens from your first visit to your recovery, so you know what to expect at each step. Seeing the surgeon does not mean you will have surgery — for most shoulder and upper-limb problems, non-surgical treatment is tried first. If an operation is recommended, it is only after we have discussed it together and you understand why.

1Before any decision about surgery

• At your first visit Dr Julyan examines your shoulder (or elbow, wrist or hand) and reviews your X-rays or scans to reach a clear diagnosis.
• Most conditions are first managed without surgery — activity changes, medication, a cortisone injection, or physiotherapy or hand therapy.
• Surgery is considered when non-surgical care has not helped enough, or when the problem is one that does better with earlier repair. You decide together.

2Getting ready for your operation

• Pre-authorisation: planned surgery and your hospital or day-case admission usually need authorisation from your medical scheme first. The rooms give you the procedure and diagnosis (ICD-10) codes to arrange this.
• Pre-operative checks: depending on your health, blood tests, an ECG or a physician review may be arranged before theatre.
• Medication: tell the rooms about all your medicines. Blood thinners (for example aspirin, warfarin, clopidogrel or the newer agents) and some diabetic and other medicines may need to be adjusted before surgery — always follow the specific instructions you are given.
• Fasting: you will be told when to stop eating and drinking before your operation. Follow these times exactly, as surgery may be delayed or cancelled otherwise.
• What to bring: your ID, medical scheme card and authorisation number, your medicine list, comfortable loose clothing that opens at the front, and your toiletries if staying over.

3The day of your operation

1. AdmissionYou are admitted to Netcare Pretoria East Hospital and shown to your bed or the day-ward. A nurse (sister) checks your details and prepares you for theatre.
2. Meeting the teamYou will meet the anaesthetist, who discusses the anaesthetic with you. Shoulder surgery is often done under a general anaesthetic combined with a nerve block that keeps the shoulder comfortable for several hours afterwards. Hand and wrist procedures are frequently done under local or regional anaesthetic.
3. In theatreDr Julyan performs the procedure that was discussed and consented. The time in theatre depends on the operation.
4. Recovery roomYou wake in the recovery area where the nurses monitor you and manage pain before you return to the ward.
5. Day-case or overnightMany smaller procedures are done as a day-case, so you go home the same day. Larger operations such as a shoulder replacement usually need one or more nights in hospital. You will be told in advance which applies to you.

4The first days at home

• You will usually go home wearing a sling. You are shown how long to wear it and how to care for the arm.
• Take your pain medicine as prescribed — it works best when taken regularly at first, rather than waiting for pain to build up.
• Keep the dressing clean and dry. You will be told when it may get wet and when it is removed.
• Gentle movement of the fingers, wrist and elbow (as advised) helps reduce swelling and stiffness.

A separate guide, After your operation, covers slings, wound care, do’s and don’ts and warning signs in detail.

5Recovery, physiotherapy and follow-up

• Physiotherapy or hand therapy is an important part of shoulder and upper-limb recovery. You will be guided on when to start and what to do.
• Follow-up visits are usually arranged at around 10–14 days (wound check), then at about 6 weeks and 3 months, though this varies with the operation.
• Recovery is gradual. Returning to driving, work, sport and sleeping comfortably each has its own timeline — see the guide Your recovery timeline.
• Every person and every operation is different, so your own timeline may be shorter or longer than average.