Shoulder Clinic

Surgery Frequently Asked Questions

As a result of your consultation with Dr Cutbush, it may be decided that you require surgery. Dr Cutbush will explain the procedure and what is involved during and following your procedure.
What to do next?
It is very important for you to advise Dr Cutbush of any medication allergies you have or if you are taking any blood thinning medications.

Dr Cutbush’s staff will then be able to organise a suitable date for your procedure and provide you with details regarding your length of stay, an estimate of costs and advise the hospital and anaesthetist of your admission and surgery information.

If during this time you have any questions regarding your admission and procedure please don’t hesitate to contact the rooms.
Estimate of surgical fees?
Prior to your surgery, you will be provided with a surgery information pack which will include a letter detailing your admission, a consent form for you to sign and an estimate of costs. Please note this information may not be provided if an emergency procedure is needed or if you are directly admitted to hospital.

The administration staff at Dr Cutbush’s rooms are able to provide you with fees relating to Dr Cutbush and the assistant surgeon. There may also be costs relating to your anaesthetist and hospital stay including bed, theatre, prosthesis and incidentals. The contact details for these parties are included in the main letter in your surgery information pack.
Please keep in mind that our practice will give you the best possible care for you and your shoulder condition. It is not possible to do this through a bulk billing practice. We do not no gap or known gap initial surgical procedures.

Should you have any questions regarding the information in your pack please contact Dr Cutbush’s rooms.
Post operative information?
Following your procedure, prior to your discharge, Dr Cutbush will provide you with a letter detailing your postoperative appointments and instructions. Please read this information carefully. Should any problems or questions arise during your postoperative period please contact Dr Cutbush’s rooms.
If you are going home on the day of your surgery, you will not be able to drive yourself and if needing to catch a taxi or public transport it is not acceptable to travel unaccompanied. It is also important to make sure that you are not alone on the night following your procedure.
How do I know what time to arrive for my scheduled surgery?
Initially you will be given an admission time of 6:00am.  You will be asked to ring Dr Cutbush’s office once the list has been finalised on the day prior to surgery. We will then be able to give you an admission time closer to the actual time of your operation.

We try to reduce the time spent waiting at the hospital, however, please remember this is a surgical procedure and there will be some waiting time involved prior to the operation.
My health fund suggested I ask Dr Cutbush to bulk bill my surgery.
I give you, my patient, the best possible care for your shoulder problem. It isn’t possible for me to do this through a bulk billing practice. My surgical fees are guided by the Australian Medical Association schedule of fees. I do not no gap, or known gap, initial surgical procedures.
How to put a sling on!
Are you having trouble putting your sling on? This video will help you get that sorted.

A big thank you to our stars Lucy and Mary, physiotherapists from Extend therapy!
What time will I go home after surgery?
Most shoulder operations involve an overnight stay in hospital.  This is because shoulder operations can be painful for the first night after surgery.  If you are in hospital, the nurses can administer strong pain relief if it’s needed, often it isn’t.

Almost all patients having an arthroscopic shoulder procedure are discharged the next day; usually about 11 am after seeing Dr Cutbush and the Physiotherapist. Patients having shoulder replacement surgery will often spend two nights in hospital following a shoulder replacement.

There are a few things that need to be done the morning following surgery, before you discharge from hospital.

The nurses will change your dressings from the large suction dressing that we put on in theatre to collect any arthroscopic fluid (saline) that we use in your surgery that might come otherwise out from under the dressings.

One of the physiotherapists from Extend Therapy (dedicated shoulder physio group) will see you. The physiotherapist will stand you up and fit your sling with you standing to get the fit just right for you. They will take you through the exercise programme that we recommend for you after your particular surgery for the next 6 weeks and give you a handout with these exercises detailed.
If you need a reminder of how to do each exercise we have videos of the most common physio exercises that we recommend on the physiotherapy and the rehabilitation pages. The physiotherapist will also explain how to get dressed and how to shower safely following your surgery.

The pharmacy will dispense and bring up your post-op medications that your anaesthetist has prescribed for post-op pain relief and your nurse will go through these medications to ensure you understand them.

I will see you on the ward, usually, between 6:30 to 8:30am.

Some patients will require an x-ray or scan post-op and we will usually get this performed by Brisbane Private Imaging before you are discharged.

The nurses on the ward will make sure all of this happens in time for you to discharge from hospital by about 11am. If you need to discharge earlier please alert the nurses on the ward as soon as you can so that they can help get you ready for discharge earlier.
How many incisions will I have after my arthroscopic surgery?
A typical arthroscopic operation, such as an arthroscopic stabilisation procedure will require three to four incisions. An arthroscopic rotator cuff repair usually requires six incisions. A complex reconstruction such as for a massive rotator cuff tear utilising a graft to protect the repair may require as many as 12 incisions, sometimes more.
How large are the incisions after arthroscopic surgery?
Most incisions for arthroscopic surgery are 5mm or less and are used to insert the camera or to insert instruments to manipulate the tissues. The main working portals are larger and usually about 10mm in size, occasionally larger. An arthroscopic procedure that involves the insertion of anchors or grafts such as a rotator cuff repair or a stabilisation procedure will require at least one working portal.
What time will I ask my family to pick me up after my shoulder surgery?
You will usually be ready to discharge from hospital about 11am the day after your surgery.

There are a few things to do in the morning before you go home from hospital. The nurses will check and change your dressings if they to be changed; the physiotherapist will see you and go through how to look after your shoulder after your surgery and give you an exercise programme to follow for the first 6 weeks postop; the pharmacy will dispense your postop pain medications; and if you need an XRay after your surgery that will be done too. Normally all of this will be done and the nurses will have you ready to discharge by 11am.

If you need to discharge earlier than this please let the nurses know so that they can get you organised and away in time. The nurses may need to ask pharmacy to dispense your postop medications the night before and they may also need to ask the physiotherapist if they can come in early for you. If you need an XRay postop the nurses will need to check that you are booked in with XRay first thing in the morning.
Do I need to shave/wax before my operation?
No, you do not need to shave or wax before your surgery. However, you may find on your admission to hospital that a nurse may shave the operative site if required.
Can I wear deodorant under my arms on the day of surgery?
No, please avoid using deodorant, perfume or moisturisers on the morning of your surgery.
Do I need to remove my nail polish from my fingernails or toenails?
It would be preferable if you could remove all nail polish before your admission.
Should I purchase the Benzoyl peroxide cream or gel and how long should it be left on my shoulder for?
Please purchase Benzoyl Peroxide 5% cream over the counter at your local Pharmacy. Apply to the shoulder region and underarm, leave for approximately 30 minutes and wash off thoroughly. If your skin becomes irritated, please wash off and reduce the length of time you leave the benzoyl peroxide on your skin. If you are sensitive to the benzoyl peroxide, please wash off after 15min or less if needed. Please refer to the pamphlet for further information.
What is a PICO dressing and why is it used?
A PICO dressing is applied to the operative site at the completion of your surgery. This single use pressure wound therapy system is completely portable and used to drain excess fluid from your operation site. PICO dressings are used for patients who have had arthroscopic procedures. They are absorbent dressings and are very useful for patients that have had arthroscopic surgery where a lot of fluid is used intraoperatively to perform the surgery. There is some evidence that the PICO dressings also reduce the risk of infection following surgery and aid in recovery. The dressings will be changed the morning after surgery by the nursing staff and a PICO dressing will only be reapplied if required to absorb fluid.
How do I manage my dressings following a shoulder replacement procedure?
In the operating theatre at the end of your shoulder replacement surgery for either an anatomic or a reverse shoulder replacement, we place two dressings over your skin incision. The first dressing is a prineo dressing that is placed directly onto the incision. Over the prineo dressing, we place a second dressing which is usually a honeycomb dressing. The two dressings are positioned separately so that the top, honeycomb dressing, can be removed without disturbing the prineo dressing underneath.

After your surgery at approximately 7 days after the operation, I suggest that you remove the top, honeycomb, dressing. The prineo dressing can be left in place until it starts to fall off, at which time it can be removed.Both dressings are waterproof. You can shower with the honeycomb dressing in place, and once it is removed, you can shower with the prineo dressing in place. It is okay for both of the dressings to be wet in the shower.

For more information please see Your Shoulder Replacement & Your Dressings
What clothes should I wear when I come in for surgery?
It is best to wear button up, loose, comfortable clothes. Also, zip front bras are recommended for ease of dressing postoperatively for women.
Where do I present to on the day of surgery?
Please present to the main admissions at the front entrance of the Brisbane Private Hospital (Ground Floor) at the time advised by my rooms.
When can I expect to be discharged following surgery?
The usual discharge time is before lunchtime the day after surgery, normally this is about 11am. Occasionally the discharge time is delayed by the need to have scans or X-rays performed or if the nursing staff need more time to complete all your discharge arrangements.
Is it normal to have bruising after surgery?
This is a frequent question that patients ask. Bruising after surgery is very common and normal. Most patients experience at least some degree of bruising after surgery. The bruising is due to blood from the operative site tracking under the skin and often travels quite a distance from the surgical site. However, if you are concerned please don’t hesitate to contact the office. If you can send a photo of what you are concerned about to the office by email or perhaps by text message it helps us a lot to give you accurate advice especially if we need to ask Dr Cutbush.
What do I do if I think my wound might be infected?
Infection is extremely rare. Please contact the office if you are concerned you might have an infection. It is very helpful if you can send through photos of your wound either by email or perhaps by text if you are able to. With photos it is usually straightforward to be able to reassure you that infection isn’t present. If it is out of business hours, you may call Dr Cutbush on his mobile phone. Dr Cutbush will have given you this number for emergencies after your surgery. Alternatively, seek medical advice from your GP. We may also ask you to come in for a postoperative consultation.
If I need further postoperative pain management who prescribes this?
If you require postoperative pain management support beyond what was prescribed to you for discharge by the anaesthetist it is usually best to contact your anaesthetist or your GP. In the days/weeks following surgery if you require further pain management please visit your GP.

If, prior to your surgery, you are concerned about postoperative pain control you might want to consider booking an appointment with your GP for a few days after your operation. Dr Cutbush suggests your GP is best to prescribe extra pain medication for you as they can give appropriate advice and ensure you are taking safe doses of pain tablets that are most effective for you.
Do I need a physiotherapist?
Most shoulder conditions whether amenable to surgery or not can be improved with some therapy and advice from your physiotherapist.

If you do not require surgery and are being treated conservatively Dr Cutbush will liaise with your physiotherapist to provide information regarding your shoulder condition. Dr Cutbush prefers to work with your usual physiotherapist. Having information from Dr Cutbush helps your Physio give you the best care possible.

If you do proceed with surgery, you will invariably benefit from a therapist being involved in your postoperative rehabilitation. If you don’t have a physio, please ask the reception staff to help you locate one. Dr Cutbush works with a lot of very skilled and experienced Physiotherapists that have a lot of experience in treating shoulder conditions.
When do I need to see my physio after my surgery?
A physio from Extend Rehabilitation will be booked to see you on the ward day one following surgery. Following discharge from hospital you will need to arrange follow up appointments with your Physio depending on the surgery you have had and rehab requirements. This can be discussed with Dr Cutbush and staff before your surgery. Please ensure you have provided your physiotherapist’s details to the reception staff so they can ensure that all appropriate documents are sent to your Physiotherapist. Dr Cutbush will write to your Physio to give them information about your shoulder so they can best treat you.
Why do I require a preoperative appointment with a physician prior to my shoulder replacement?
All patients undergoing a total shoulder replacement are recommended to have a routine physician appointment to confirm you are medically fit for the procedure and the anaesthetic. This has been shown to improve operative outcomes and to be cost effective. The Physician will examine you, review your current medical issues and liaise with any other specialist involved in your care. In doing so the Doctor will discuss your current medication and whether any changes need to be made for your surgical care. We will provide you with a referral to see the physician and help you book this appointment at the time of booking your surgery.
Do I require antibiotic cover for dental treatment following my shoulder replacement?
No. You do not require antibiotic cover for dental work/treatment following a shoulder replacement. Please see the recommendations of the Australian Arthroplasty Society from October 2016.
AOA Arthroplasty Society of Aus 2016
When can I expect the surgery invoice to claim my rebates from Medicare and my Healthfund?
Following your surgery, Dr Cutbush will confirm the item numbers used, and the invoice will usually be issued and sent within two business days. If you do not receive the invoice, please don’t hesitate to contact the office.
Can I fly following my operation?
Yes, you can fly the day following your shoulder operation. However, Dr Cutbush recommends that you don’t plan any long distance travel the first day after surgery as you may be nauseous or sore following the surgery.
Please keep in mind there is an increased risk of DVT (deep vein thrombosis) following any surgical procedure, especially if flying. If you are at risk of DVTs consider discussing taking aspirin or blood thinners postop with your doctor.
Please keep an eye out for signs of DVT and present to your GP or local Emergency Department if you are concerned.
Can I have an ultrasound guided injection prior to my surgery?
It is best not to have an injection at least three months prior to surgery as there is evidence that it can increase the risk of infection for your surgery.
Can I wear a seatbelt after surgery?
A seatbelt can be worn after surgery, just be mindful of your operative shoulder to fit the seatbelt comfortably.

If you travel in a motor vehicle you must wear a seatbelt.
Do I pay my excess to the hospital before surgery?
After completing your online admission form, you can make contact with the hospital and check if there is any excess to pay due to your health insurance policy. You can also check with your Health Fund, if you aren’t sure, if you have an excess to pay.
When can I drive after my shoulder operation?
After reconstructive procedures such as joint replacement, rotator cuff repairs, shoulder stabilisations Dr Cutbush requires you to wear a sling for 6 weeks. You are not able to drive while you are wearing a sling.

After a rotator cuff repair procedure Dr Cutbush requires you to not drive for 12 weeks.

If you undergo surgery for which you don’t have to wear a sling; such as a frozen shoulder release, excision of your AC joint, or an acromioplasty you can drive once you can confidently and safely control your vehicle. Usually this is a few days to a week after your operation.

Manual vehicles are harder to drive following shoulder surgery. If you have a manual vehicle consider making arrangements to drive an automatic vehicle when you do start driving again after your shoulder surgery.
Could Dr Cutbush give me a certificate saying that I don't have to wear a seatbelt after shoulder surgery?
No, he can’t.

If you are travelling in a motor vehicle you must, by law, wear a seatbelt.
When will I see Dr Cutbush following surgery?
Dr Cutbush will visit you on the ward the morning after your surgery. Ken will discuss the outcome and findings of your surgery. After your operation, Ken writes a letter detailing what he did in surgery and outlining any precautions he would like you to follow. This letter will be available for you when you wake up from the anaesthetic along with your postoperative appointment details.
How many incisions are made at the time of my arthroscopic surgery?
For most arthroscopic procedures you will have 4 or more port holes, 5 – 10mm in size. A typical stabilisation procedure will require 3 to 4 ports. A typical medium size rotator cuff repair will require 6 to 8 ports. More complex surgery will require more incisions.
Do I need to stop taking my vitamins and supplements?
No. Dr Cutbush is happy for you to continue taking vitamins, however, it is best to stop taking any supplements that increase your risk of bleeding, such as fish oil, 7 to 10 days prior to surgery. If you need clarification it may be worthwhile to discuss this with your GP or anaesthetist prior to surgery.
I’m having a joint replacement. In relation to the three preparations Dr Cutbush has asked me to use, in order to reduce the risk of any infection, in which order do I use them?
The Mupirocin Ointment (Bactroban or generic)* is applied to your nostrils twice daily, commencing 7 days prior to your surgery date.

The Benzoyl peroxide 5% (Benzac AC 5%)* is the gel/cream that you are to apply to your shoulder 48 hours prior to your surgery. You need to leave this on your shoulder for 30 mins and then wash off, thoroughly. Please be mindful this is a peroxide and it will take the colour out of anything it comes into contact with.

Chlorhexidine wipes – these are to be used after your shower at night time following the use of the benzoyl peroxide. There are multiple cloths in the packet, you are to use all of the wipes, all over your body ensuring you follow the directions on the back of the pack (it explains which areas to use the cloths so you don’t miss any parts).
These preparations are used to prevent and minimise any bacteria on the skin that may enter your body and cause complications with your surgery.

*You need to bring the Mupirocin Ointment (Bactroban or generic) and the Benzoyl peroxide 5% (Benzac AC 5%) to the hospital. You will be admitting to the hospital the night before your procedure. You will need to use these in hospital the night of your admission and the morning of your surgery.

For joint replacement surgery you either admit the day prior to surgery or if you live close you can admit on the morning of surgery. If you admit the day prior to surgery the nurses will give you another packet of Chlorhexidine wipes to use after you use the Benzoyl peroxide and have your shower.
How do I shower after surgery?
You can shower after your shoulder surgery. This video shows how to do it safely!

A big thank you to our stars Lucy and Mary, physiotherapists from Extend therapy!
How do I take my dressings off?
Are you worried about how to take your dressings off? Many people are.

After an arthroscopic procedure, I place a suction dressing on your shoulder that absorbs any fluid from the surgery. The nurses at the hospital will change your dressings before you discharge from hospital to small waterproof dressings. You can shower over the top of these dressings.

I like you to take your dressings off 5 to 7 days after your shoulder surgery. Under the dressings are steristrips and you can leave these in place until they fall off.

This video will show you how to take your dressings off.

A big thank you to our stars Lucy and Mary, physiotherapists from Extend therapy!
How do I put a shirt on with my arm in a sling?
It can be a little tricky getting dressed when you have to keep your shoulder in a sling after your surgery. This video will take you through how to put your shirt on.

A big thank you to our stars Lucy and Mary, physiotherapists from Extend therapy!
What is the correct posture for my shoulders?
Posture is very important for your shoulders. Good posture helps all shoulder conditions. For some conditions posture correction may be all that is required to fix it and avoid surgery. Here is how to have correct shoulder posture.

A big thank you to our stars Lucy and Mary, physiotherapists from Extend therapy!
Can you help me with how to do my physio exercises?
Are you having trouble remembering how to do your physio exercises? Here are some videos explaining some of the common shoulder exercises your physio will ask you to do.

You will need to refer to your exercise programme that your physiotherapist gave you. Many of these exercises are not suitable to begin straight after your shoulder surgery and you could risk your reconstruction if you start advanced exercises too soon after surgery. If you are not certain of your exercise programme please refer back to your physiotherapist. They are highly qualified professionals having spent many years at university learning how best to look after you!
A big thank you to our stars Lucy and Mary, physiotherapists from Extend therapy!
Am I at risk of blood clots following my shoulder surgery?
It is very rare to develop blood clots following surgery on your shoulder.  Blood clots or deep vein thromboses (DVT) are much more common following surgery on your hip or knee.

If you are concerned regarding the risk of you developing a blood clot please ring the office or ask Dr Cutbush.

The measures that are frequently taken to reduce the risk of blot clots forming include TED stockings, calf compression pumps, early mobilisation and medications such as heparin, clexane and aspirin. Aspirin is a simple over the counter medication that many people can take that reduces the risk of blod clots forming.

The federal government has produced a brochure that discusses how to reduce the risk of blood clots. Blood clots – Reducing your risk
I have developed a lump on my elbow from wearing the sling after surgery. Should I be worried?
This is olecranon bursitis. Olecranon bursitis is a common benign condition that can be precipitated by wearing a sling. It is a collection of fluid and inflammatory tissue at the tip of the elbow. It is caused by friction of the elbow against the material of the sling.

The best way to treat it is to avoid whatever is rubbing against the elbow. When the olecranon bursitis is due to wearing a sling then it will normally resolve a few weeks after discontinuing wearing the sling. If it isn't yet time to stop wearing the sling then padding the inside of the sling where the elbow rests will often help.
I have developed swelling in my arm above the sling. Should I be worried?
It is common to develop swelling in your arm after shoulder surgery. Fluid collects around the shoulder after surgery as part of the body's normal response to the surgery. The fluid tends to track under the skin with gravity and so it runs down into the arm. The pressure of the sling on the inside of the arm slows the progress of the fluid down the arm as it flows under the influence of gravity. It consequently tends to accumulate above the sling giving this characteristic appearance.

The swelling is entirely benign and will resolve once the shoulder has fully healed. It can take some months before the swelling entirely disappears. You don't need to do anything about the swelling as it goes away by itself.

It is common to get some swelling in the hand after shoulder surgery for the same reason. It is good to keep moving the hand by opening and closing the fingers. The swelling in the hand will eventually resolve. However, it can take some months before the swelling goes away completely.
I have noticed that my is arm is bruised below my shoulder surgery. Should I be worried?
It is common for bruising to come up in the arm below the shoulder surgery. Usually the bruising appears towards the end of the first week following surgery. Patients sometimes worry that something has happened to the arm where the bruising appears during the operation.

The bruising appears due to blood and fluid from the operative site tracking along the subcutaneous tissues with gravity. The blood from the operative site will settle in the subcutaneous tissues some distance from the operative site and will take on the characteristic appearance of a local bruise. The appearance isn't due to local tissue trauma; instead, it is due to the blood and fluid flowing along tissue planes and following the pull of gravity. As the blood in the tissue is broken down and removed by the body, it will change colour as a real bruise would.

You don't need to do anything about it. The discolouration is entirely benign and will disappear within a couple of weeks of its own accord.
My fingers have started to feel a little numb after my surgery. What do I do?
It is not uncommon for patients to notice some numbness or tingling or altered sensation in their fingers on the operative side following shoulder surgery.

The commonest cause is irritation of the ulnar nerve at the elbow. This is related to wearing the sling postop. The ulnar nerve runs behind the elbow (the funny bone) and just like the skin on the back of the elbow the ulnar nerve is stretched when you bend your elbow. Some people's ulnar nerves are sensitive to being stretched with the elbow bent in the sling and will start to notice numbness or pins and needles in their fingers as a result. The ulnar nerve supplies sensation to the little and ring fingers in your hand and these are the fingers that are affected.

If this happens you need to release the bottom part of the sling so that you can straighten your arm out and take the pressure off the ulnar nerve. Straightening your arm at the elbow will normally make a big difference to the tingling in your fingers. If this is happening it is best to loosen the strap of the sling that goes around your neck so that your hand rests lower across your abdomen and your elbow sits straighter when it is in the sling. Doing this won't compromise your shoulder surgery.

You need to regularly let your elbow straighten, out of the sling, after your shoulder surgery. Your physio can go through with you how to do this.
Why did this bruising come in my other wrist a week after my shoulder surgery?

This bruising appeared in the wrist of the opposite arm to the shoulder surgery, a week after the operation. This is bruising related to the IV cannula that was used during surgery to give intravenous medications and fluids. Blood spreads under the skin through the subcutaneous tissue. As it breaks down the blood under the skin changes colour. You don't need to do anything about it. The bruising will resolve completely after a couple of weeks.