Surgery FAQs

Once you and Dr Cutbush have agreed that surgery is the right option for you, please liaise with the office so a date can be arranged. You will be asked to complete health and admission forms.

It is important to tell us if you take any blood thinning medication, if you have any medication allergies, and if you have conditions such as sleep apnoea, epilepsy, a heart condition, a previous stroke, chronic respiratory disease, high or low blood pressure, kidney problems or a blood borne communicable disease. Please also tell us about any other specialists involved in your care. These details help Dr Cutbush, your anaesthetist and the hospital plan your surgery safely.

Yes. A surgery information pack is usually sent to you before your operation. It sets out your expected length of stay in hospital, an estimate of costs, your anaesthetist's details and a consent form to complete and return.

The office can give you the fees for Dr Cutbush and the surgical assistant. Hospital, anaesthetist and prosthesis costs are charged separately and are quoted by those providers. Dr Cutbush's fees are set with reference to the Australian Medical Association schedule.

Please note that a pack may not be issued if your procedure is an emergency or if you are admitted directly to hospital. If you have not received yours, please contact the office.

This depends on your health fund policy. Once you have completed the hospital's online admission form, the hospital will confirm whether an excess is payable and when it needs to be paid. You can also check directly with your health fund before your surgery. Any excess is payable to the hospital rather than to the practice.

Dr Cutbush does not bulk bill, and the practice does not offer no gap or known gap arrangements for initial surgery. Fees are set with reference to the Australian Medical Association schedule.

You will be given an estimate of costs before your surgery so that you know what to expect, and the office is happy to go through it with you.

The surgical receipt is usually issued within two business days of your operation. Once you have it, you can use it to claim your rebates from Medicare and your health fund.

You can generally continue your usual vitamins. However, supplements that increase the risk of bleeding, such as fish oil, should be stopped 7 to 10 days before surgery.

If you are not sure whether a particular supplement should be stopped, please check with your GP or your anaesthetist.

It is best not to have an injection for at least three months before surgery, because an injection close to the time of surgery may increase the risk of infection.

If an injection has been recommended for you, please let the office know so that the timing of your surgery can be taken into account.

A routine appointment with a physician is recommended before a total shoulder replacement to confirm that you are medically fit for surgery and for the anaesthetic. The physician reviews your general health and any existing medical conditions, and can adjust your medications beforehand if needed.

A referral is provided when you book your surgery.

Three preparations are used in the days before a joint replacement to reduce the risk of infection:

• Mupirocin nasal ointment (Bactroban or a generic equivalent), apply a small amount inside each nostril twice a day, starting 5 days before your surgery.
• Benzoyl peroxide 5%, apply to the shoulder 48 hours before surgery, leave it on for about 30 minutes, then wash it off thoroughly. Benzoyl peroxide bleaches fabric and other materials, so keep it away from clothing, towels and bedding.
• Chlorhexidine wipes, use these after your evening shower on the night you have used the benzoyl peroxide. Use all of the wipes over your whole body, following the directions on the pack.

Please bring the mupirocin ointment and the benzoyl peroxide with you to hospital, and use both on the night of your admission and again on the morning of surgery.

You will usually be admitted the day before surgery, or on the morning of surgery if you live close by. If you are admitted the day before, the nursing staff will give you another packet of chlorhexidine wipes.

Yes. Benzoyl peroxide 5% can be bought over the counter at a pharmacy and does not need a prescription.

Apply it to the shoulder and the underarm, leave it on for about 30 minutes, then wash it off thoroughly. If your skin becomes irritated, reduce the time you leave it on. If your skin is sensitive, wash it off after 15 minutes or less. Remember that benzoyl peroxide bleaches fabric, so take care with clothing and towels.

Physiotherapy is an important part of treatment, whether or not you go on to have surgery. Dr Cutbush prefers to work with your own physiotherapist wherever possible, so please let reception know who you see.

If you do not have a physiotherapist, the office can help you find one who is experienced in shoulder rehabilitation. You can read more on the rehabilitation page.

Arthroscopic, or keyhole, surgery is carried out through several small incisions called portals. The incisions used for the camera and the instruments are generally 5mm or less, and the working portals are usually around 10mm, occasionally a little larger.

The number depends on the procedure:

• Stabilisation, about 3 to 4 incisions
• Rotator cuff repair, usually about 6 incisions
• Complex reconstruction, such as a massive rotator cuff tear repaired with a graft, up to 12 incisions, and sometimes more

The exact number can only be confirmed once Dr Cutbush can see the shoulder from the inside, as it depends on what the procedure requires.

The initial admission time you are given is 6:00am. The operating list is not finalised until the day before surgery, so please ring the office the day before to confirm your admission time, as it may have changed.

Dr Cutbush operates at St Andrew's War Memorial Hospital, 457 Wickham Terrace, Spring Hill. Your admission paperwork will confirm where to present on arrival.

Please wear loose, comfortable clothing that is easy to put on and take off, ideally buttoned at the front rather than anything that has to be pulled over your head. Women are advised to wear a bra that zips at the front.

Your arm will be in a sling afterwards, so front opening clothing makes dressing considerably easier.

No. You do not need to shave or wax the area before your operation. If the surgical site needs to be shaved, the nursing staff will do this when you are admitted.

Please do not use deodorant, perfume or moisturiser on the morning of your surgery. These can interfere with the skin preparation and with the sterile dressings used during the operation.

Yes. Please remove nail polish from your fingernails and toenails before you are admitted. The monitoring equipment used during your anaesthetic measures your oxygen levels through the nail bed, and nail polish can interfere with the reading.

When you wake after surgery you will be given a folder and a letter. These set out your follow up appointment details, your precautions, and instructions for looking after your dressings.

Dr Cutbush also records a video of your procedure, which is emailed to you as a link afterwards.

You cannot drive yourself home. If you are travelling by taxi or public transport you must be accompanied, and someone should stay with you on the first night after your surgery.

Most shoulder operations involve one night in hospital. Patients who have had arthroscopic surgery are usually discharged the following day, at around 11am. Patients who have had a shoulder replacement often stay two nights.

Before you go home, a number of things need to happen: Dr Cutbush will see you on the ward, the nursing staff will change your suction dressing, a physiotherapist will fit your sling and start your exercise programme, and the pharmacy will supply your medications. Some patients also need an X-ray or a scan before discharge.

Please arrange for someone to collect you, as you cannot drive yourself home. If you need to be discharged earlier in the day, let the ward nursing staff know as early as possible so that this can be organised.

Dr Cutbush visits the ward on the morning after your surgery, usually between 6:30am and 8:30am, to discuss how the operation went and what happens next.

You will also be given a letter summarising your procedure, which you can share with your GP and your physiotherapist.

A physiotherapist will see you on the ward on the first day after your surgery to fit your sling and start you on your exercise programme.

Your ongoing appointments should be arranged after you are discharged. Please give your physiotherapist's details to reception so that your progress can be followed.

A PICO dressing is a small, single use portable pressure dressing applied at the end of arthroscopic surgery. It applies gentle suction to the wound, which helps draw away the fluid used during keyhole surgery and keeps the dressing dry.

The nursing staff remove it the morning after your surgery, and it is only reapplied if needed.

Before you go home your dressings are changed to small waterproof dressings, which you can shower over.

Remove these 5 to 7 days after your surgery. Underneath you will find Steri-Strips across the incisions. Leave these in place and allow them to fall off on their own.

After a shoulder replacement a Prineo dressing is applied directly over the incision, with a honeycomb dressing on top.

Remove the honeycomb dressing at about 7 days. Leave the Prineo dressing in place and remove it only once it begins to lift and fall away by itself. Both dressings are waterproof, so you can shower normally.

Your dressings are waterproof, so you can shower after surgery. Take your sling off to shower, keep your arm resting by your side, and avoid actively lifting it. It is easier and safer to have someone with you the first few times.

A video demonstrating how to shower comfortably while your shoulder is recovering is available on the videos page.

Signs that a wound may be infected include increasing redness, warmth, increasing pain, and pus or discharge from the wound. Some swelling and bruising is normal after surgery, but swelling can also be a sign of infection, so if you are unsure it is always better to ask.

Take a photograph of the wound and email it to the office so that it can be reviewed. Outside office hours, you can text Dr Cutbush on the mobile number in the documents you were given after surgery. You can also see your GP, who can examine the wound and contact the practice if needed.

This depends on your procedure:

• If you are in a sling for 6 weeks after a reconstructive procedure, such as a joint replacement or a stabilisation, you must not drive while your arm is in the sling.
• After a rotator cuff repair, you should not drive for 12 weeks.
• After procedures that do not require a sling, such as a frozen shoulder release, an AC joint excision or an acromioplasty, most people can drive again within a few days to a week.

In every case you must be able to control the vehicle safely and comfortably, including in an emergency, before you drive. A manual car is considerably harder to manage after shoulder surgery, so if you have the option, an automatic is much easier. Check your position with your insurer as well, since cover can depend on your fitness to drive.

Yes. You can and should wear a seatbelt after surgery. Position the belt so that it sits comfortably, and pad it where it crosses your shoulder if that helps.

Dr Cutbush is not able to provide a seatbelt exemption certificate, as wearing a seatbelt is a legal requirement.

You can fly from the day after your surgery, although long distance travel is not advised on the first day.

Flying carries a higher risk of deep vein thrombosis, so if you have risk factors, discuss with your doctor whether aspirin or another blood thinner is appropriate before you travel. Move about when you can and keep well hydrated during the flight.

Blood clots are uncommon after shoulder surgery, and considerably less common than after hip or knee surgery. They remain a recognised risk, however, and a number of measures are used to reduce it. These include compression stockings, calf compression pumps, getting you up and moving early, and medications such as heparin, Clexane or aspirin where appropriate.

Please tell your doctor promptly if you develop pain or swelling in your calf, chest pain, or shortness of breath.

Your anaesthetist or your GP can prescribe further pain relief once you are home. It can be helpful to book a GP appointment for a few days after your surgery in advance, so that you have it if you need it.

Your GP will have the letter summarising your procedure and can prescribe additional medication safely.

No. Antibiotic cover is not required for dental treatment after a shoulder replacement. This follows the recommendations issued by the Australian Arthroplasty Society in October 2016.

If your dentist has any questions, they are welcome to contact the office.

Your physiotherapist will fit your sling and show you how to put it on before you leave hospital. The sling should support your forearm with your elbow close to your side and your hand resting across your abdomen.

A video demonstrating how to put on and adjust your sling is available on the videos page.

Dress the operated arm first, guiding it gently into the sleeve without lifting or twisting the shoulder, then bring the shirt around your back and put your other arm in. Undress in the reverse order, taking the unoperated arm out first.

Front opening or button up shirts are much easier than anything that has to be pulled over your head. A video demonstrating this is available on the videos page.

Good posture is important for many shoulder conditions. Sitting and standing tall, with your shoulder blades gently drawn back and down rather than rounded forward, reduces the strain on the shoulder.

In some cases correcting posture improves symptoms enough that surgery is not needed. Videos demonstrating correct posture are available on the videos page, and your physiotherapist can assess your posture and work through it with you.

Please follow the exercise programme your physiotherapist has given you. Many exercises are not suitable immediately after surgery, and starting more advanced exercises too early can put your repair at risk.

Demonstration videos are available on the videos page. They are intended to support the programme you have been given, not to replace the advice of your physiotherapist.

Yes. Bruising is very common after shoulder surgery and is not a cause for concern. Blood tracks under the skin with gravity, so bruising often appears some distance from the incisions, including down the arm and across the chest.

It settles on its own, usually over a couple of weeks.

This is usually olecranon bursitis, caused by friction and pressure where your elbow rests in the sling. It is not dangerous.

It generally settles over a few weeks once you stop using the sling. Padding the sling where your elbow sits can make it more comfortable and help stop it getting worse.

Swelling in the upper arm above the sling is normal. It is caused by fluid moving under the influence of gravity and collecting in the soft tissues, and it is harmless.

No specific treatment is needed, although it can take some months to resolve completely. If your hand feels swollen, opening and closing your fingers regularly helps.

This is common and harmless. The bruising typically appears towards the end of the first week, as blood from the surgery tracks down the arm under the skin. It usually fades within a couple of weeks.

This is from the intravenous cannula, or drip, that was placed in your other arm during surgery. It commonly appears about a week afterwards, is harmless, and resolves within a couple of weeks.

Numbness or tingling, usually in the little and ring fingers, is most often irritation of the ulnar nerve caused by your elbow being held bent in the sling.

Release the lower strap of the sling so that your arm can straighten a little, and loosen the neck strap so that your hand sits lower across your abdomen. Let your elbow straighten out of the sling regularly, as your physiotherapist will show you.

If the numbness does not settle with these changes, please contact the office.

A repaired rotator cuff tendon takes time to heal back onto bone, and that biology sets the timetable rather than how you feel. Most people wear a sling for about six weeks, begin gentle guided movement in that period, start strengthening from around three months, and reach their best result somewhere between six and twelve months after surgery.

Larger tears, revision surgery, smoking and diabetes all tend to slow healing. Small repairs in otherwise healthy shoulders often move faster. Dr Cutbush will give you the protocol for your own repair, and your physiotherapist will work to it. The ranges here are a guide to help you plan work and travel, not a promise about your shoulder.

It depends on what was done. As a rough guide, a decompression or an AC joint excision may need a sling only for comfort for a few days to two weeks, while a stabilisation, a rotator cuff repair or a joint replacement is usually around six weeks.

Your own sling time is set by Dr Cutbush and is written in the instructions you go home with. Please follow those instructions rather than the general guide here, because the timing protects the repair.

Desk based work is often possible within one to two weeks, sometimes sooner, as long as you can get to work safely and are not driving. Work that involves lifting, reaching overhead, ladders or vibrating tools usually means six to twelve weeks away, and sometimes longer after a large cuff repair or a replacement.

Tell the office what your job actually involves and we can prepare a certificate and talk through a graduated return to work. If your claim is through WorkCover or CTP, let us know early so the paperwork keeps pace.

Most patients describe the first two to three days as the most uncomfortable, easing steadily after that. Shoulder surgery is usually done under a general anaesthetic combined with a nerve block placed by the anaesthetist, which keeps the shoulder numb for much of the first day and takes the edge off the early period.

You will go home with a pain plan, usually regular simple analgesia with something stronger available for the first few days, and ice. Pain that is getting worse rather than better after the first week, or pain with fever or a discharging wound, is a reason to call the rooms.

Published joint registry data shows that most modern shoulder replacements are still functioning well at ten years, and a substantial proportion at fifteen. Longevity depends on the type of replacement, your age and activity, the condition of your bone and rotator cuff, and whether the shoulder has been operated on before.

A younger, more active patient places more demand on the implant and is more likely to need revision at some point in their life. Dr Cutbush will talk through what the registry data means for your particular situation.

Sleep is the part most patients find hardest for the first few weeks. Lying flat tends to be uncomfortable, so most people sleep propped up, either in a recliner or in bed with pillows behind the back and under the operated elbow, with the sling on.

It does settle. Set up a sleeping position before you go to hospital so you are not working it out on the first night. If pain is consistently waking you after the first fortnight, let the rooms know.

Light resistance work usually starts under physiotherapy guidance at around three months. Heavier loading, overhead pressing and contact or collision sport are generally left until the shoulder has the strength and control to protect itself, often six to twelve months after a repair.

Pushing those dates is the common way a good repair comes undone, so please work to the programme rather than to how the shoulder feels on a good day. Driving has its own timeframes, which are set out above.

No. Many cuff tears, particularly degenerate partial tears in older shoulders, settle well with physiotherapy, activity modification and sometimes an injection. Surgery is considered when a tear is causing pain or weakness that has not responded to those measures, when a tear is acute and traumatic in a younger shoulder, or when a tear is likely to enlarge and become unrepairable if left.

The decision takes account of your age, your symptoms, the size and quality of the tendon on imaging, and what you need your shoulder to do. Dr Cutbush will set out the reasonable options, including not operating, and the likely course of each.

All surgery carries risk. For shoulder surgery the recognised risks include infection, bleeding, stiffness, ongoing pain, nerve or blood vessel injury, blood clots, an anaesthetic complication, failure of a repair to heal, and the possibility of needing further surgery. For replacements there are additional risks including loosening, instability, fracture around the implant and wear over time.

Serious complications are uncommon, but they are not impossible, and they are part of an informed decision. Dr Cutbush will go through the risks that are specific to your procedure and your health before you consent.

Most shoulder operations at this practice involve one night in hospital, because the first night can be uncomfortable and nursing staff can give stronger pain relief if it is needed. Patients having a shoulder replacement often stay two nights.

Your expected length of stay is set out in the surgery information pack sent to you before the operation. Arrange for someone to take you home and stay with you on the first night, because you cannot drive or travel alone after an anaesthetic.

Operating time varies with the procedure, from around thirty to forty five minutes for a straightforward arthroscopic decompression to two hours or more for a complex reconstruction or a revision replacement.

Plan for most of the day at the hospital regardless, because admission, the anaesthetic, the operation and recovery all take time, and theatre lists can move.

That is a fair question and sometimes the right answer. Some conditions, such as frozen shoulder, tend to improve with time and guided physiotherapy. Others, such as a large traumatic cuff tear in a younger patient or a recurrently dislocating shoulder, tend to deteriorate, and delay can make a repairable problem unrepairable.

Dr Cutbush will tell you which category your shoulder falls into, what is likely to happen over the next few years without surgery, and what the trade off is either way, so that the choice is yours to make with the facts in front of you.