Shoulder Surgery
Shoulder replacement (arthroplasty) or reverse shoulder replacement.
Rotator cuff repair: arthroscopic (keyhole), open, or a mix.
What to expect
Your Journey
-
Before surgery
Before your operation, arrange for someone to help you at home for the first 2–4 weeks. You will not be able to use your operated arm freely, so preparing your home and stocking the fridge in advance makes a real difference. Loose, easy-on clothing (button-up shirts rather than pullovers) is helpful for the first few weeks. -
The day of surgery
Shoulder surgery is performed under general anaesthesia, usually combined with a nerve block that numbs your arm and provides excellent pain control for 12–24 hours after surgery. Often a nerve catheter is placed by the anaesthetist which can provide pain relief for 3–5 days after surgery.
The operation takes 1.5–3 hours; you may go home the same day or stay one night for rotator cuff repair.
A shoulder replacement you may stay 1–2 nights.
For either operation, your arm will be placed in a sling before you wake up.
Please see the nerve catheter patient information. -
In hospital
If you stay overnight, a physiotherapist will show you the gentle early exercises to do within your sling and teach you how to manage daily tasks one-handed.
Pain is usually well-controlled with a nerve catheter and you will be shown how to use the pump by the nursing staff.
If you only receive a single injection, no catheter inserted, the numbness will wear off after 12–24 hours (typically overnight). As it wears off, you should take pain relief medication regularly as prescribed so that you stay comfortable.
Ice packs wrapped in a cloth can help with soreness around the shoulder. -
Going home
Your arm will be in a sling for 4–6 weeks. Do not remove it without your surgeon's advice, as early movement can damage the repair. You cannot drive until your surgeon says so, usually at least six weeks after surgery. A physiotherapy programme is essential for a good outcome; full recovery to your best possible function takes 3–6 months, but most people notice significant improvement much sooner.
Nerve catheter removal
You will be instructed how and when to remove the nerve catheter.
Generally it all comes out when you or someone else removes the dressings.
You should contact your anaesthetist if there is:- Pain, redness, swelling in your neck at any point
- Abnormal swallowing, face or tongue numbness or hearing change
- Numbness in your arm or hand that persists 24 hours after nerve catheter removal
* If you have breathing difficulty that you are concerned about, you should phone an ambulance then inform your anaesthetist.
Get ready for surgery
Prehabilitation
Research shows that patients who are fitter before surgery recover faster, have fewer complications, and spend less time in hospital.
Prehabilitation has six main parts:
- Stop smoking and vaping
- Breathing exercises (before and, more importantly, after surgery)
- Reduce alcohol intake
- Aerobic exercise
- Strength training
- Mental readiness
Aim to start at least 4–8 weeks before your operation if you can.
This is not as essential compared with major chest or abdominal surgery. Still, improving your general health and fitness is beneficial for reducing the risks associated with surgery and anaesthesia, for making a good recovery faster, and for living a longer healthier life.
Stop smoking and vaping
This is one of the most important things you can do before surgery. You could lower your risk of a complication by up to 40%. Smoking reduces the oxygen reaching your heart and other vital organs, raises your risk of breathing complications, and slows wound healing. Longer term, it increases your risk of heart disease, lung disease and cancer.
Aim to stop at least 8 weeks beforehand. Even 24 hours helps. If you are ready to quit smoking, Quitline can support you with a plan designed to help you, all for free.
Breathing exercises
Why this matters
Every day, you breathe in bacteria and particles from the air around you. Your lungs clear these continuously using a layer of mucus and millions of tiny hair-like structures called cilia, which work like a moving belt, sweeping debris upward to be coughed out or swallowed.
Anaesthetic medicines and prolonged bed rest temporarily impair this system. Without active steps to compensate, bacteria can build up and cause a chest infection (also called pneumonia). Abdominal and chest surgery adds another challenge: your main breathing muscle, the diaphragm, is held back by pain and surgical trauma, making deep breathing feel difficult.
Up to 50% of patients undergoing major abdominal or chest surgery develop a breathing complication (including chest infections and pneumonia) if breathing exercises are not performed. For non-major operations this is up to 30%.
The good news: starting deep breathing exercises as soon as you wake from anaesthesia significantly reduces this risk. Practise before your operation so you know exactly what to do when it counts.
How to do your breathing exercises
Work through the cycle below. Aim to complete 20 deep breaths per session, and do a session every waking hour after surgery. Before your operation, practise 2 to 3 times a day so it becomes natural.
- Take a big, slow breath in through your nose, letting your chest and abdomen expand fully.
- Pause briefly at the top, then take two short extra sniffs to fully inflate your lungs.
- Hold for 3 to 5 seconds.
- Let the air rush out freely. If you feel any phlegm, press a folded pillow or both hands firmly against your wound and have a strong cough.
- Repeat until you reach 20 breaths per session.
When to do this
After your operation (this is the most important time): every hour while awake.
Before your operation: 2 to 3 sessions each day to build the habit.
Download: Preventing Lung Problems After Surgery (PDF)
Reduce alcohol intake
Cutting down alcohol lowers the risk of bleeding, infections and heart complications.
Stopping harmful drinking before surgery can lower some complications by up to 75%.
Is your drinking OK? Fill in this quick questionnaire to find out. Extra help and support can be found here.
Aerobic exercise
Activity that raises your heart rate and deepens your breathing. Brisk walking is ideal. Aim for 30 minutes each day, split into shorter blocks if needed (for example, three 10-minute walks). Build up gradually.
Strength training
Exercises to maintain muscle mass. Try 60 to 100 sit-to-stands through the day (sets of 10 to 20 using a chair), plus arm curls with a light weight.
Stop if you feel dizzy or unwell.
Always work within your own limits. It is normal to feel slightly tired or mildly sore as your body adapts. If you experience chest pain, severe breathlessness, or dizziness, stop and seek medical advice.
Mental readiness
Feeling prepared and knowing what to expect reduces anxiety and helps you take an active part in your recovery. Read through the educational information your team gives you, and the guides on this website, so there are no surprises along the way. Simple relaxation or breathing techniques, a regular sleep routine, and arranging help at home before you come in all support a calmer, smoother recovery.
Eating well before surgery
Nutrition
Good nutrition in the weeks before your operation helps your body prepare for the physical stress of surgery and supports faster healing afterwards.
- Eat regular meals with a good source of protein at each one (meat, fish, eggs, dairy, legumes, or tofu).
- Eat plenty of vegetables and fruit to provide vitamins and minerals that support healing.
- Stay well hydrated. Aim for 6–8 glasses of water per day. Limit sugary drinks and excessive caffeine.
- Try to maintain a healthy weight. If you are significantly underweight or have lost weight recently, tell your surgical team. You may benefit from nutritional support before your operation.
Fasting before surgery reduces the risk of complications during anaesthesia.
-
6 hours before surgery
Stop eating solid food. You may continue to drink clear fluids. No milk, smoothies, or fizzy drinks. You can chew gum but make sure to spit it out before going into theatre.
-
2 hours before surgery
Stop all fluids, including water, black tea or coffee, and clear juice.
Many hospitals now use sip 'til send. This means you can have up to 200ml of water per hour until the time you go through to theatre. Please ask the nurses who call you regarding this. -
Some hospitals provide a carbohydrate drink
Your team may give you a carbohydrate loading drink (such as Preload or similar) to take 2 hours before surgery. This reduces thirst, hunger, and post-operative nausea. Follow your team's specific instructions.
Always follow the specific fasting instructions from your surgical or anaesthetic team. These take priority over the general guide above, particularly if you have diabetes or a condition affecting stomach emptying.
Protein is the building block your body uses to heal wounds, rebuild muscle, and fight infection. In the weeks before surgery, aim to eat more protein than usual.
- Target: 1.2–1.5 grams of protein per kilogram of body weight per day. (For a 70kg person, that is 85–105g per day.)
- Good food sources: chicken, fish, eggs, Greek yoghurt, cottage cheese, lentils, chickpeas, tofu, and nuts.
- Protein supplement drinks (e.g., Fortisip, Ensure, Complan) can be helpful if your appetite is poor or you are struggling to eat enough. These are available from pharmacies without a prescription.
If your surgical team recommends specific nutritional supplements, take these as directed. Tell your team if you are finding it difficult to eat enough. Nutritional support services are available.
Alcohol
Stop drinking alcohol at least 4 weeks before surgery. Alcohol increases bleeding risk, impairs wound healing, suppresses immune function, and affects how your body responds to anaesthesia and pain relief.
Smoking
Stop smoking as early as possible, ideally 8 weeks before surgery. Smoking significantly increases the risk of wound infection, chest complications, blood clots, and slower healing. Your GP can help with cessation support.
Herbal supplements
Stop all herbal and natural supplements at least 2 weeks before surgery. Many affect bleeding or interfere with anaesthetic drugs. This includes: garlic capsules, ginkgo biloba, ginseng, St John's Wort, kava, valerian, and high-dose fish oil.
Grapefruit
Avoid grapefruit and grapefruit juice in the week before surgery. Compounds in grapefruit block a liver enzyme that breaks down many medications, including some used in anaesthesia and pain management.
Understanding your anaesthetic
Anaesthesia
Anaesthesia means using medicines to block pain and keep you comfortable during your operation. There are several types. Your anaesthetist will discuss which is most appropriate for you and your surgery.
General anaesthesia
You are completely unconscious for the operation. Medicine is given through a drip in your arm, and you breathe with the help of an airway device placed once you are under anaesthesia. You wake up in the Post Anaesthesia Care Unit (PACU) when the operation is finished. This is the most common type for major surgery.
Spinal or epidural
An injection into your back numbs the lower half of your body. You stay awake or are given light sedation to keep you comfortable. This is commonly used for hip and knee replacement, some bladder surgery, and some bowel operations. The numbness wears off gradually over a few hours after surgery. Sometimes a spinal or epidural is combined with a general anaesthetic for major chest or abdominal surgery, to provide pain relief after the operation.
Nerve block
A targeted injection of local anaesthetic near a specific nerve numbs just one area (for example, your arm, shoulder, or leg). Nerve blocks are often used alongside general anaesthesia to reduce pain after the operation and reduce the need for strong opioid pain relief.
Sedation
You receive medication through a drip to make you relaxed and drowsy. You remain breathing on your own and can still respond. Used for some minor procedures, scopes, and operations under local anaesthetic where a degree of relaxation is helpful.
What to tell your anaesthetist
Before your operation, make sure your surgical and anaesthetic team knows about all of the following:
- Allergies, especially to medicines, latex, iodine, or any previous reaction to an anaesthetic
- All supplements, vitamins, herbal products, and over-the-counter medicines, including things you might not think of as medicines
- Recreational drug use. This is confidential and is essential for safe anaesthetic planning
- Previous anaesthetic problems, including nausea, awareness, slow waking, or any family history of anaesthetic reactions (particularly malignant hyperthermia)
- Dental work: loose teeth, crowns, caps, veneers, or a bridge at the front of your mouth
Common questions
Anaesthetic awareness (waking up or having any awareness during a general anaesthetic) is very rare. Overall, it occurs in around 1 in 20,000 cases with modern techniques. The risk can change depending on the type of operation and anaesthesia. Your anaesthetist monitors the depth of your anaesthetic continuously throughout the operation using dedicated monitoring equipment. If you are worried about this, please raise it at your pre-assessment appointment. Your anaesthetist can discuss the precautions used.
Post-operative nausea and vomiting (PONV) is common after surgery but very manageable. Your anaesthetist will give you anti-nausea medication routinely during and after the operation. If you have a strong history of PONV, motion sickness, or have felt very sick after a previous anaesthetic, tell your team at your pre-assessment. They can plan extra precautions, including additional anti-nausea medications and changes to your anaesthetic technique.
Most regular medications should be taken as usual on the morning of surgery with a small sip of water, even if you are fasting. However, some medications (particularly diabetes medications, blood thinners, and certain newer drugs) need specific adjustments. Your surgical and anaesthetic team will give you written instructions. See the Medications section on this page for a detailed guide. If in doubt, contact your pre-assessment clinic or GP.
Feeling anxious before surgery is completely normal. Most patients do. It helps us to look after you better if you talk about your concerns with your anaesthetist at your pre-assessment appointment. Understanding exactly what will happen often helps significantly. If your anxiety is significant, ask your GP or surgical team about additional support options.
A pre-assessment appointment happens before your operation. A specially trained nurse and anaesthetist will review your general health, current medications, and any test results. You may have blood tests, an ECG, or other checks done at this appointment. It is also your opportunity to ask questions about your anaesthetic and what to expect on the day. Completing the pre-assessment questionnaire on this website before your appointment will save time and help your team prepare.
Managing your medications
Medications
Getting your medications right before surgery is important for your safety. Use this as a general guide, but always follow the specific written instructions from your surgical or anaesthetic team. These take priority.
Fasting for surgery does not usually mean stopping your regular tablets. Most should still be taken on the morning of surgery with a small sip of water. Bring all your medicines (and any devices such as a CPAP machine) with you on the day.
Usually continue
Keep taking these as normal, including on the morning of surgery with a sip of water, unless your team tells you otherwise:
- Blood pressure and heart medicines (such as beta-blockers and calcium channel blockers)
- Heart rhythm medicines
- Cholesterol medicines (statins)
- Thyroid medicines
- Inhalers (asthma, COPD)
- Acid reflux medicines (omeprazole, pantoprazole, famotidine)
- Antidepressants, antipsychotics, and lithium
- Anti-epilepsy (seizure) medicines
- Parkinson's medicines (it is important not to miss doses)
- Inhaled and regular steroids (do not stop just because you are fasting)
- Regular pain medicines, including anti-inflammatories (ibuprofen, diclofenac, naproxen) and opioids
- Eye drops
Some blood pressure medicines called ACE inhibitors (names ending in "pril") and ARBs (names ending in "sartan") are sometimes withheld on the day of surgery. Follow your team's instructions.
Usually stop (with advice)
These are usually paused before surgery. Do not stop anything without first confirming the timing with your team:
- Diabetes tablets (metformin, gliclazide): usually stopped on the morning of surgery.
- SGLT-2 inhibitors (Jardiance/empagliflozin, Forxiga/dapagliflozin): stop 3 days (72 hours) before. They can cause a serious problem (ketoacidosis) around surgery even if your blood sugar looks normal. If you take one for heart failure rather than diabetes, your team may advise continuing.
- Aspirin taken for general prevention: stop 5 days before. If you take aspirin after a heart attack or stroke, it is usually continued. Check with your team.
- Appetite suppressants (phentermine/Duromine, Contrave): stop several days before (2 to 7 days, depending on the medicine and your heart health).
- ADHD stimulants (methylphenidate/Ritalin/Rubifen, dexamfetamine): hold on the day of surgery.
- Erectile dysfunction tablets (sildenafil/Viagra, tadalafil): stop 2 weeks before. If prescribed for pulmonary hypertension, continue.
- Cannabis and cannabis products: avoid for at least 12 hours before, and cut down in the week beforehand. Tell your team if it is medically prescribed.
Need an individual plan
These need a plan made just for you. Your team will give you specific written instructions:
- Insulin and overall diabetes management: doses almost always change around surgery. Wait for your team's plan.
- Blood thinners (anticoagulants) (warfarin, rivaroxaban/Xarelto, apixaban/Eliquis, dabigatran/Pradaxa): when to stop depends on your surgery and your clot risk, and some people need bridging. Your team will give you a written plan.
- Antiplatelets (clopidogrel/Plavix, ticagrelor): whether and when to stop depends on why you take them.
- GLP-1 medicines (Ozempic/semaglutide, Saxenda/liraglutide, Trulicity/dulaglutide): usually continued, but you will be asked to have only clear fluids for at least 24 hours before surgery, because they slow stomach emptying. Follow your team's fasting instructions.
- Immune-suppressing and biologic medicines (methotrexate, adalimumab/Humira, etanercept/Enbrel, and similar): timing is planned around your dose, with your specialist and anaesthetic team.
- Long-term steroids: you may need extra ("stress dose") steroids around surgery, which your team will arrange. Do not stop them.
- Contraceptive pill and menopause hormone therapy (HRT): usually continued with clot-prevention measures. If you have a high clot risk, your team may discuss stopping.
This is a general guide and does not cover every medicine. For combination tablets, or any medicine, supplement, or herbal product not listed here, or if you are at all unsure, ask your pre-assessment clinic, GP, or anaesthetic team. See the Anaesthesia section for what else to tell your anaesthetist.
Pre-Assessment Questionnaire
Complete this at home before your pre-assessment appointment. When you reach the end, you can print your summary or email it directly to your clinic.
Start questionnaire