We recommend operative intervention only when non-surgical treatments (physical therapy, injections, or activity modification) have failed to sufficiently alleviate symptoms or resolve functional limitations. Our recommendation is based on a careful correlation of your history, a detailed physical exam, and advanced imaging to ensure we are addressing the primary source of your pain.

In some instances, such as certain fractures, we can proceed to discussing surgery more immediately without trying non-surgical treatment first. This is always decided on a case-by-case basis and multiple patient and injury factors must be considered. Most shoulder conditions do not fall into this category and do require exhaustion of all available non-surgical measures first.

To minimize risks such as infection or poor healing, we require all patients to meet certain safety criteria before surgery. Some examples of patient optimization are:

• Medical Clearance: Everyone must be cleared by your Primary Care Physician and any involved specialists (e.g., Cardiology). We provide a specific clearance form that must be returned to our office before we proceed.

• Lab Work: Standard preoperative labs are required to ensure you are safe to undergo anesthesia and surgery. For joint replacement (arthroplasty) patients, we also obtain an MRSA swab and perform decolonization if necessary to reduce your infection risk.

• Blood Sugar (A1c): For patients with diabetes or hyperglycemia, an A1c below a specific threshold is required to prevent postoperative complications. We will help coordinate with your Primary Care Physician if you need assistance reaching this goal.

• Weight Loss: This is occasionally required for some patients prior to undergoing elective surgery in order to minimize risk and improve the likelihood of a successful outcome. If required for you, we will help you find the resources you need.

• Smoking Cessation: Nicotine significantly impairs bone and soft tissue healing and increases the risk of complications. Due to both an institutional and personal policy, Dr. Wall requires a period of time without any nicotine use both before and after surgery. This is to prevent your potential surgery from harming you. For patients with a history of tobacco use, we perform nicotine blood testing to confirm cessation prior to surgery.

• Pain Control: Some patients are on long-term pain medications prescribed by a Primary Care Physician or a Pain Specialist. Other patients may require this kind of pain control but don’t have it set up yet. While our office exclusively manages pain for a short period of time around surgery, we will work with your other physicians to ensure you have a comprehensive plan. We may require a detailed letter, or contract, from your Pain Specialist outlining this plan and who is responsible managing your medications.

Some medications need to be held around the time of surgery. Bringing a complete list of your medications, including why you take them, is essential when you visit our office. The durations that each medicine needs to be avoided around the time of surgery can vary greatly, but the main categories of medications that we must consider are any blood thinners, immunosuppressants (including steroids), and weight-loss (GLP-1 agonist) drugs such as Ozempic, Wegovy, Mounjaro, Trulicity, etc. Our office will help you navigate this process.

For arthroplasty (joint replacement) procedures, Dr. Wall utilizes 3D CT Digital Planning.

• We use software to map your unique anatomy, allowing us to select the exact implant size, placement, and orientation before you enter the operating room.

• This tool helps us optimize range of motion based on your bone structure and the planned implants.

Please Read: Educational Overview of Potential Complications

At our practice, we believe that an informed patient is a safer patient. While the specific risks of your procedure will be discussed in detail during your preoperative consultation and formally reviewed in your surgical consent documentation, it is important to understand the general risks associated with orthopedic surgery.

Important Note: The following list is for educational purposes only and is not an exhaustive list of every possible complication. Individual risks vary significantly based on your medical history, anatomy, and the specific procedure being performed.

Common Surgical Risks Include (but are not limited to):

• Infection: Can occur superficially at the incision or deeply around the joint/hardware, potentially requiring antibiotics or further surgery.

• Bleeding/Hematoma: Collection of blood under the skin that may require drainage.

• Stiffness: Loss of range of motion, which may require aggressive therapy further surgery to resolve.

• Nerve or Vessel Injury: Damage to surrounding nerves (causing numbness or weakness) or blood vessels.

• Other Tissue Injury: Damage may also occur to bone, cartilage, tendon, ligament and skin.

• Blood Clots (DVT/PE): Clots forming in the leg or lung, which can be life-threatening.

• Anesthesia Risks: Adverse reactions to medications used during surgery.

• Hardware Failure: Implants may loosen, break, or wear out over time, potentially requiring future surgery.

• Failure to Resolve Symptoms: In some cases, pain or dysfunction may persist despite a technically successful procedure.

Your Specific Consent: Prior to your surgery, Dr. Wall will review the specific risks tailored to your case. You will have the opportunity to ask questions and will be asked to sign a formal informed consent document confirming your understanding. Consent is an ongoing process and patients may withdraw it at anytime, even after they sign their consent form - it is not a contract that you are bound to and surgery is always a choice.

Risk Reduction: Multiple effots will be used to reduce all of the above risks but no medical intervention has zero risk. The ways we reduce risk include: sterile technique in the operating room, antibiotics, careful surgical technique and adherence to evidence-based practice, thorough explanations of postoperative restrictions and precautions, and a temporary blood thinner. All of these will be discussed in further detail before and after surgery and other measures not listed here may also be used.

1. Morning Preparation

• Hygiene: Shower using an antibacterial soap. Do not apply lotions, perfumes, deodorant, or makeup, as these can increase infection risk or interfere with surgical monitoring.

• Medications: Take only the specific morning medications discussed during your Anesthesia pre-op call with a tiny sip of water.

• Clothing: Wear a loose, comfortable button-down shirt or a very wide-necked t-shirt. You will need clothing that is easy to put on over a bulky dressing and sling after surgery.

• Fasting: Strict adherence to NPO guidelines is required. No food or drink (including gum, mints, or coffee) after the designated time, or your surgery will be cancelled for safety reasons.

2. What to Bring

• Your Orthosis/Sling: [CRITICAL] You must bring the custom sling or brace that was fitted for you in the clinic. We cannot proceed without ensuring you have the proper protection for your repair immediately after surgery.

• ID & Insurance: Photo identification and current insurance cards.

• Case for Glasses/Contacts: If you wear contact lenses, bring your case and solution, or wear glasses. You cannot wear contacts during anesthesia.

• Leave at Home: Please leave all jewelry, watches, and valuables at home.

3. Arrival & Pre-Operative Care

• Check-In: Please arrive at the surgery center at your designated arrival time (typically 2 hours before your case start time).

• The Nerve Block: You will meet your Anesthesiology team. For most shoulder and scapular procedures, they will perform a regional nerve block (interscalene block) under ultrasound guidance. The goal of this is to numb your arm for the first day, occasionally up to 3-4 days, providing excellent pain relief when your pain is at its worst. In some instances, they may leave a small catheter in the side of your neck to allow the block to last longer. You would go home with this catheter in place with a small container of medicine attached to it and the anesthesia team will give you instructions on how to easily and safely remove it yourself. The goal of these blocks is to both help you achieve optimal pain control right after surgery and to consequently reduce your need to take opiate medication. The Anesthesia team will discuss specific risks and benefits of these blocks with you on the day of surgery if Dr. Wall believes you should have one.

• Surgeon Confirmation: Dr. Wall will see you in the holding area to answer any final questions and mark the operative shoulder with his initials.

4. Discharge Plan

• Most of Dr. Wall’s surgeries are outpatient, which means patients discharge home on the same day, directly from the recovery room. Some patients may need to spend a night or longer in the hospital if their surgery is more invasive, they have more medical problems or if they have any issues with anesthesia. Dr. Wall will attempt to anticipate what type of surgery is most appropriate for you and schedule you accordingly. This will be communicated with you in clinic before surgery.

• Mandatory Escort: You must have a responsible adult (over 18) present to drive you home and stay with you for the first 24 hours. For your safety, you are strictly prohibited from using public transportation or rideshare services (Uber/Lyft) or taxis unless accompanied by a responsible adult escort.

• Help at home: You are strongly encouraged to have additional help at home beyond the first 24 hours. Most shoulder surgery patients are in a sling and have only the use of one arm after surgery. This makes daily activities challenging and puts some people at a risk of falling. It can take a while to get used to. The more help you have for as long as you can have it is often helpful but many patients do find they regain most of their independence within a few days.