Surgery Procedures
Please take a moment to review the following information. Listed below are forms with detailed information pertaining to your surgery and recovery. We encourage you to print them out and read over the instructions. If you have any questions or concerns regarding any of the material provided please bring it to our attention.
GENERAL INSTRUCTIONS FOR SURGICAL PATIENTS
What To Do Before Surgery:
1) Stop taking Aspirin, Motrin, Advil, Aleve, Vitamin E, St. John’s wort, Ginko biloboa, Feverfew, Ginseng, Echinacea, and any anti-inflammatories ONE week prior to surgery. Stop Glucosamine and Chondroitin and any diet pills TWO weeks prior to surgery.
2) Stop smoking five days prior to surgery. Smokers have 100% longer recovery time with high risk of failed surgery.
3) Take a multi-vitamin with at least 500mg Vitamin C a day for the week prior and several weeks after surgery.
4) Take two Tylenol Extra Strength 4 times a day, the day before surgery to decrease surgical pain.
5) Pre-operative check list:
-EKG (All patients > 45 yrs old, within 3 months of surgery)
-Chest x-ray (All patients > 65 years old, within 3 months of surgery)
-Pre-operative clearance by a primary care physician (Recommended depending on current medical status)
-Cold Therapy Unit (Most surgeries except Hip Surgery)
-CPM machine (Continuous Passive Motion) used for the following:
–ACL Reconstruction
–Hip Osteoplasty Surgery
–ORIF Osteochondral Fracture
–Hip or Knee Cartilage Restoration Surgery
-My pre-operative appointment is on:
-My post-operative appointment is on:
-My surgery is scheduled for: __________ Time: __________ **
**Surgery time available the day before surgery for surgeries at Newport Center Surgical 949-706-6300. For surgeries at Hoag Surgicare Fashion Island surgery time will be provided at the pre-operative appointment.
There will be a non-refundable fee of $150.00 for any surgeries that are cancelled or rescheduled. Some surgeries require an Assistant Surgeon and you will receive a separate bill. THIS MAY NOT BE COVERED BY YOUR INSURANCE COMPANY.
The Pre-Operative Instructions
1) You will be asked if you have any allergies and for a complete list of medications you take. Please let us know of any rashes, cuts, abrasions, or infections you may have.
2) If you have any history of excessive snoring, breathing problems, or sleep apnea, even years ago, this needs to be evaluated prior to surgery.
3) Do not shave the extremity two days prior to surgery. On the morning of surgery, shower with cleansing soap from head to toe.
4) Pre-arrange your home environment for your convenience after surgery. Establish where you will recuperate (your bed, living room sofa, a reclining chair, or in the guest room). For shoulder surgeries, it is often most comfortable to sleep in a “beach chair” position, reclining chair, or place cushions against the head board of your bed.
5) Dress in comfortable clothes for the trip to the surgery center and for recovery. You must have someone take you to and pick you up from the surgery center.
6) Do not eat or drink anything (including water) after midnight before surgery to prevent vomiting while you are anesthetized, unless you are instructed differently from the anesthesiologist. If you take medications for blood pressure or anxiety you may take them with small sips of water the morning of surgery.
Post-Operative Instructions
1) Your caretaker will be notified as soon as the surgery is finished and may see you in recovery in 20-30 minutes.
2) Do not remove dressings for 2 days (48 hours); however, you may adjust the ace bandage if it feels too tight. After 48 hours, you may remove your dressings. Do not be alarmed if your dressings are fairly bloody. Also, the cold therapy pad may cause the area to be moist. Leave the steriips (white pieces of tape covering the incision) in place. You may let the shower water run over the steriips. Please no baths for 10 days because the incisions should not be soaked in water during that time.
3) You should get up and walk every few hours and take deep breaths to prevent pneumonia, bed sores, blood clots and a myriad of other complications. For lower extremity surgery, you will be able to get around on crutches.
4) You should apply ice to the operative site after surgery to reduce pain and swelling. For knee and shoulder surgeries, we recommend use of the cold therapy unit in place of ice. Remember to always have something between your skin and the ice/cold therapy pad, an old T-shirt or thin dish towel is adequate. Plan to have the cold therapy unit up to 5-7 days after surgery. THE COLD THERAPY UNIT MAY NOT BE COVERED BY YOUR INSURANCE COMPANY.
5) You may experience constipation post-operatively from inactivity and pain medicine. You will benefit from increasing your fluid intake to 1 1/2 quarts of juice or water per day. Stool softeners or mild laxatives are recommended, such as Colace or Senokot.
6) Except in all upper extremity (shoulder) surgeries and ACL reconstruction, take one 325mg Aspirin tablet daily beginning the day after surgery for at least 2 weeks. It helps prevent formation of blood clots and phlebitis. Do not take aspirin if you have a history of stomach ulcers, internal bleeding or intolerance to aspirin.
7) Elevate your affected limb to the level of your heart to reduce pain and swelling. Make sure to take it easy for the first week following surgery.
8) Pain medications are prescribed at the pre-operative appointment. The following pain medications are generally used:
• Senokot-S for constipation
• Vicodin (hydrocodone/acetaminophen) for moderate pain
• Darvocet (propoxyphene/acetaminophen) for moderate pain
• OxyContin (oxycodone controlled-release) for severe or long lasting pain relief
• Robaxin (methocarbamol) a muscle relaxer
• Zofran for nausea
• Phenergan for nausea
9) Keep the steristrips in place for 7-10 days. If the steriips do come off early, apply over-the-counter antibiotic ointment (such as Neosporin) to moisten the wound. Use a band aid to cover the wound. Keep the wound covered until it is healed. Change the ointment and covering every day or two. When showering, remove the bandage and replace with a clean one after the shower. Do not pick at the wound as you may increase the chances of additional scar. Keep the scar out of the sun or covered with sunscreen for 6 months. After healing is complete, you may massage the scar gently but firmly with the tips of your fingers to soften the scar and help minimize its appearance.
10) If you have any of the following problems call the office immediately. If you cannot contact me or my staff, go to the emergency room to have the situation checked: fever, chills or inordinate pain, excessive bleeding through the dressing, * calf or leg pains that make it difficult to walk, * numbness, coldness or tingling in the foot, chest pain, signs of infection including red streaks or pus from the wound.
11) Ask for a temporary parking pass if you have had lower limb surgery
ANTERIOR CRUCIATE LIGAMENT (ACL) RECONSTRUCTION POSTOPERATIVE PROTOCOL
Below are guidelines developed to familiarize you with the general protocol following reconstruction of an anterior cruciate ligament tear:
1) After your injury and prior to surgery it is very important to obtain full knee range of motion. To achieve this goal, move the knee into full extension and flexion for two or three minutes five to ten times per day. Although this exercise should not necessarily hurt, you should feel the stretch.
2) Control the swelling by icing, ace wrapping, elevating the leg, wiggling the ankle and foot, and moving the knee as much as possible. These measures will pump the fluid out of the leg and knee.
3) Maintain muscle strength by doing one- or two-legged squats, straight-leg raises, and heel drags.
Once the swelling has decreased and the knee has regained almost complete range of motion, a reconstruction can be performed. Crutches should be rented prior to your scheduled surgery date. Surgery is performed under a general anesthetic on an outpatient basis. On the day of surgery your knee will be placed in a brace locked in a position of full extension.
On the night of surgery or early the next morning remove only the brace, exclusive of the dressing, and put the leg into a Continuous Passive Motion (CPM) machine. Initially the CPM machine will be set from -5 to 40 degrees. A good speed is right in the middle setting. The knee goes into full extension in the last 3-5 degrees. It is good to put some pressure on the knee to make sure it becomes perfectly straight and to tighten the front thigh muscle (quadriceps) simultaneously. It is also important to stop the machine once an hour in the -5 degree position and push the knee down completely straight several times. The thigh muscle should then be tightened and held for a period of five seconds before relaxing. This sequence should be repeated ten times every hour.
The position on the CPM machine should be increased five degrees at a time using comfort as your guide. Improvement in motion varies for each patient. It can be as dramatic as reaching up to 100 degrees of flexion within the first day and a half, or it can take as long as five days. When you increase the CPM machine flexion, let it run for five or ten rotations and the initial discomfort and tightness will diminish.
A cold therapy unit consists of a pad through which cold water is circulated. The pad is placed under the dressing on top of the knee. A sufficient supply of ice must be available to continuously replenish the machine. This is an excellent adjunct for minimizing the swelling and pain.
Both the CPM machine and the cold therapy unit are usually used for a period of seven to fourteen days after surgery. It is recommended that you stay at home for at least five days after surgery to ensure the swelling has significantly decreased and you have good range of motion prior to returning to work. Many patients take the cold therapy unit to work and continue to use the CPM machine when they return home. You may initially want to consider returning to work on a part-time basis.
Although immediately after surgery you will use crutches, you may progress to full weight bearing with the brace locked at zero degrees as tolerated. In addition to tightening the muscles after surgery ( Quad sets), you should begin straight-leg raises within one to three days, after surgery. Twenty to one hundred raises daily should be performed with your brace on. Once you have obtained good quadriceps control(able to do 30 leg raises) and are walking with full weight, the brace can be unlocked or removed completely and you can begin to walk more normally. This milestone can be expected one to two weeks after surgery.
Physical therapy will be instituted and sutures will be removed anytime between five and ten days after surgery. Showering with assistance is permitted at approximately five days after surgery. An ACL sports brace will be fitted at three to four months postoperatively when the size of the thigh has returned to almost normal. Most patients resume sports five to six months after surgery when good muscular control is present.
Every patient has a different knee problem and therefore will require some modification to the above-referenced guidelines depending on associated injuries.
ARTHROSCOPY KNEE REHABILITATION
Phase I: Beginning Day of Surgery
GOALS:
• Decrease Swelling
• Increase Range of Motion
• Initiate Strengthening
1) Apply ice 15 to 20 minutes, 3 to 5 times per day until swelling is diminished, or use cold therapy pad with cooler at 40-50 degrees 23 hours per day for 2-3 days, then 6-8 hours per day until swelling is minimal.
2) Wear ace wrap until swelling is insignificant.
3) Elevate leg until swelling is insignificant.
4) Use crutches, beginning with partial weight bearing, and progressing to full weight bearing without crutches, as soon as possible, as pain permits, usually within 2-4 days.
5) Do active range of motion (fully straighten and bend as pain permits) exercises while sitting, set of 10, 4 times per day. Discontinue when range of motion is normal.
6) Do straight leg raises, lock knee, two sets of 20, two times per day.
Phase II: To be started after 1 week.
GOALS:
• Continue Strengthening
• Return to Functional Activity
1) When active knee range of motion reached 90 degrees flexion, begin progressive-resistive knee extension exercise with ankle weight or light gym equipment (knee extension machine).
2) Do short squats, progress to single leg squats (to 30 degrees of flexion).
3) When active knee ROM (range of motion) reaches 100 degrees of flexion, begin cycling for aerobic conditioning and to enhance ROM. Start with 10 minutes of cycling, and add 5-10 minutes per week.
4) When you can walk without pain, begin step up exercises: start with 4″ to 6″ steps. Do as many step ups as can be accomplished, up to 50. When goal of 50 is achieved, add 1″ to step height.
5) Wall sits (put back against the wall while holding a partially seated position) – three reps, 15 seconds each.
LATERAL RELEASE
A lateral release is a procedure used to realign kneecap. As the knee bends, the kneecap moves up and down in the groove located at the end of the thigh bone. Sometimes, the kneecap is pulled towards the outside of the groove. When the kneecap does not slide well within the groove, cartilage irritation and pain can result. When the lateral retinaculum is too tight, it can pull the kneecap out of place. A lateral release is a procedure performed to release this tight retinaculum, and allow the kneecap to sit properly within its groove.
Patients are advised to weight bear as tolerated but may use crutches for one to three days after surgery. Patients can expect to be swollen for up to two months. It is important to maintain active range of motion (keep the knee moving) after surgery. It is common to experience stiffness for up to two weeks after surgery. Patients are advised to avoid stairs and walking downhill for a period four weeks to avoid excess pressure on the kneecap and the groove it tracks in. Physical therapy will be started approximately four to seven days after surgery. Patients typically return to sports at four to six weeks.
The most common side effect of a lateral release is bleeding into the knee; this can lead to pain and swelling. Other complications include infection, and scar tissue formation.
MENISCUS: GENERAL INFORMATION
The meniscus is a circular piece of cartilage with its blood supply coming from the outer rim. A meniscal repair is only possible if the tear is located in this outer rim where the necessary blood flow is located to promote healing. Tears located in the central portion of the meniscus will not heal even if a meniscus repair is performed. These tears will be removed (partial meniscectomy).
MENISCECTOMY
A partial meniscectomy is a surgery performed to remove a piece of torn cartilage in the knee joint that is in a area of poor blood supply.
There is usually mild pain associated with arthroscopic knee surgery. Patients can expect to be swollen for up to two weeks. It is important to maintain active range of motion (keep the knee moving) after surgery. It is common to experience stiffness for up to one week after surgery. Patients are advised to weight bear as tolerated but may use crutches for one to three days after surgery for comfort. Physical therapy will be started approximately four to seven days after surgery. Patients typically return to sports at four to six weeks.
MENSICUS REPAIR
A meniscus repair is an arthroscopic surgery used to place sutures to repair the torn edges. There is usually minimal pain associated with arthroscopic knee surgery. The success of a meniscus repair is dependent on the patient being non weight bearing for a period of three weeks, avoiding squatting for three months and following our physical therapy protocol. Physical therapy will be started four to seven days after surgery. It is important to maintain active range of motion (moving the knee) to avoid stiffness. It is common to have stiffness and pain behind the knee for up to six weeks after surgery. Patients typically return to sports at three to four months.
CHONDROPLASTY
Arthroscopy is performed to clean out bone and cartilage fragments that, may cause pain and inflammation.
There is usually mild pain associated with arthroscopic knee surgery. Patients can expect to be swollen for up to two weeks. It is important to maintain active range of motion (keep the knee moving) after surgery. It is common to experience stiffness for up to one week after surgery. Patients are advised to weight bear as tolerated but may use crutches for one to three days after surgery for comfort. Physical therapy will be started approximately four to seven days after surgery. Patients typically return to sports at four to six weeks.
MICROFRACTURE
Microfracture is a surgical option used to treat areas of damaged cartilage. When a patient has an area of damaged cartilage with bare bone, microfracture can be done by penetrating the bone and allowing stem cells to grow fibro new cartilage. Ideally, the area undergoing microfracture should be less than two centimeters in diameter and have healthy surrounding cartilage. A small, sharp pick is used to create the small holes in the bone.
This new cartilage is very fragile and needs to be protected. The success of microfracture is dependent on the patient being non weight bearing for a period of six to eight weeks, using a continuous passive motion machine (CPM) for a period of six to eight weeks for a duration of four to six hours per day and following our physical therapy protocol.
There is usually mild pain associated with arthroscopic knee surgery. Patients can expect to be swollen for up to two weeks. It is important to maintain active range of motion (keep the knee moving) after surgery. Physical therapy will be started approximately four to seven days after surgery. Patients typically return to sports at four to six months.
OATS (OSTEOCHONDRAL AUTOGRAFT TRANSFER SYSTEM)
OATS is a arthroscopic surgery where cartilage plugs are taken from areas of non weight bearing areas and transferred to the damaged area of cartilage. Over time, the cartilage donor site will fill with bone and scar tissue. The success of a the OATS procedure is dependent on the patient being non weight bearing for a period of two to six weeks, using a continuous passive motion machine (CPM) for a period of one to four weeks for four to six hours per day and following our physical therapy protocol.
There is usually mild pain associated with arthroscopic knee surgery. Patients can expect to be swollen for up to two weeks. It is important to maintain active range of motion (keep the knee moving) after surgery. Physical therapy will be started approximately four to seven days after surgery. Patients typically return to sports at four to six months.
ARTHROSCOPY HIP REHABILITATION
The hip joint is made up of a ball (femoral Head) and socket joint (acetabulum). The surfaces of the acetabulum and end of the femur are covered with articular cartilage, which allows smooth pain free motion of the joint. Damage to this cartilage results in areas of roughness and can lead to areas of exposed bare bone. These changes in the joint can result in changes of the bone shape (osteophytes), loose bodies, inflammation, pain, stiffness and decreased motion.
The labrum is a type of cartilage that aides in stability of the joint and easy movement. This forms a rim around the socket portion of the joint and cushions the joint. Damage to the labrum can lead to catching and pain in the joint.
Femoral Acetabular Impingement(FAI) is a condition that causes abnormal rubbing inside the hip joint. As a result, damage can occur to the articular cartilage (smooth white surface of the ball or socket) or the labral cartilage (soft tissue bumper of the socket).
There are two types Cam and Pincer. Cam type FAI means the femoral head is misshapen, not perfectly round. Pincer type FAI occurs when the acetabulum covers too much of the femoral head. FAI is associated with cartilage damage, labral tears, early hip arthritis, hyperlaxity, and low back pain. An osteoplasty can be done to correct these two problems.
Under general anesthetic you are positioned on a special operating table with your feet strapped into boots to allow traction to be placed on the hip. Under x-ray guidance the portals are made for surgery. Three or four small incisions made in the skin during the procedure. Following the procedure local anesthetic is injected into the hip and the incisions are stitched closed.
Risk and Complications:
As with any surgery, there are risks involved.
Infection is rare. If you have any redness around the wound or if you have any temperatures or are feeling unwell you need to contact our office as soon as possible.
Nerve damage is rare. There can be damage to superficial nerves, which can result in temporary or rarely permanent loss of sensation in the groin, thigh, scrotal or labial region.
Deep venous thrombosis (DVT) are rare with arthroscopic surgery. DVT can cause pain and swelling in the leg due to restriction of blood flow back to the heart. If you get increasing calf pain or shortness of breath you should notify our office right away. Long airplane flights can also cause DVT and flying should be avoided for 2 weeks following surgery.
Joint stiffness can occur no matter what the procedure, this is minimized and treated with physiotherapy.
Post Operative Protocol:
Below are guideline developed to familiarize you with the general protocol following hip arthroscopy. This is an outpatient procedure that can correct common conditions of the hip.
Theses conditions include:
Loose bodies
Labral Tears
Chrondromalacia (softening of the hard cartilage)
Femoral Acetabular Impingement (FAI)
Early degenerative arthritis
A Continuous Passive Motion (CPM) machine will be ordered for patients scheduled to have osteoplasty or microfracture. The night of surgery or early the next morning place your leg in the CPM machine. This machine is used to promote new fibro-cartilage to grow. This should be used for a period of 6 to 8 hours each day. Most patients find it comfortable to use the machine while they sleep. Patients who have osteoplasty done typically are instructed to use the CPM machine for a period of one to three weeks. Patients who have microfracture done are advised to use the CPM machine for a period of six to eight weeks.
Ice may be applied to the operative site to help diminish pain and swelling (twenty minutes on, twenty minutes off).
It is recommended that you stay home for a period of three to five days after surgery to ensure swelling has significantly decreased. We strongly advise against operating a motor vehicle while taking any pain medication, as this can alter your ability to respond quickly.
Crutches will usually be given at the operating room, or can be rented prior to your scheduled surgery date. Depending on the procedure done, crutches will be used for a period of one day to eight weeks.
Labral Resection: crutches will be used primarily for comfort for a period of one to three days.
Labral Repair: crutches will be used for a period of two weeks in order to protect the repair.
Osteoplasty: crutches will be used for a period of one to three weeks in order to avoid possible stress fractures.
Microfracture: crutches will be used for a period of six to eight weeks in order to protect the new cartilage forming.
Physical therapy will be instituted anytime between five and fourteen days after surgery. Showering with assistance is permitted at forty eight hours after surgery. Most patients may resume sports at three to six months depending on the surgery performed. Return to work depends on your occupation but usually occurs one to four weeks.
Every patient has a different hip problem and therefore will require some modification to the above-referenced guidelines depending on associated injuries.
SHOULDER SURGERY
TREATMENT PROTOCOLS FOR SHOULDER SURGERY
Most surgeries are performed in an outpatient care setting or surgery center. As a patient you will be asked to arrive at the center an hour prior to surgery and can expect to spend approximately one hour following the case in recovery before being discharged. The more complicated procedures often require an assistant surgeon be present at the time of the procedure.
After surgery, a pad connected to a cold therapy unit will be placed on the shoulder over the dressings. The unit is designed to decrease pain and swelling by pumping cold water (approximately forty degrees Fahrenheit) into the pad. Although antibiotics are administered at the time of surgery, they are usually not needed afterwards.
Several small strips of tape will be placed over the wounds at the time of the surgery and are to be left on for seven to ten days. Two or three days after surgery, at the time of your post-op visit, dressings will be changed. The cold therapy pad can be used as needed. From then on you can remove the pad to take a shower or to change clothes. It is imperative, however, that when the cold therapy pad is being used there is a thin white paper or a T-shirt between the pad and the skin. A cold therapy unit is usually used for a period of three to seven days after surgery.
Acromioclavicular (AC) Separation
Only symptomatic grade three and four injuries require surgical reconstruction. This surgery will normally involves a single tendon graft harvested from behind the patient’s knee and then transplanted to the clavicle. A small incision over the clavicle and another smaller incision behind the patient’s knee are required for this surgery.
The arm will be kept in a sling for six weeks after surgery. Minimal range-of-motion exercises will be done during the first six weeks. Physical therapy will be started at six weeks after surgery. A return to sports or more aggressive lifting can be expected at four to six months after surgery depending on pain.
Bankart Repair or Capsulorrhaphy
The arm will be kept in a sling for three to four weeks after surgery. Range-of-motion exercises (Figures 1, 2, & 3 on page 2) and the scapular squeezes will be done during the first four weeks.
Figure 1 – Forward Elevation and Figure 2 – External Rotation: should be done one to three times per day in sets of ten.
Figure 3 – Circle Pendulum: should be done for approximately thirty to sixty seconds, one to three times daily.
Scapular Squeezes: should be done three times per day in sets of ten.
At the end of four weeks physical therapy is started. Full shoulder range of motion is usually achieved within two to four months after surgery.
In the early postoperative period isometric strengthening exercises will be performed. The arm is held gently against the body pushing against the uninvolved hand. This posture is maintained for three seconds to tense the muscles before relaxing. It is important not to stress the repair while doing the isometric exercises. This technique should be applied to all six directions of shoulder motion in sets of ten once daily.
Biceps Tenodesis
This procedure is indicated for a patient with severe biceps tendonitis or a rupture in which the biceps tendon is repaired by suturing it down into the front part of the upper arm. Although the arm is in a sling for two weeks, the sling is removed once a day for gentle straightening and bending of the elbow after one week. The exercises shown in Figures 2 & 3 should be started immediately.
These exercises should be done three to five times per day in sets of ten.
Physical therapy is often started four to six weeks after surgery with stronger elbow flexion exercises following at two months postoperatively.
Capsular Release with Manipulation under Anesthesia
This procedure is indicated for patients with limited range of motion. The arm will be kept in a sling after surgery primarily for comfort. Range-of-motion exercises should be started the morning after surgery. Physical therapy will be started at one to three days after surgery. Patients may still take six to eight weeks until they have adequate range of motion in order to return to sports.
Clavicle Fracture
A sling will be used for two to three weeks after this procedure. Minimal range-of-motion exercises will be done until three weeks after surgery. It is rare to have significant shoulder stiffness following this procedure, for that reason we do not begin aggressive physical therapy until three to six weeks after surgery.br />
A return to sports or more aggressive lifting can be expected at three to four months after surgery when the fracture is healed.
Distal Clavicle Resection (Mumford Procedure)
This procedure is usually performed in conjunction with other surgeries such as rotator cuff repair or decompression. If the resection is performed alone, a sling is used for one to five days. The three range-of-motion exercises (as directed by our office) should be started the morning after surgery.
The range-of-motion exercises should be done three to five times per day in sets of ten.
Gentle isometric strengthening exercises will also be started on the first day. The arm is held gently against the body pushing against the uninvolved hand. This posture is maintained for three seconds to tense the muscles before relaxing. This technique should be applied to all six directions of shoulder motion in sets of ten once daily.
A return to sports or more aggressive lifting can be expected at four to six weeks after surgery depending on pain.
Distal Biceps Repair
A long posterior arm splint will be used for four weeks after this. No range-of-motion exercises should be started after surgery. No lifting with the affected arm even when wearing the splint.
Physical Therapy will begin at four weeks after surgery and gentle range of motion exercise will be started at that time. A return to sports or more aggressive lifting can be expected at three months after surgery depending on pain.
Rotator Cuff Repair
A sling will be used for four weeks after this procedure depending on the size of the tear. The range-of-motion exercises (Figures 1 & 2 shown on page 2) should be started the morning after surgery.
These exercises should be done three times per day in sets of ten.
At four weeks, the arm is taken out of the sling and active range of motion is started. Strengthening is started at ten weeks after surgery. Overhead sports can be resumed four to five months after surgery and golfing can be resumed at approximately three to four months.
Precautions:
-Maintain arm in abduction sling, remove only for exercises
-No shoulder AROM
-Keep incision(s) clean and dry
-No lifting
-No supporting body weight with hands and arms
-No sudden jerking motions
-No excessive behind the back movements
-Avoid upper extremity bike and ergometer
Subacromial Decompression
This procedure involves removing bone spurs and bursitis from the shoulder. The patient will be placed in a sling for approximately one to five days and range-of-motion exercises are started the morning. These exercises are shown in figures 1, 2, and 3. These exercises should be done two to three times per day in sets of ten.
In the early postoperative period isometric strengthening exercises will be performed. The arm is held gently against the body pushing against the uninvolved hand. This posture is maintained for three seconds to tense the muscles before relaxing. This technique should be applied to all six directions of shoulder motion in sets of ten once daily.
SLAP Lesion Repairs
The arm will be in a sling for three to four weeks depending on the severity of the lesion and associated injuries. Two range-of-motion exercises (Figures 1 & 2 on page 2) and scapular squeezes will be performed during the first four weeks.
Figure 1 – Forward Elevation and Figure 2 – External Rotation: should be done one to three times per day in sets of ten.
Scapular Squeezes: should be done three times per day in sets of ten.
It is important to avoid shoulder extension or any type of biceps stressing during the first two to three months following a repair. Physical therapy will usually be started at three to four weeks followed by more aggressive strengthening of the biceps and shoulder at approximately two to three months.
SUMMARY
These are general guidelines for the more common shoulder surgeries. Often the surgery will involve a combination or variations of the procedures referenced above. Although the general guidelines usually apply in these scenarios, more specific guidelines will be supplied. Please feel free to ask questions at any time.
POST OPERATIVE PROTOCOL
POST OP MEDICINE: The following information is a general guideline of the typical medication that is used in our patients post-operatively. It is not meant for use as medical advice, please take medication only as your physician or pharmacist has instructed you to do so.
Celebrex
200mg: Take 1 by mouth each day, for five days following surgery. *If you have a sulfa allergy please consult a physician prior to taking this medication.
Adverse Reactions: Dyspepsia, diarrhea, abdominal pain, nausea, dizziness, headache, sinusitis, upper respiratory infection, rash.
Senokot-S
take 1 by mouth every 12 hours as needed for constipation.
Vicodin (hydrocodone/acetaminophen)
5/500mg take 1-2 by mouth every 4-6 hours as needed for pain.
Note to Patient: Do not take more than 2 tablet in a 4 hour period and do not take more than 8 tablets in a 24 hour period. Do not take Tylenol in addition to this medication as it already contains acetaminophen.
Adverse Reactions: Lightheadedness, dizziness, sedation, nausea, vomiting.
Darvocet N-100 (propoxyphene/acetaminophen)
100mg/650mg 1-2 by mouth every 3-4 hours as needed for pain.
Note to Patient: This medication contains 650 mg of Tylenol per pill. Do not take more than 6 tablets per 24 hour period. Do not take Tylenol in addition to this medication as it already contains acetaminophen.
Adverse Reactions: Dizziness, sedation, nausea, vomiting, liver dysfunction.
OxyContin 20mg (oxycodone controlled-release)
take 1-2 by mouth every 12 hours.
Note to Patient: OxyContin tablets are to be swallowed whole. They are not to be broken, chewed, crushed, or cut. Taking pills which have been tampered with leads to rapid release of and absorption of a potentially fatal dose of oxycodone.
Adverse Reactions: Respiratory depression, constipation, nausea, somnolence, dizziness, vomiting, pruritis, headache, dry mouth, sweating, asthenia.
Robaxin (methocarbamol)
500 mg take 1 by mouth every 6 hours as needed for muscle spasms.
Adverse Reactions: Lightheadedness, dizziness, drowsiness, nausea, urticaria, pruritis, rash, conjunctivitis, nasal congestion, blurred vision, headache, fever, seizures, syncope, flushing.
Zofran ODT
8mg take one pill under the tounge every 8 hours as needed for nausea and vomiting.
Adverse Reactions: Headache, diarrhea, dizziness, drowsiness, malaise/fatigue, constipation, LFT abnormalities.
Phenergan
25mg administer 1 per rectum every 6 hours as needed for nausea and vomiting.
Adverse Reactions: Drowsiness, sedation, blurred vision, dizziness, increased or decreased blood pressure, urticaria, dry mouth, nausea, vomiting.
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