To My Patients: Post Operative Procedures & Instructions

 |  Medical Procedures  | 

To My Patients:

Thank you for choosing me to provide you with state-of-the-art medical care. I know that many of you have been dealing with painful and debilitating conditions, and I want you to know that your comfort and recovery are my highest priorities. During the past few years, there have been extraordinary advances in all the procedures I perform, and these refinements put you in an optimal position for a strong recovery. I hope your experience so far has been a positive one.

If you have arrived home, you may want to be reminded about what will happen next. For your convenience, I have posted my postoperative instructions on this site, as well as links to informative, surgery-specific websites.

I look forward to seeing you in the office for your follow-up visits. If you have any additional questions or concerns, do not hesitate to contact the office for further assistance. If you are concerned about something or you do not see the information you need on this site, I need to hear from you.

To Those Who Are Considering Treatment:

It is normal to have questions and concerns about treatment for painful musculoskeletal conditions or injuries. I invite you to call for an appointment so I can answer your questions and discuss the important medical refinements that make our procedures safer and more effective than ever. The success rate for these procedures is very high, and the vast majority of my patients enjoy greatly improved mobility and relief from pain. Every day I talk to people who tell me that treatment has changed their lives.

The following information will help you understand the operations I perform and the post-operative program. If your specific operation is not listed here, please call us.

Total Knee Arthroplasty (Total Knee Replacement)

GENERAL POST-OPERATIVE INSTRUCTIONS

Following total knee arthroplasty, you will be involved with several care providers. Our office will coordinate physical therapy and home health to make sure that your surgery has been a success and you obtain maximum benefit from this procedure. I routinely use a rotating platform knee (knees that bend and rotate).

To learn more about your knee, click on the following link:
http://orthoinfo.aaos.org/topic.cfm?topic=A00221

Home health personnel will follow up with you after you have arrived home. These nurses will help you with wound care and follow up laboratory work. Wounds will typically turn a little red around your staples or sutures. Some swelling is expected. Bruising may extend down the leg into the calf. These things are common after such a major surgery. Home health nurses are trained to look for excessive swelling, redness and drainage, which could indicate an infection.

Computer-navigated total knee patients will notice two small incisions on the front part of their leg. Pins are placed in the tibia during the surgery to allow the computer to "see". These should be treated like any other wounds and should heal uneventfully. Many therapists are not familiar with this technique and may ask you why they are there. Simply smile and say that your knee was done with computer navigation to ensure that the position of the knee is as precise as possible.

PHYSICAL THERAPY AND EXERCISE

Physical therapy will have begun in the hospital, and your therapy at home is essential to improving the motion and function of your new knee. It is my experience that concentrating on full extension in the early period is very important. The knee feels better bent, and this is normal. Extension or straightening of the knee is painful at first, but it is necessary for you to do this in order to reach maximum benefit. Work on this by resting the heel on a stool while sitting in a chair or on the side of the bed. You will feel the stretch in the back of the knee, and it will become more comfortable after a few days. Good extension will allow good flexion or bending as time progresses.

Your preoperative class introduced you to other exercises you will be doing now that surgery has been completed. These exercises are not only to be done with the therapist, but also on your own at home.

Total knee physical therapy link:
http://orthoinfo.aaos.org/booklet/view_report.cfm?Thread_ID=16&topcategory=Knee

Gentle exercise is also important. Walking is done initially with a walker for balance, and the transition to walking with a cane is made as soon as possible. Your physical therapist will help you with this transition. Before long, you will be walking again on your own without aids. These transitions should be done when you feel comfortable and balanced. It is especially important that you avoid falling and injuring yourself during this time.

CPM machines or continuous passive motion machines are not routinely needed after total knee replacements. They are expensive to rent, and there is no documented long term benefit on motion of your new knee with these devices.

Any questions should be directed to your physical therapist. Many questions can be answered with physical therapy link listed above. Of course, any concerns you may still have should be directed directly to the office.

MEDICATION

Antibiotics
Joint arthroplasty patients are given antibiotics before surgery and for twenty-four hours after the surgery. In rare cases, antibiotics may be given for a longer time period after the surgery while you are in the hospital. This is usually done for patients who are obese or have diminished wound healing properties because of chronic medical problems. Very rarely, short courses of antibiotics by mouth may be administered after the surgery for continued wound drainage.

Pain medication
You will receive a prescription for pain medication during the postoperative period. Narcotics are used for the first three weeks, if needed. Please direct all medication needs to me during office hours or during our first post op visit. Some medicines cannot be "called in" to the pharmacy and require a prescription from me to be filled by your pharmacist.

SPECIAL INSTRUCTIONS AND CONCERNS

Compression Stockings
You will be taking blood thinners after your surgery. Compression stockings on each leg should remain in place until your blood thinning medication is discontinued. Lab work is done to ensure that the medicines given to thin the blood are adjusted to the correct dose. I will monitor these values and adjust your dose accordingly during the post-operative period. You will begin taking the blood thinner immediately after your surgery and continue for a period of twenty-one days. Some patients will be given injections to take. These may be administered by a home health nurse or a family member. These medicines help prevent the development of blood clots, but do not eliminate this potential complication.

Swelling of the Calf
Calf swelling may indicate a blood clot, and you should contact me immediately if you notice this. I may order an ultrasound to look for this. Again, our office should be called if you have any questions or concerns.

Post-Operative Infections
Any infection of the sinuses, urinary tract, skin, teeth or other area requires prompt medical attention to avoid the complication of a late joint infection. Contact your primary care provider immediately if you suspect you are suffering from one of the above conditions.

Dental Care
You will need antibiotics prior to dental cleanings or any other invasive procedures for the first two years after your surgery. Communicate to your dentist that you have a new joint and you require antibiotics prior to your visit. A protocol of antibiotic coverage for dental procedures is listed on the following link: http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=364&topcategory=Patient%20Safety

Additional Sites on Total Knee Replacement

Total Hip Arthroplasty (Total Hip Replacement)

SPECIAL RESTRICTIOINS

Total hip arthroplasty post-operative patients have several unique and specific restrictions. These instructions and precautions are initially introduced during the preoperative class and continue for as long as you live. Specific precautions for total hip patients include restrictions on position of the hip after surgery. The hip should not be flexed, adducted, and internally rotated at the same time or a dislocation may occur.

This set of positions of the hip is best illustrated in the seated position with the hip flexed or bent at the waist. Adduction is when the leg crosses the midline of the body towards the other leg. Internal rotation is what happens when you try to move your foot to the side while your knee stays next to the other knee. Common situations during which this may arise include sitting on the toilet, getting in and out of the car, and just sitting down and trying to tie your shoes. You will need an elevated toilet seat.

Activities after a total hip are explained at the following link:
http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=274&topcategory=Hip

GENERAL POST-OPERATIVE INFORMATION

Home health personnel will follow up with you after you have arrived home. The nurses will help you with wound care and follow up laboratory work. Wounds will typically turn a little red around your staples or sutures. Some swelling is expected. Bruising may extend down the leg into the calf. These things are common after such a major surgery. Home health nurses are trained to look for excessive swelling, redness and drainage, which could indicate an infection.

Computer navigated total hip arthroplasty patients will have small incisions in several places other than the hip. The crest of the pelvis around the belt line will have a small incision as will the lateral aspect of the leg. These incisions allow placement of pins that allow the computer to "see" the hip and aid in the positioning of the hip and adjustment of length if needed in your legs. These wounds should be treated like any other wounds and should heal uneventfully. An ace wrap may be used for the first week or so around the thigh to prevent potential swelling of the thigh after these pins are removed in the operating room. (This is done before you leave the operating room at the time of your hip replacement.)

PHYSICAL THERAPY AND EXERCISE

Be aware of the special precautions for hip replacement patients, which are listed above. Shortly your actions will become second nature and you won't have to think about them so hard. The most common time a dislocation occurs is in the first three months after surgery. Although it is much less likely to happen after this time period, in rare circumstances it may still occur later on in the life of your hip.

Physical therapy was started in the hospital and will continue until you are walking well without aids. Much of the therapy will be this transition from walking with a walker and then cane, if needed. Emphasis on hip precautions will be reinforced during this period as well. Any questions should be directed to your physical therapist. Many questions can be answered with the physical therapy link listed below. Of course, any concerns you may still have should be directed directly to the office. See the following link for specific instructions.

Post Operative Total Hip Arthroplasty Physical Therapy: http://orthoinfo.aaos.org/booklet/view_report.cfm?Thread_ID=20&topcategory=Hip

MEDICATION

Pain medication
Pain medication will be prescribed for you during the postoperative period. Narcotics are used for the first three weeks if needed. Please direct all medication needs to me during office hours or during our first postoperative visit. Some medicines cannot be "called in" to the pharmacy and require a prescription from me to be filled by your pharmacist.

Antibiotics
Joint arthroplasty patients are given antibiotics before surgery and for twenty four hours after the surgery. In rare cases, antibiotics may be given for a longer time period after the surgery while you are in the hospital. This is usually done for patients who are obese or have wound healing properties that are diminished because of chronic medical problems. Very rarely, short courses of antibiotics by mouth may be administered after the surgery for continued wound drainage. As noted below, antibiotics will also be needed prior to dental cleanings or any other invasive procedures for the first two years after your surgery.

INSTRUCTIONS AND CONCERNS

Compression Stockings
You will be taking blood thinners after your surgery. Compression stockings on each leg should remain in place until your blood thinning medication is discontinued. Lab work is done to ensure that the medicines given to thin the blood are adjusted to the correct dose. I will monitor these values and adjust your dose accordingly during the post-operative period. You will begin taking the blood thinner immediately after your surgery and continue for a period of twenty-one days. Some patients will be given injections to take. These may be administered by a home health nurse or a family member. These medicines help prevent the development of blood clots, but do not eliminate this potential complication.

Swelling of the Calf
Calf swelling may indicate a blood clot, and you should contact me immediately if you notice this. I may order an ultrasound to look for this. Again, our office should be called if you have any questions or concerns.

Post-Operative Infections
Any infection of the sinuses, urinary tract, skin, teeth or other area requires prompt medical attention to avoid the complication of a late joint infection. Contact your primary care provider immediately if you suspect you are suffering from one of the above conditions.

Dental Care
You will need antibiotics prior to dental cleanings or any other invasive procedures for the first two years after your surgery. Communicate to your dentist that you have a new joint and you require antibiotics prior to your visit. A protocol of antibiotic coverage for dental procedures is listed on the following link: http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=364&topcategory=Patient%20Safety

Additional Sites on Total Hip Replacement

Arthroscopy of the Knee

Arthroscopy of the knee is done as an outpatient procedure. Some of the most common knee arthroscopy procedures I perform are listed below. You were given a set of instructions after your surgery explaining the basics of what is coming now that your surgery is complete. Hopefully this site will answer any further questions you may have regarding your surgery and post operative course. This section is broken down to the following procedures:
Partial Meniscal Debridement
Meniscal Repair
Anterior Cruciate Ligament Reconstruction
Chondroplasty and Microfracture
Chondral Repair or OCD repair
Synovectomy
Loose Body Excision
If you are unsure of your procedure, please call the office.

Please note that operative photographs are routinely taken during these procedures. Make sure that the discharging nurse or I hand these to you or your family before you leave the hospital. Bring these to the office so that we might discuss your surgery in detail, and I can explain your procedure and your prognosis further. You will be given a copy of your operative notes in the office to keep with your photos so that you have a permanent record of your operation. The hospital and I do not have copies of these photos, and they become your responsibility. These pictures are important in deciding further surgical interventions should you have any arthritic condition and may help in the decision-making process for further surgeries should this need arise. So hold on to them!

Partial Meniscal Debridement

After arriving home, make sure that the knee remains iced and elevated. You may begin to put weight on the leg as you feel comfortable. Crutches may be needed in the first several days after this surgery. When your pain permits, crutches may be discontinued.

This surgery is done using minimally invasive techniques. There will be two or more small incisions that will be closed with sutures or staples. Some are closed with sutures under the skin and these do not need to be removed and will dissolve with time. Wounds should remain clean and dry. Change dressings if they become saturated with blood. No dressing is required after day three unless this is more comfortable for you. Replace ace wrap and remember to start with the foot. If the foot is not wrapped with the ace it will definitely swell. Sutures will be removed at your first postoperative visit.

Showers can be taken on the third day after surgery. Please do not take a bath or swim until sutures are removed or you are seen in the office. Swelling and discoloration are common. Redness outside of the suture line and drainage occurring longer than three days post operatively should be brought to my attention immediately. Please call the office if you have questions or concerns.

Pain medicines will be prescribed for you during this postoperative period. Narcotics are used for the first ten days if needed. Please direct all medication needs to me during office hours or during our first post op visit. Some medicines cannot be "called in" to the pharmacy and require a prescription from me to be filled by your pharmacist.

Physical therapy is not usually required after this procedure. If there is a delay in your return to full motion, I may prescribe physical therapy to you at your first postoperative visit. This is rare following this procedure, as most patients are able to do their exercises on their own.

Here's a link which will help you proceed by yourself:

http://orthoinfo.aaos.org/booklet/view_report.cfm?Thread_ID=15&topcategory=Knee

Operative photographs are routinely taken during this procedure. Make sure that we give them to you at the hospital, and make sure you keep them, along with the operative notes we give you at your first postoperative visit.

Additional Sites on Arthroscopy of the Knee

Meniscal Repair

Meniscal repair is usually performed in conjunction with anterior cruciate ligament reconstruction, but occasionally is performed as an isolated procedure. Specific to meniscal repair is the need to use postoperative bracing. Weight bearing is allowed only in extension (with the leg fully straight). The brace may be removed for sleep, showers, and range of motion exercises. Bending the leg while in the seated position is encouraged. This restriction will continue for about six weeks after surgery.

Remember not to walk without the brace. Crutches may be needed for this period and are recommended. This surgery is done using minimally invasive techniques. There will be two or more small incisions that will be closed with sutures or staples. Some are closed with sutures under the skin and these do not need to be removed and will dissolve with time. Wounds should remain clean and dry. Change dressings if they become saturated with blood. No dressing is required after day three unless this is more comfortable for you. Replace ace wrap and remember to start with the foot. If the foot is not wrapped with the ace it will definitely swell. Sutures will be removed at your first post operative visit.

Showers can be taken on the third day after surgery. Please do not take a bath or swim until sutures are removed or you are seen in the office. Swelling and discoloration are common. Redness outside of the suture line and drainage occurring longer than three days post operatively should be brought to my attention immediately. Please call the office if you have questions or concerns.

Pain medicines will be prescribed for you during this postoperative period. Narcotics are used for the first ten days if needed. Please direct all medication needs to me during office hours or during our first post op visit. Some medicines cannot be "called in" to the pharmacy and require a prescription from me to be filled by your pharmacist.

Physical therapy is not usually required following this procedure. An assessment of your motion will be done on your first postoperative visit. If needed, physical therapy will be ordered.

Operative photographs are routinely taken during this procedure. Please be sure we give them to you at the hospital and please be sure to keep them, along with the operative notes you will receive at your first postoperative visit.

Anterior Cruciate Ligament Reconstruction

Anterior Cruciate Ligament Reconstruction is usually done with a graft from one of two sources: from a donor (allograft) or from your own tissue (autograft).

In each case the graft itself may come either from hamstring tendons (soft tissue graft) or from portions of the patella, patella tendon and tibia, (btb graft). The postoperative protocol will depend on the type of surgery you had.

Hamstring grafts require post operative protection and touch-down weight bearing follows for the first month.

Bone tendon bone (btb) grafts are allowed to walk immediately after surgery, pain restricted. Both types of ACL reconstruction require extension bracing at least until the first post operative visit. This is done at night only. The brace may be removed for range of motion exercises or showers as needed during the day. After weight bearing is progressed to pain restricted, the brace is recommended for the first month at least.

The following link to the American Academy of Orthopaedic Surgeons will help you understand anterior cruciate ligament reconstruction:

http://orthoinfo.aaos.org/indepth/thr_report.cfm?Thread_ID=14&topcategory=Knee

Anterior cruciate reconstruction is done using minimally invasive techniques. There will be two or more small incisions that will be closed with sutures or staples. Some are closed with sutures under the skin and these do not need to be removed and will dissolve with time. Wounds should remain clean and dry. Change dressings if they become saturated with blood. No dressing is required after day three unless this is more comfortable for you. Replace ace wrap and remember to start with the foot. If the foot is not wrapped with the ace, it will definitely swell. Sutures will be removed at your first post operative visit.

Showers can be taken on the third day after surgery. Please do not take a bath or swim until sutures are removed or you are seen in the office. Swelling and discoloration are common. Redness outside of the suture line and drainage occurring longer than three days post operatively should be brought to my attention immediately. Please call the office if you have questions or concerns.

Pain medicines will be prescribed for you during this postoperative period. Narcotics are used for the first ten days if needed. Please direct all medication needs to me during office hours or during our first post op visit. Some medicines cannot be "called in" to the pharmacy and require a prescription from me to be filled by your pharmacist.

Operative photographs are routinely taken during this procedure. Make sure you ask for them before leaving the hospital and make sure you keep them, along with the operative notes you will receive at your first postoperative visit.

Physical Therapy is vital to the success of this operation. Be sure that you are clear on your weight bearing status.

Hamstring reconstructions are touch down weight bearing for the first two weeks, progressing to 25-50lbs of weight bearing over the next two weeks, followed by pain restricted weight bearing as tolerated there after.

BTB graft reconstructions are allowed to weight bear as tolerated immediately after the surgery, although most people require several days of crutches because of pain to make this transition.

If a meniscal repair was performed at the same time, follow those instructions as well; weight bear only in extension when weight bearing starts. Most likely you are already involved with a therapist. Therapy begins immediately post operatively at home on your own. Extension bracing at night is followed by range-of-motion exercises during the day.

You should have a therapy appointment approximately five days after surgery to begin formal exercises. Ice and elevation are important to reducing the swelling. Use the ace wrap during this period as well. Expect some pain and frustration for the first several days. Look below for physical therapy links for both types of commonly performed anterior cruciate ligament reconstruction.

Chondroplasty and Microfracture

The post operative period should follow the instructions for Meniscal Debridement. Make sure weight-bearing status is clear. Microfracture patients will undergo a short period of protected weight bearing for the first month with restrictions remaining touch-down until released by me.

Chondral Repair and OCD Repair

As far as the weight-bearing status goes, Chondral Repair and OCD Repair must be touch-down weight bearing until released by me.

Synovectomy and Loose Body Excision

Patients should follow Meniscal Debridement instructions.

Additional Sites on Anterior Cruciate Ligament Reconstruction

Arthroscopic Rotator Cuff Repair

Arthroscopic rotator cuff repair is done using minimally invasive techniques. Prior to surgery, you have worked extensively with your therapist to strengthen the rotator cuff muscles and regain your shoulder motion. After surgery, you will be concentrating on regaining your preoperative motion and eventually strengthening the muscles again. This page will describe the therapy and your postoperative course.

Here are some links that describe the anatomy, the treatment, and the surgery that you have just had:

http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=531&topcategory=Shoulder

http://orthoinfo.org/indepth/thr_report.cfm?Thread_ID=2&topcategory=Shoulder

During surgery I will take pictures of the inside of your shoulder. These will be given to you before you leave the hospital. Please bring them to your first clinic appointment so that we may review your surgery together. These are the only copies, so be sure to hold on to them for future reference.

At the end of your surgery, a catheter will be placed under the shoulder's acromial process (the bony bump on the top of your shoulder and at the top of your arm) and above the rotator cuff repair. It contains pain medication (usually marcaine, a local anesthetic) which will be carefully delivered by a computerized pump into your shoulder to reduce the pain of the operation. Between this pain pump and the addition of an interscalene block, you should be quite comfortable. The interscalene block is the set of shots the anesthesiologist placed in your neck prior to the surgery. This block usually last 12 to16 hrs. Pain medication by mouth will be prescribed to help with any further discomfort you may experience. Take this medication as directed. The pain pump will last for 72 hours or so, and the catheter should be pulled out of the shoulder at the end of that period. The catheter for the pain pump looks like heavy fishing line, is very thin and durable, and should not hurt when it is pulled out. Just throw the pump in the trash and change your dressings at that time.

A sling will also be placed on the operative arm at the end of the operation. This is for comfort and also should be worn at night for sleep for the first three to five days after the surgery. It is a good idea to sleep in a recliner for these first few days. This just keeps you from rolling over on the shoulder and causing pain. It is unlikely that you will do any damage to your shoulder should you roll over in bed. The recliner may be more comfortable for you during this time. Patients who don't have a recliner should prop themselves up in bed with many pillows for the same result.

Showers can be taken on post op day three after the pain pump has been removed. Please do not take a bath or swim until sutures are removed or you are seen in the office. Swelling and discoloration are common. Redness outside of the suture line and drainage occurring longer than three days post operatively should be brought to my attention immediately. Please call the office if you have questions or concerns.

Physical therapy begins at home when pain permits. This should start by day two or three. Carefully remove the sling and allow your hand to point to the floor straightening the arm at the elbow. Lean over and begin gentle swinging motions, circular motions, and figure of eight motions. This set of exercises is described as pendulum or Codman exercises. These can be done as frequently as tolerated and are great to get the shoulder moving.

Passive exercises such as Codman exercises are always encouraged immediately postoperatively. Most rotator cuff repairs may begin active motion exercises as soon as pain permits.

If the tear of the rotator cuff is large, or the repair difficult, I may restrict your motion in the early postoperative period to just the Codman exercises. All others may proceed to active assisted exercises such as pulley and broomstick motions as soon as pain permits. Resistance exercises do not start until the end of the sixth week after surgery. This allows the repair to fully heal prior to putting any stress on it. Be sure not to do the isometric or rotational exercises until instructed by me or by your therapist.

Please refer to the following link for explanations of the therapy after a rotator cuff repair below:

http://orthoinfo.aaos.org/booklet/view_report.cfm?Thread_ID=19&topcategory=Shoulder

Your first postoperative visit happens about 7 to 10 days after the surgery. Wounds will be checked and the pictures will be reviewed. I will also discuss the upcoming therapy and answer any questions you may have.

Your second postoperative visit will occur at the 5 to 6-week mark. I will assess your range of motion, and we will begin strengthening in therapy at this time. Hopefully you will be back to full strength at the 10 to 12-week mark. All restrictions will be lifted at this time, and your strengthening exercises will continue at home with the therabands.

By this time, you are well on your way to a successful recovery after a rotator cuff repair.

Notes

Some patients will have had a small incision to repair the tendon if it is impossible to repair through the scope. I do not perform formal open repairs of the rotator cuff; I prefer to do this with minimally invasive techniques either entirely through the scope, or with a mini- open technique.

Additional Sites on Rotator Cuff Repair

Arthroscopic Subacromial Decompressions

Arthroscopic subacromial decompressions of the shoulder are done for impingement, also known as subacromial bursitis. This disorder is characterized as an inflammation of the tissue between the rotator cuff and the bony prominence of the shoulder at the top of the arm or the acromium. Prior to surgery you learned some exercises from your physical therapist. These will be the mainstay of your rehabilitation and therapy after the surgery.

This surgery is performed arthroscopically using minimally invasive techniques. It is often performed in conjunction with a distal clavicle excision or as an integral part of an arthroscopic rotator cuff repair. The surgery involves removing the inflamed tissue and opening of the space where the rotator cuff "lives". This is accomplished by removing the undersurface of the acromium and removing the bony spurs associated with this area.

Please see the following link for further explanations:

http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=133&topcategory=Shoulder

During surgery I will take pictures of the inside of your shoulder. These will be given to you before you leave the hospital. Please bring them to your first clinic appointment so that we may review your surgery together. These are the only copies, so be sure to hold on to them for future reference.

At the end of your surgery, a catheter was placed under the shoulder's acromial process (the bony bump on the top of your shoulder and at the top of your arm) and above the area of the decompression. It contains pain medication (usually marcaine, a local anesthetic) which will be carefully delivered by a computerized pump into your shoulder to reduce the pain of the operation. Between this pain pump and the addition of an interscalene block, you should be quite comfortable. The interscalene block is the set of shots the anesthesiologist placed in your neck prior to the surgery. This block usually last 12-16 hrs. Pain medication by mouth was prescribed to help with any further discomfort you may experience. Take this medication as directed. The pain pump will last for 72 hours or so, and the catheter should be pulled out of the shoulder at that time. The catheter for the pain pump looks like heavy fishing line, is very thin and durable, and should not hurt when it is pulled out. Just throw the pump in the trash and change your dressings at this time.

A sling will also be placed on the operative arm at the end of the operation. This is for comfort and also should be worn at night for sleep for the first three to five days after the surgery. It is a good idea to sleep in a recliner for these first few days. This just keeps you from rolling over on the shoulder and causing pain. It is unlikely that you will do any damage to your shoulder should you roll over in bed. The recliner may be more comfortable for you during this time. Patients who don't have a recliner should prop themselves up in bed with many pillows for the same result.

First postoperative visit happens about 7-10 days after the surgery. Wounds will be checked and the pictures will be reviewed. I will also discuss the upcoming therapy and answer any questions you may have.

Showers can be taken on post op day three after the pain pump has been removed. Please do not take a bath or swim until sutures are removed or you are seen in the office. Swelling and discoloration are common. Redness outside of the suture line and drainage occurring longer than three days after surgery should be brought to my attention immediately. Please call the office if you have questions or concerns.

Physical therapy begins at home when pain permits. This should start by day two or three. Carefully remove the sling and allow your hand to point to the floor straightening the arm at the elbow. Lean over and begin gentle swinging motions, circular motions, and figure-eight motions. This set of exercises is described as pendulum or Codman exercises. These can be done as frequently as tolerated and are great to get the shoulder moving. After the first office visit, physical therapy will be resumed. Strengthening exercises will be resumed as soon as the surgical pain ends.

Please refer to the following link for further explanations and illustrations of exercises:

http://orthoinfo.aaos.org/booklet/view_report.cfm?Thread_ID=19&topcategory=Shoulder

Our therapists have put together the following illustrations for you showing common shoulder exercises to be used both before and after surgery:

Shoulder exercises BRBJ Therapy

Unlike a rotator cuff repair, motion is only limited by pain. Activities are encouraged as soon as you can tolerate them.

Arthroscopic SLAP Repair, Bankhart Repair

Arthroscopic SLAP repairs are done with minimally invasive techniques. SLAP stands for Superior Labrum Anterior Posterior lesion. This problem is characterized by a tear of the cartilage from the top of the glenoid. This cartilage is vital to the stability and function of your shoulder. It is also the insertion of the long head of the biceps muscle. This muscle is the "Popeye" muscle in your arm. Its anchor, or insertion, is at the top of the labrum and is a common anatomical landmark found during every arthroscopy of the shoulder. Inferior labrum tears are also called Bankhart lesions and are associated with prior shoulder dislocations. Although SLAP lesions are in the same family, they are characterized by positional pain. Your motion will be limited to Codman exercises for the first seven to ten days. I may limit your overhead activities for a short while to allow the repair to heal.

The link below helps explain SLAP and Bankhart lesions of the shoulder.

http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=255&topcategory=Shoulder

During surgery I will take pictures of the inside of your shoulder. These will be given to you before you leave the hospital. Please bring them to your first clinic appointment so that we may review your surgery together. These are the only copies, so be sure to hold on to them for future reference . After the surgery, you and I will review your operative photographs and I will show you where your labrum was torn.

Showers can be taken on post op day three after the dressings have been removed. Please do not take a bath or swim until sutures are removed or you are seen in the office. Swelling and discoloration are common. Redness outside of the suture line and drainage occurring longer than three days post operatively should be brought to my attention immediately. Please call the office if you have questions or concerns.

Physical therapy begins at home when pain permits. This should start by day two or three. Carefully remove the sling and allow your hand to point to the floor straightening the arm at the elbow. Lean over and begin gentle swinging motions, circular motions, and figure of eight motions. This set of exercises is described as pendulum or Codman exercises. These can be done as frequently as tolerated and are great to get the shoulder moving. After the first office visit, physical therapy will be resumed. Strengthening exercises will be resumed as soon as the surgical pain ends. Specific physical therapy instructions will be given to you at your first post op visit. You should avoid overhead activities for now.

Additional Sites on SLAP Repair, Bankhart Repair