DISCHARGE  INSTRUCTIONS:  ROTATOR  CUFF  REPAIR   - PDF Document

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  1.    DISCHARGE  INSTRUCTIONS:  ROTATOR  CUFF  REPAIR     You  have  undergone  rotator  cuff  repair,  which  involves  placing  tendon  against  bone   with  suture  and/or  other  devices.  It  will  take  6  weeks  on  average  for  the  tendon  to   actually  biologically  heal  and  re-­‐attach.  During  those  first  six  weeks,  protecting  the   repair  is  paramount.  This  means  that  you  should  not  lift  the  arm  in  front  of  you   (elevate)  or  away  from  the  side  of  your  body  (abduct).  There  is  one  simple  rule  to   follow:  keep  your  elbow  at,  or  close  to,  your  side.  If  you  actively  use  the  repaired   tendon(s),  the  repair  will  fail.     Most  of  my  rotator  cuff  repairs  on  performed  arthroscopically.  If  you  had  an  “open”   or  “mini-­‐open”  approach,  you  had  a  large  or  complex  tear.  Your  initial  postoperative   recovery  may  be  more  restricted  in  some  of  these  cases:  you  may  have  a  sling  with   an  additional  pillow  attached  and  you  may  be  asked  not  to  perform  the  pendulums   exercises  listed  below.       A.Comfort  (see  postop  pain  control  instructions  for  details  and  precautions)   1.Ice  –Place  crushed  ice  over  your  shoulder  for  20  minutes,  four  times  a   day.       2.Pain  Medication  –These  should  be  taken  only  as  often  as  necessary.    Do   not  take  pain  medication  with  alcohol,  sleep  aids,  or  other  sedatives.     3.Anti-­‐inlfammtories  (NSAID’s)—Most  patients  will  be  given  a   prescription  for  NSAID’s,  or  asked  to  obtain  some  over  the  counter.  If  so,   this  will  be  on  your  discharge  instructions  from  the  surgical  facility.   4.Nerve  block—Most  patients  receive  a  nerve  block  placed  in  the  neck  to   numb  the  shoulder.  This  can  last  6-­‐12  hours  on  average.    Start  taking   your  pain  medication  before,  or  at,  the  first  sign  that  the  block  is   resolving  (return  of  tingling  or  sensation  in  the  hand).  Nerve  blocks   wear  off  quickly,  and  if  you  do  not  have  pain  medication  circulating,  it   can  be  hard  to  get  the  pain  back  under  control.     5.Sling  –  A  sling  has  been  provided  for  your  comfort  and  to  protect  the   repair.    You  must  sleep  with  the  sling  on.  When  upright,  the  elbow   should  be  seated  deeply  in  the  corner  of  the  sling,  with  the  wrist  above   the  level  of  the  elbow  (heading  “downhill”  from  hand  to  elbow).  The   sling  should  be  worn  such  that  the  elbow  is  in  front  of  the  body  (on  the   abdomen,  not  at  the  side).  During  sleep,  I  recommend  placing  a  pillow   behind  the  elbow  to  keep  it  from  falling  down  along  your  side.  You  may    

  2.   take  off  the  sling  as  long  as  the  elbow  is  supported  by  your  other  arm,  an   armrest  on  a  chair,  or  your  lap.  The  sling  can  be  removed  for  hygiene  or   showering,  again  making  sure  the  arm  is  supported.   B.Activities   1.The  sling  should  be  used  in  the  manner  noted  above  for  6  weeks   postoperatively.  If  you  had  an  open  or  mini-­‐open  repair  of  a  large-­‐sized   tear,  your  sling  may  have  an  attached  pillow  to  support  the  elbow  away   from  the  body.   2.Motion  –  Regaining  motion  in  your  shoulder  can  decrease  pain  and   quicken  your  recovery.  However,  you  must  remember  to  protect  your   repair  at  all  times.  If  you  had  a  large  tear,  you  will  be  asked  not  to   perform  any  shoulder  exercises  until  after  your  first  follow  up   appointment.   a.At  your  first  follow  up  visit  with  Dr.  Tenholder,  you  will  be  given   a  prescription  for  formal  physical  therapy.   b.Pendulum  exercises—Start  the  day  after  surgery.  Sit  in  a  chair  or   stand  and  support  yourself  with  the  nonoperative  arm.  Carefully   remove  your  sling,  hang  your  arm  at  your  side.  With  your  elbow   straight,  lean  forward  over  your  knees  and  gently  swing  your   arm  forward  and  backward  like  a  pendulum  or  in  small  circles.     Do  this  for  a  few  minutes,  4  times  daily.       c.With  your  sling  off  and  upper  arm  supported,  you  may  flex  and   extend  your  elbow  and  wrist  (3X  a  day  for  15  repetitions)  to   avoid  elbow  stiffness.   d.Active  range-­‐of-­‐motion  (when  you  move  the  arm  without   someone’s  help)—it  is  ok  for  you  to  move  your  arm  actively   ONLY  if  the  elbow  is  supported  at  your  side,  not  allowing  your   elbow  to  come  away  from  the  body.  This  includes  activities  like   using  a  computer  keyboard  or  mouse,  buttoning  a  shirt,  or   bringing  your  hand  to  your  mouth.  The  shoulder  should  only   rotate  through  a  small  range  of  motion,  and  should  not  elevate  or   abduct.   e.It  is  OK  to  shrug  your  shoulders  and  perform  ball  squeezes  in  the   sling.   f.Athletic  activities  such  as  lifting,  swimming,  bicycling,  jogging,   running,  and  stop-­‐and-­‐go  sports  should  be  avoided  until  cleared   by  Dr.  Tenholder.    

  3.   g.Return  to  Work  –  Your  ability  to  return  to  work  depends  on  a   number  of  factors,  including  pain  control  and  the  specific   demands  of  your  job.    You  must  wear  a  sling  and  abide  by  the   restrictions  noted  above  for  six  weeks.  You  will  not  be  able  to   work  at  shoulder  level  or  above,  or  lift  more  than  a  pound  or  two   for  8-­‐12  weeks.   C.  Wound  Care   1.Remove  the  surgical  bandaging  the  day  after  surgery.  Use  peroxide  to   remove  any  dried  blood  the  first  time,  but  do  not  use  peroxide   repetitively.  Clean  the  incisions  with  anti-­‐bacterial  soap  and  water,  and   place  Band-­‐aids  (patches  or  guaze  for  any  larger  incisions).   2.You  may  shower  3  days  after  surgery.  Keep  it  brief  and  try  to  keep  the   surgical  site  out  of  the  water.   3.Bathing,  swimming,  and  soaking  should  be  avoided  until  one  week  after   the  stitches  are  removed.   4.It  is  common  to  see  bruising  around  the  shoulder  and  into  the  upper  arm   and  chest  develop  1-­‐5  days  after  shoulder  surgery.   D.Call    Dr.  Tenholder  if:   1.Pain  is  not  controlled  or  worsens  the  first  few  days  after  surgery.   2.Excessive  redness  or  drainage  of  cloudy  or  bloody  material  from  the   wounds.    (Clear  red  tinted  fluid  is  OK  and  some  mild  drainage  should  be   expected  for  a  day  or  two).   3.Temperature  elevation  greater  than  101.5  degrees.   4.Pain,  redness,  or  swelling  in  your  arm  or  hand.   5.Numbness  or  weakness  in  your  arm  or  hand  that  persists  after  the  nerve   block  wears  off.   E.Return  to  Dr.  Tenholder’s  Office:   Your  first  return  to  our  office  is  typically  within  5-­‐10  after  your  surgery.     The  postoperative  appointment  day  and  time  was  selected  by  my  surgery   scheduler  during  the  scheduling  process.  If  this  was  not  communicated  to   you  or  you  do  not  recall  the  specifics,  please  call  the  office  at  850-­‐863-­‐ 2153.  Any  of  the  receptionists  can  inform  you.  Alternatively,  you  can  call   my  surgery  scheduler  directly.