The following are “Frequently Asked Questions” that apply to most surgical procedures that Dr. Weldon performs.
Often after surgery the person will be given precautions such as no active motion of the operated side. This limits the type of exercise that is safe for the person to do. Two activities that allow the person to obey the precautions and still get exercise are:
- Ride an exercise bike with the operated arm in a sling and not holding on to the handle bar. The person should concentrate on keeping the arm relaxed while peddling.
- Find a steep hill and walk up it with big strides. The arm should be in a sling. The hill should be paved to limit the chance of tripping and falling (trail hiking is not advised).
If the person is not given precautions or the previous precautions are lifted then the person can engage in any form of exercise they would like. They should, however, use common sense when choosing their activities. For example, if precautions are lifted at the 6 week mark and the person would like to resume swimming, then they should start out in the shallow end of a pool -not in the ocean with big waves and strong current. Or if precautions are lifted at 6 weeks and the person would like to resume playing golf, then start out at the driving range rather than jumping into 18 holes with their friends.
Getting the wound wet with showering is okay after the 3rd day following surgery. However, for the first 2 weeks after surgery the person will be asked not to submerge their wound in water. Therefore activities such as taking a bath, soaking in a hot tub, or swimming are not advised. After 2 weeks it is okay to submerge the wound and the person can bath, soak in a hot tub, enter into a pool or the ocean.
For people who have been given no precautions or for whom precautions have been lifted swimming using the operative arm to swim is okay. The person should use common sense when resuming swimming. For example, if precautions are lifted at the 6 week mark and the person would like to resume swimming, then they should start out in the shallow end of a pool -not in the ocean with big waves and strong current.
For people who have been given precautions entering into a pool 2 weeks after surgery is okay but they should not use the operative arm to propel themselves through the water or to keep afloat. It is best not to enter water that is too deep to stand.
When a person can return to work following a surgery is dependent on 1) the type of work they do, 2) the type of surgery they had. Please refer to the Shoulder Surgery and Elbow Surgery menu items above for specifics on your type of surgery. When a person goes back to work it is important that they follow any precautions that they have been given. Also, most people will be given home exercises after surgery and as such if they go back to work they must find time while at work to do the exercises.
Bruising or darkening of the skin following surgery or an injury to the shoulder or elbow is normal and to be expected. It happens because bleeding at the injury site or surgical site. It is usually first seen at the injury or surgery site. Over time it travels down through the tissue planes and can reach the finger tips, the flank and even the waist.
The main problem with bruising is the discoloration. Many people don’t like the way it looks. Bruising is usually not a clinical problem and does not decrease the persons chance of recovery.
Occasionally the blood causing the discoloration can irritate the skin. When this happens the discolored areas should be massaged which helps break down the blood and often relieves the irritation.
Bruising is often accompanied by swelling (see swelling section).
Postoperative fever is a temperature higher than 102.2 F on any day after surgery or 100.4 F on any two consecutive days after surgery. Fever after surgery is very common. Postoperative fever occurs in up to 90% of people who have surgery. Most cases are harmless and go away on their own.
Fever can sometimes be a sign of something that needs to be treated such as a wound infection or pneumonia. If the fever continues or is getting worse the person should notify their doctor.
Handicap placards are not usually needed following upper extremity surgery or injury.
However, for people who require the use of a walker or two canes to ambulate an injury or a surgery to the upper extremity may limit their ability to get around. In these circumstances a temporary handicap placard may be useful.
In order to get a handicap placard a person must first go down to Satellite City Hall and request the form. The person and the doctor will each fill out their portion. The person will then bring the form back to Satellite City Hall and obtain their handicap placard.
Handicap placards given following upper extremity injury or surgery are always temporary. For people who need a permanent handicap placard, the same process should be followed working with their primary care physician (PCP).
After most surgeries non-steroidal anti-inflammatory drugs or NSAIDs are not recommended. This is because most surgeries require the body to heal. The second stage of healing is inflammation: the more inflammation the body produces following a surgery the greater the healing response. NSAIDs generally limit the inflammatory response and therefore have the potential to limit healing.
There are exceptions to this. Taking NSAIDs following surgeries that do not require deep healing is okay. Examples of such surgeries include a manipulation under anesthesia or arthroscopic release for a frozen shoulder or an arthroscopic elbow clean out.
Also people who take daily NSAIDs for other medical conditions may need to stay on the medications to maintain their general function. In these situations continuing their daily NSAID to maintaining function following surgery may be more important than a robust healing response.
Medications- Pain Medications
Opiate pain medications can be very helpful in decreasing pain following a surgery. As such, most people will be given a prescription for oral pain medication which will be taken at home. There are some important rules that must be followed when taking such medications:
- Take the medications only as prescribed by the doctor. For example if the doctor wrote to take 2 pills every 6 hours, do not take 3 pills every 6 hours or take 2 pills every 4 hours.
- Do not take other pain medication with the pain medications your doctor gave you unless approved by your doctor. For example, do not take a different type of pain pill that you had left over from a previous surgery and take the pills your doctor prescribed for the current surgery.
- Do take over-the-counter Tylenol (acetaminophen) with pain pills that already have Tylenol in it. Doing so could lead to an overdose of Tylenol and damage to the liver.
- Do not drive a car or operate any machine while taking pain medication. This is dangerous and illegal.
- Pain medications should be stopped by the 5th day after surgery. This means that if a person had surgery on a Wednesday, they should stop taking their pain medication by Monday at the latest. Staying on pain medications longer than this greatly increases the chances of the surgical repair failing.
- Pain medications have side-effects. If you think you are having a side-effect from the medication given, you should notify your doctor.
- There are different types of pain medications. People respond to the different medications in different ways. If a person finds the medications given are not working well for them then they should notify their doctor. Often changing the pain medication to another type will offer more relief.
Tylenol or acetaminophen can be a helpful medication following surgery. It is not considered an NSAID and therefore does not disrupt healing. There are a couple of rules that must be followed when taking Tylenol:
- Tylenol has side-effects and should only be taken if your primary care physician says it’s okay for you.
- Do not take more than the amount allowed that is written on the bottle.
- Do not take Tylenol if the pain medication given to you by your doctor already has Tylenol in it. Examples of pain medication that contain Tylenol include: Tylenol with Codeine, Percocet, Vicodin, Norco to name a few.
- Do not take Tylenol if you have liver disease unless approved by your primary care physician.
Medications- When to Resume
Most medications that a person was taking before surgery can be restarted immediately after surgery. There are important exceptions to this generalization so please talk with your doctor ahead of time.
Numbness to the skin following surgery is not uncommon and is usually not something to be concerned about. Some reasons why numbness occurs include:
- Block: Before many surgeries a person will be given a “block” in their neck or arm for pain control. This can help with the pain but also causes the nerves to the arm to “go to sleep”. The block usually last between 6 and 24 hours but it can last up to 48 hours. While the block is working the person will feel numbness. This numbness usually goes away when the block wears off.
- Skin nerves: During surgery an incision in the skin is often made. This cuts the tiny skin nerves causing the skin to become numb. This is normal and to be expected. This type of numbness usually resolves itself over time (up to a year).
- Nerve irritation: When performing a surgery deep nerves often need to be protected by moving them out of the way. This can cause the nerve to become irritated and go to sleep causing numbness to the skin and weakness to muscles. Nerve irritation is not uncommon. Over time the nerve almost always calms down and the numbness and weakness go away.
- Nerve injury: On very rare occasions a deep nerve may be injured or even cut. When this happens numbness and weakness will occur. Often a second surgery is needed to repair the nerve. In these situations, return of normal skin sensation and strength does not always occur.
- Carpal tunnel: Occasionally swelling to the hand following an upper extremity surgery can lead to a new onset of carpal tunnel syndrome or a worsening of pre-existing carpal tunnel syndrome. If this occurs the person may note numbness to the thumb, index, long and part of the ring finger.
- Ulnar nerve irritation from a sling: Often following an upper extremity surgery the arm will be kept in a sling. This can sometimes cause irritation of the ulnar nerve at the elbow. When this happens the person may feel numbness to the pinky and ring fingers.
- Neck: Nerves leaving the neck can get irritated. This can occur either from the position of the neck during surgery or from the position of the neck during therapy. When this happens the skin of the shoulder and/or arm and/or hand can become numb.
Physical Therapy- Existing Therapist
After surgery a person may request to do the post-operative therapy with their previous therapist. While this is often okay, sometimes it is best to work with a specialized therapist who know the exact protocols that are requested by the surgeon. Often this therapist and the surgeon have a close working relationship and are in constant contact with each other. In these circumstances, working with such a therapist usually improves the person’s chance of doing well from surgery.
Recovery after Surgery
Recovery following a surgery has two main components: a return of function and a decrease in pain. How long it takes to recover from surgery depends on the person’s meaning of the word “recovery”:
- Recover from anesthesia: Most shoulder or elbow surgery is done under “general anesthesia”. This means that the person is asleep during surgery. Generally a person will regain normal thinking 1 to 2 hours after surgery. At this point they will be released to go home or sent up to their hospital room. It usually takes 1 or 2 days before they will stop feeling “hazy”.
How long a person feels the effects of anesthesia vary from person to person. Heavy people take longer to recover. Also, the longer the surgery the longer the effects of anesthesia will last.
- Recover function: How long it takes to recover normal function following a shoulder or elbow surgery varies with the individual and with the surgery. Healthy people recover function faster than frail people. People who had a small surgery recover function faster than people who have had larger surgeries.
On average people will take 3 to 4 months or so after surgery to recover “normal” function.
- Recover completely: People will continue to improve their function and have a decrease in their pain following a shoulder or elbow surgery for up to 1 1/2 years.
Recovery after Surgery- Home Health Care
Most upper extremity surgeries do not require a person to obtain help with home health care. Even with restricted use of the operative arm, almost everybody is able to continue living independently following surgery.
On occasion, a circumstance may arise where the person feels that they need home health care to maintain independent living. In these circumstances, the person will be given the contact of the hospital’s social worker/case manager who will work with the person to see if their insurance plan will cover the costs. Unfortunately, the answer to this question is often “no”.
If the insurance company will not cover the cost and the person would like to spend their own money to acquire home health care, the social worker/case manager will often help them find the appropriate care.
Sleep- Night Pain
Pain at night following shoulder surgery is very common. It occurs because the shoulder tightens up during sleep. Once it gets to a certain point it begins to hurt and wakes the person up.
The solution for night pain is to recognize that pain is the shoulder’s way of asking the person to stretch it. So, in order to give the shoulder what it wants, the person should do their stretches right before they lay down to sleep. Every time the shoulder wakes the person up with pain, the person should do their stretches again. The next day the shoulder will be looser than it was the day before. The next night the period of time that the shoulder allows the person to sleep should be longer than the night before. If the person keeps this up, very soon the person will be sleeping through the night.
Sleep- Sleeping Positions
Many people will have trouble finding a comfortable sleeping position following shoulder surgery. It is up to the person to experiment with different sleeping positions to find what works for them. While they are doing this, it is important that they follow any shoulder precautions given.
Sleeping on the surgical side is usually okay. The person should let pain be their guide.
Some people find the only way they can sleep is in a recliner chair. Care needs to be taken to follow the given precautions getting in and out of the chair.
Most people resume normal sleeping patterns and positions by the 6 week mark after surgery.
Swelling to the hand following a shoulder/elbow surgery or injury is common. It is to be expected and is usually of no consequences.
The only time swelling is of concern is when it stops the hand from making a tight fist. When this happens the hand and wrist can become stiff and painful. An early hand/wrist stretching program is started at the first sign of swelling can prevent this stiffness.
While swelling can take months to go away, usually it resolves in a matter of weeks.
Wound- Bandage Removal
You may remove your bandage two days after your surgical date (for example, if you have surgery on Wednesday, you may remove your bandage on Friday). There are strips of tape (steri-strips) underneath the bandage. Please leave them on your skin until they fall off naturally, which can take up to 4 to 6 weeks.
There may also be small strings (that look like fine fishing line or a straight hair) coming out of the skin. Leave these alone. They will be removed on the first post operative visit.
Bathing or submerging the wound under water should not occur until 2 weeks after surgery. After the 2nd week, bathing, going in a hot tub or entering the ocean are okay. Showering and getting the wound wet with soap and water can begin on the 3rd day after surgery.
Whether drainage from the wound is okay or not depends on when it occurs.
During the first week following surgery drainage from the wound is normal and to be expected. Drainage during this period is usually only worrisome if it drains in large amounts.
Drainage after the first week usually means the wound is having trouble closing. This could be from a stitch, or from a superficial infection. Usually this is treated with local antibiotics and sometimes oral antibiotics.
Sometimes wound drainage means a deep infection. Deep infections usually happen after the first week. The drainage is in large amounts and does not get better with time. Surgery to address the deep infection is usually needed.
Redness about the wound is usual during the first 2 weeks. There are times when the redness can be concerning:
- If the redness is getting worse -not better.
- If the redness is associated with drainage after the first week.
- If the person has a fever after day 2 or 3 or feels run down or has chills.
- If the person has increased pain at the incision site.
You may take a shower and get the wound wet 3 days after your surgical date (for example, if you have surgery on Wednesday, you may shower and get your wound wet on Saturday). If you would like to shower prior to this day, please keep the bandage covered and dry. Do not submerge your wound under water until 2 weeks after the date of surgery.
Wound- Stitch and Staple Removal
Stitches and staples are used to hold the edges of the wound closed. Stitches are usually taken out 2-5 days after surgery. Staples are usually taken out 10-14 days after surgery.