INSTRUCTIONS FOR SURGERY › pdf › open-elbow... · Open Elbow Surgery, Golfers Elbow Surgery Day...

Laith M Jazrawi, MD

Professor of Orthopedic Surgery Chief, Division of Sports Medicine T 646-501-7223

NYU Langone Orthopedic Center 333 E 38th St, New York, NY 10016 T 646-501-7223 F 646-754-9505 www.NewYorkOrtho.com

INSTRUCTIONS FOR SURGERY Inordertomakeyouradmissionandhospitalstaysmoothandmorepleasant,pleasecomplywiththefollowinginstructions:

c IfyoursurgeryisonMONDAY,pleasereportto:

NYULangoneOrthopedicHospital301East17thStreetNewYork,NY10003

Ifindicatedbyyourphysician,scheduleyourpre-surgicaltesting,locatedat

3032ndAvenue,1stFloorSuite16

NewYork,NY10003

c IfyoursurgeryisonFRIDAY,pleasereportto:

NYULangoneOutpatientSurgeryCenter339East38thStreetNewYork,NY10016

Ifindicatedbyyourphysician,pleasecall212-263-5985toscheduleyourpre-surgicaltesting,locatedat

240East38thSt.

NewYork,NY10016MezzanineLevel

*Onebusinessdaypriortoyoursurgery,hospitalstaffwillcontactyoutofinalizeyoursurgerytime.

A. Bringjogging/warm-uppants,shorts/skirtifhavingkneesurgery.

B. Bringashirt/blousethatbuttonsopeninfrontinsteadofapulloverifhavingshoulder/elbowsurgery.

C. Ifyouowncrutches,bringthemwithyou,ifhavingknee,ankleorhipsurgery.

D. Bringallmedicationsoralistofcurrentmedicationsyouaretakingwithyou.Alsobringalistofany

allergies.

E. Bloodpressuremedicationshouldbetakenasusualwithasipofwaterthemorningofsurgery.DONOTtakeadiureticorfluidpill.Seizuremedicationsmaybetakenbeforesurgery.

F. DONOTtakeoraldiabetesmedications(pills)thenightbeforeorthedayofsurgery.Ifyouareoninsulin,DONOTuseinsulinthemorningofsurgeryunlessyouarea"problemdiabetic"inwhichcaseyouneedtoconsultyourphysicianregardingtheproperinsulindoseforyoutousepriortosurgery.

Laith M Jazrawi, MD



G. PleaseDONOTwearmakeupornailpolishthedayofsurgery.Youwillneedtoremovecontactlens

(includingextendedwear),denture,orbridgespriortosurgery.Pleasebringyourowncontainersforstorage.

H. Leavealljewelryandvaluablesathome.Thehospitalwillnottakeresponsibilityforlostormissingitems.

I. Youneedtoreportanyskinirritation,fever,cold,etc.,toDr.Jazrawi.

J. Youwillneedtobringyourinsurancecard/informationwithyou.

K. DONOTeat,drink(includingwater),chewgum,candy,smokecigarettes,cigars,usesmokelesstobacco,etc.,aftermidnightthenightbeforesurgeryorthemorningofyoursurgery.Theonlyexceptionisasipofwatertotakenecessarymedicationsthemorningofsurgery.

L. Youmustarrangesomeonetodriveyouhomewhenreadytoleavethehospital.Youwillnotbeallowed

todriveyourselfhomeaftersurgery.Wecanassistyouifyouneedtransportationtotheairportorhotel,however,youneedtoletusknowinadvance(ifpossible)sowecanmakethearrangement.

M. NOTE:DONOTtakeanyaspirin,aspirinproducts,anti-inflammatories,CoumadinorPlavixatleast5days

priortosurgery.YouareallowedtotakeCelebrexuptoyourdayofsurgery.Ifyourmedicaldoctororcardiologisthasyouonanyoftheabovemedications.Pleasecheckwithhim/herbeforediscontinuingthemedication.YoumayalsotakeTylenolorExtra-StrengthTylenolifneeded.

NonsteroidalAnti-Inflammatory(Arthritis)Medications:

SomeofthemostcommonnamesforfrequentlyusedNSAID'sinclude:Motrin,Indocin,Nalfon,Naprosyn,Naprelan,Arthrotec,Tolectin,Feledene,Voltaren,Clinoril,Dolobid,Lodine,Relafen,Daypro,Advil,Aleve,Ibuprofen.Yourfirstfollowupappointmentisusuallyscheduledforapproximately2weeksafteryoursurgeryatthe333East38thstreetoffice.Thedateandtimeofyourfollow-upis__________________________.Ifyoucannotmakethisappointmentorneedtochangethetime,pleasecontacttheoffice.Ifyouhaveanyquestionsregardingyoursurgery,pleasecontacttheofficeat646-501-7223option4,option2orviatheinternetatwww.newyorkortho.com

Laith M Jazrawi, MD



Home Supplies For Your Surgery Laith M Jazrawi, MD

OpenSurgery

A. Openkneesurgery(ACLreconstructions,ALL(Anterolateralligament)reconstructions,AutologousChondrocyteImplantation,PCLreconstructions,Hightibialosteotomy,Distalfemoralosteotomy,

Posterolateralcornerreconstruction,MCLreconstruction,OATS(osteochondralautograft),Osteochondral

allograft,)

a. Youwillneed4x4(orsimilarsize)waterproofbandagesforfourteendays.Bandagechangesforopenkneesurgerydonepost-opday#3.

B. Openshouldersurgery,(BicepsTenodeis,Latarjet,Opencapsulorrhaphy,GlenoidreconstructionusingDistaltibialallograft):

a. Youwillneed4x4(orsimilarsize)waterproofbandagesforfourteendays.Also,aboxofBandagechangesforopenshouldersurgeryaredonepost-opday#3.

C. OpenAnkleSurgery(AchillesTendonRepair,OsTrigonumExcision,AnkleOCD,ModifiedBrostrom-GouldProcedure,PeroneusLongus/BrevisRepair)-Youdonothavetoworryaboutdressingchangesas

yourlegwillbeinsplint/castforthefirsttwoweeks

D. OpenElbowsurgery(DistalBicepsRepair,LCLReconstruction,RadialHeadorCapitellumORIF,RadialHeadReplacement/Resection,TricepsRepair,UCLReconstruction–TommyJohnSurgery)-Youdonot

havetoworryaboutdressingchangesasyourarmwillbeinsplint/castforthefirsttwoweeks.ForTennis

Elbowsurgery(lateralepicondylitis)andGolfer’sElbowSurgery(medialepicondylitis),dressing

changesarearestartedonpost-opday#3.Youwillneed4x4(orsimilarsize)waterproofbandagesfor

fourteendays.

E. HamstringrepairYouwillhaveaspecialdressingplacedonatthetimeofsurgerythatwillbekeptonforthefirst2weeksaftersurgery.Youwillthenneed4x4(orsimilarsize)TegadermorTelfa

waterproofdressings.Also,aboxof4"by4"gauzespongesifthereisbleedingattheincisionsite.

ArthroscopicSurgery

A. ForArthroscopicshoulder,elbow,knee,oranklesurgery:a. Regularadhesivebandages(“Band-aids”)canbeusedforarthroscopicportalsx2weeks.

b. Ifbicepstenodesiswasperformed,use4x4(orsimilarsize)waterproofbandagesonwounds.

c. Ingeneral,dressingchangesforarthroscopyaredoneonpostoperativeday3

Laith M Jazrawi, MD



Post-Operative Medication Administration

Knee Arthroscopy

• Pain- Motrin 800mg. 1 tab three times daily, as needed • Adjunctive pain: Percocet (Oxycodone/Acetaminophen) 5/325 (5 tabs); One tab every 6 hours as

needed for adjunctive pain* Meniscal Repair, Meniscal Root Repair

• Pain- Percocet (Oxycodone/Acetaminophen)10/325; One tab every 6 hours as needed* • Constipation – Docusate (Colace) 100mg; 1 tab twice daily as needed. • DVT prophylaxis- Aspirin 81mg; 2 tabs daily x 14 days • ****** Aspirin starts post-operative day #1

Knee Ligament Reconstruction

• Pain- Percocet (Oxycodone/Acetaminophen) 10/325; One tab every 6 hours as needed* • Antibiotic – Keflex 500mg; One tab 4 times daily x 4 days

o Keflex allergy – Clindamycin 300mg; One tab twice daily x 7days. • Constipation – Docusate (Colace) 100mg; 1 tab twice daily as needed (Max 3 tabs) • DVT prophylaxis- Aspirin 81mg; 2 tabs daily x 28 days • *****Antibiotics and Aspirin starts post-operative day #1

Non-weight bearing Lower Extremity Surgery (Distal Femoral Osteotomy, High Tibial Osteotomy, Tibial Tubercle Osteotomy, Cartilage Transplant)

• Antibiotic – Keflex 500mg; One tab 4 times daily x 4 days o Keflex allergy – Clindamycin 300mg; One tab twice daily x 7days.

• Pain- Percocet (Oxycodone/Acetaminophen) 10/325; One tab every 6 hours as needed* • Constipation – Docusate (Colace) 100mg; 1 tab twice daily as needed (Max 3 tabs) • DVT prophylaxis- Aspirin 81mg; 2 tabs daily x 28 days • ******Antibiotics and Aspirin starts post-operative day #1

Shoulder/Elbow Surgery


• Pain- Percocet (Oxycodone/Acetaminophen)10/325; One tab every 6 hours as needed* • Constipation – Docusate (Colace) 100mg; 1 tab twice daily as needed.

Laith M Jazrawi, MD



Ankle fracture surgery & Achilles Tendon Surgery


• Pain- Percocet (Oxycodone/Acetaminophen)10/325; One tab every 6 hours as needed* • Constipation – Docusate (Colace) 100mg; 1 tab twice daily as needed. • DVT Prophylaxis - Aspirin 81mg; 2 tabs daily x 28 days • ****Antibiotics and Aspirin starts post-operative day #1

Ankle arthroscopy +/- Microfracture

• Pain- Percocet (Oxycodone/Acetaminophen) 10/325; One tab every 6 hours as needed* • DVT Prophylaxis - Aspirin 81mg; 2 tabs daily x 14 days • ****Aspirin starts post-operative day #1

Hamstring repair


• Pain- Percocet (Oxycodone/Acetaminophen)10/325; One tab every 6 hours as needed* • Constipation – Docusate (Colace) 100mg; 1 tab twice daily as needed. • DVT Prophylaxis - Aspirin 81mg; 2 tabs daily x 28 days • ****Antibiotics and Aspirin starts post-operative day #1

* No refills of narcotic pain medication will be given. You must transition to over the counter Aleve or Motrin after your initial course of narcotic pain medication is completed. If you have any stomach issues you may transition to Extra Strength Tylenol instead.

*** HIGH RISK DVT Patients – patients on oral contraceptives, smokers, or history of previous DVT or embolus

• Will receive o Xeralto (Rivaroxaban) 10mg; 1 tab daily x 14 days o Followed by aspirin 81mg; 2 tabs daily x 14 days

Laith M Jazrawi, MD



Post-Operative Instructions Open Elbow Surgery, Golfers Elbow Surgery

DayofSurgery

A. Dietastolerated.B. Painmedicationasneededevery6hours.C. Icingisimportantforthefirst5-7dayspost-op.Whilethepost-opdressingisinplace,icingshouldbedone

continuously.Oncethedressingisremovedonthefirstorsecondday,iceisappliedfor20-minuteperiods3-4timesperday.Caremustbetakenwithicingtoavoidfrostbite.

D. Ifyouhaveasplintorhalfcast,youwillstartPTafterthesplintisremovedintheofficeatyourfirstpostoperativeappointmentwhichisusuallyat2weeks

FirstPost-OperativeDay

A. ContinueicingB. Youwillneedtokeepyourincisiondrywhentakingashower.Dothisforabout2weeksaftersurgery.If

youhaveasplintorhalfcast(hardshell)leaveitdry.Noneedtododressingchangesuntilyourfirstfollow-upvisitat2weekspost-op.

SecondPost-OperativeDay

A. ContinueicingThirdPost-OperativeDayUntilReturnVisit

A. Continueicepackasneeded.B. Ifyoudon’thaveasplitorhalfcast,youmayremovesurgicalbandageafteryoushowerandapplya

waterproofbandage(maybepurchasedatyourlocalpharmacy)tothewounds.Pleaseensurethatthebandageislargeenoughtocompletelycovertheincision.Applyafreshwaterproofbandageaftereachshower.Ifyouhavesplintyoudonotneedtochangeanything.Keepextremitydry

Callouroffice@646-501-7223option4,option2toconfirmyourfirstpostoperativevisit,whichisusuallyabout1-2weeksaftersurgery.Ifyouareexperiencinganyproblems,pleasecallourofficeorcontactusviatheinternetatwww.newyorkortho.com.

Laith M Jazrawi, MD



Post-Operative Rehabilitation Following Golfers Elbow Surgery

Name: Date:

Diagnosis: DateofSurgery:

PhaseI–Days1-7

• Goalso Improve/regainofrangeofmotiono Retardmuscularatrophyo Decreasepain/inflammation

• Day1-7o Movementofwristandfingersfor2minutes

§ 3-5x/dayo IceandNSAIDsusedforpaincontrolo Lookforsignsofwoundinfection:

§ Excessiveswelling,warmth,redness,oozingfromtheincision,fevero Day3:Showeringisallowed,withbandagesoffo Gentlepain-freeelbow,wristandshoulderROMisstartedo Compression/ice4-5timesdaily

• Day7-17o MoreaggressiveROMencourageinandoutofshowero Goalforday17are80%ofnormalelbowROMo Resumelightelbowactivitiesonlyo continueisometricsandgrippingexerciseso continueuseofice

• Day18-21o Submaximalisometricsarestartedo Beginantigravitywristflexion,extension,supinationandpronationwithoutpain

§ Ifpainful:utilizecounterforcebraceduringexerciseo Oncepatientcanperform30repswithoutpaintheycanprogresstoa1-poundweightorlight

resistanceband.§ Allexercisesareperformedwiththeelbowbentto90⁰andrestingonatableorlower

extremityo Overpressureintoextension(3-4timesdaily)o Continuejointmobilizationtechniqueso Biceps,triceps,wristflex/ext,sup/pronatorso Continueuseoficepost-exercise

Laith M Jazrawi, MD



PhaseII–IntermediatePhase

• Goalso Increaserangeofmotiono Improvestrength/power/enduranceo Initiatefunctionalactivities

• Week3to6o Therapeuticexercises:

§ Rotatorcuff,elbowandscapularstabilizationtrainingwithlightresistance§ Aerobicconditioningonstationarybikeortreadmill

o Overpressureintoelbowextensiono ContinuePREprogramforelbowandwristmusculatureo Initiateshoulderprogram(Thrower’sTenShoulderProgram)o Continuejointmobilizationo Continueuseoficepost-exercise

PhaseIII–AdvancedStrengtheningProgram

• Goalso Improvestrength/power/enduranceo Gradualreturntofunctionalactivities

• CriteriatoEnterPhaseIIIo Fullnon-painfulROMo Nopainortenderness

• Week8to12o ContinuePREprogramforelbowandwristo Continueshoulderprogramo Continuestretchingforelbow/shouldero InitiateIntervalprogramandgraduallyreturntosportingactivitieso Patientisallowedtoreturntoathleticsoncetheirgripstrengthisnormal.

Comments:

Frequency: timesperweek Duration: weeks

Signature: Date:

Laith M Jazrawi, MD



PHYSICALTHERAPYLOCATIONS**Pleasescheduleyourpost-operativephysicaltherapyappointmentsBEFOREyoursurgery**

ManhattanSportsandManualPhysicalTherapy

10East33rdStreet,2ndFloorNewYork,NY10016(646)487-2495www.msmpt.com

NYULangoneOrthopedicCenterPT

333E38thSt,5thFloorNewYork,NY10016(646)501-7077

OtherLocations:BROOKLYN R.P.T.PhysicalTherapy�

335CourtStreet� CobbleHill 11231

(718)855-1543

OneonOnePT 2133RalphAve� Flatlands 11234 (718)451-1400OneonOnePT 17EasternParkway ProspectHeights 11238 (718)623-2500OneonOnePT 99204thAve� BayRidge 11209 (718)238-9873OneonOnePT 1390PennsylvaniaAve Canarsie 11239 (718)642-1100OneonOnePT 1715AvenueT SheepsheadBay 11229 (718)336-8206MANHATTAN-DOWNTOWN

HealthSOS� 594Broadway� NewYork 10012 (212)343-1500Occupational&IndustrialOrthopaedicCenter

63DowningStreet

NewYork

10014 (212)255-6690

Promobility� 401Broadway NewYork 10013 (646)666-7122MANHATTAN–EASTSIDE HarknessCenterforDance(PTService)

614SecondAve NewYork 10003 (212)598-6054

RUSKattheMen'sCenter�� 555MadisonAve NewYork

10022 (646)754-2000

RUSKPhysicalTherapy� 240E.38thStreet NewYork

10016 (212)263-6033

STARPhysicalTherapy� 160E.56thStreet NewYork 10022 (212)355-7827

Laith M Jazrawi, MD



TherapeuticInspirations 144E.44thSt NewYork

10017 (212)490-3800

MANHATTANUPPEREASTSIDE

HealthSOS� 139E.57thStreet NewYork 10022 (212)753-4767PremierPT�� 170E.77thStreet NewYork 10021 (212)249-5332RuskPTatWomen'sHealthCenter

207E.84thStreet NewYork

10028 (646)754-3300

SPEARPT 120E.56thStreet NewYork 10022 (212)759-2211SportsPTofNY� 1400YorkAve NewYork 10021 (212)988-9057MANHATTANUPPERWESTSIDE

PremierPT� 162W.72ndStreet NewYork 10023 (212)362-3595SportsPTofNY� 2465Broadway NewYork 10025 (212)877-2525MANHATTANWESTSIDE SportsMedicineatChelsea 22West21stStreet

Suite400NewYork 10010 (646)582-2056

ChelseaPhysicalTherapy&Rehabilitation

119W.23rdStreet NewYork

10011

(212)675-3447

SPEARPhysicalTherapy 36W.44thStreet NewYork 10036 (212)759-2280QUEENS ErgoPhysicalTherapyP.C.�

107-40QueensBlvd

ForestHills

11375

(718)261-3100

SusanSchiliro,PT(Hand&UpperExtremityonly)

99-3266thRoad RegoPark 11374 (718)544-1937

STATENISLAND OneonOnePT 31NewDorpLane

1st,FloorStatenIsland

10306

(718)979-4466

OneonOnePT 33RichmondHillRd

StatenIsland

10314 (718)982-6340

LONGISLAND HealthSOS� 375DeerParkAve Babylon� 11702 (631)321-6303

Laith M Jazrawi, MD



HandinHandRehabilitation(Hand&UpperExtremityonly)�

346WestburyAve�

CarlePlace�

11514 (516)333-1481

HomePTSolutions 111W.OldCountryRd.

Hicksville 11801 (516)433-4570

Bi-CountyPhysicalTherapy&Rehabilitation

270-03HillsideAve

NewHydePark

11040 (718)831-1900

Bi-CountyPhysicalTherapy&Rehabilitation

397WillisAve WillistonPark

11596 (516)739-5503

WESTCHESTER HealthSOS� 1015SawMillRiver� Ardsley 10502 (914)478-8780PremierPT� 223KatonahAve� Katonah 10536 (914)232-1480PROSportsPTofWestchester

2OverhillRoad� Scarsdale�

10583

(914)723-6987

WestchesterSportsPhysicalTherapy,PC

672WhitePlainsRoad�

Scarsdale�

10583 (914)722-2400

RyePhysicalTherapyandRehabilitation

411TheodoreFremdAve

Rye 10580 (914)921-6061

RyePhysicalTherapyandRehabilitation

15NorthBroadway;SuiteK

WhitePlains

10601 (914)686-3132

CONNECTICUT PremierPT 36OldKingsHwyS Darien 06820 (203)202-9889NEWJERSEY JerseyCentralPhysicalTherapy&Fitness�

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JagPT 34MountainBlvd Warren� 07059 (908)222-0515JagPT 622EagleRockAve West

Orange07052 (973)669-0078

INSTRUCTIONS FOR SURGERY › pdf › open-elbow... · Open Elbow Surgery, Golfers Elbow Surgery Day...

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Transcript of INSTRUCTIONS FOR SURGERY › pdf › open-elbow... · Open Elbow Surgery, Golfers Elbow Surgery Day...