Microsoft word - bankart post-op instructions.docx

Bankart Repair Post-Op Instructions Missouri Orthopaedic Institute Bankart Repair Post-Operative Instructions
Seth L. Sherman, M.D.
Tamara L Young, ATC, OTC, M.Ed
Department of Sports Medicine
Ø Anesthetic drugs used during surgery may cause nausea for the first 24 hours. If nausea is encountered, drink only clear liquids and light food (jello, soups, dry crackers, toast). If nausea and vomiting becomes severe or the patient shows signs of dehydration (lack of urination), please call for further instructions. Ø If you are not nauseated please progress to a normal diet as tolerated.  
WOUND CARE
Ø After arthroscopy the wound is covered with sterile dressing. Loosen bandage only if significant swelling Ø It is normal for the shoulder to bleed and swell following surgery – if blood soaks onto the bandage, do not become alarmed – reinforce with additional dressing. If bright red blood persists despite icing and elevation, please call for further instructions. Ø Remove surgical dressing on the third post-operative day – if minimal drainage is present, apply band-aids over incisions and change daily. Do NOT remove the paper strips or cut any of the visible sutures. Ø To avoid infection, keep surgical incisions clean and dry – you may shower by placing a large garbage bag over your shoulder starting 48 hours after surgery – NO immersion of operative shoulder (i.e. bath, hot tub, sauna, or pool). Alternatively, you may choose to sponge bath after 48 hours. Do NOT apply ointments to the incisions.  
ICE THERAPY
Ø Begin ice machine immediately after surgery. Icing is very important for the first 5 to 7 days post Ø While initial post operative dressing is in place, icing should be continuous. Once the dressing is removed on the 3rd day, ice should be applied for 20 minute periods, 4 to 6 times a day. Ø Remember to keep shoulder/arm elevated during icing. Care must be taken with icing to avoid frost bite to the skin. Do NOT apply ice directly to the skin.  
MEDICATIONS
Ø Pain medication is injected into the wound and shoulder joint during surgery – this will wear off Ø Anesthesia has most likely administered a regional block to make your arm numb during surgery. As the block wears off, you should begin to take oral pain medication as prescribed. Ø Most patients will require some narcotic pain medication (Norco, Percocet, Vicodin) for a short period of time – this can be taken as per directions on the bottle. Ø In most cases we will also prescribe Tramadol (Ultram, Ultracet), which is a non-narcotic pain medication. This medication works well and is safe to take along with your narcotic pain medication. If you have not been prescribed Tramadol, it is either because you are allergic or it interacts with your daily medications. Ø It is not uncommon for patients to encounter more pain on the first or second day after surgery. This is the time when swelling peaks. Using the pain medication as prescribed will help control pain with little risk of complication. Please avoid Tylenol while taking narcotic pain medications. If you need additional pain relief, you may take ibuprofen 600 mg (3 Advil or Over the Counter Tablets) three times a day. Remember, Bankart Repair Post-Op Instructions Missouri Orthopaedic Institute you must avoid anti-inflammatories (Ibuprofen) if you are on blood thinners or have a history of gastric ulcers. Ø Common side effects of the pain medication are nausea, drowsiness, and constipation – to decrease the side effects, take medication with food, drink lots of fluids and follow a high fiber diet – if constipation occurs, consider taking an over-the-counter laxative (colace or senakot) Ø If you are having significant problems with pain control, nausea/vomiting, or constipation, please contact Ø You should resume your normal medications for other conditions the day after surgery, unless instructed Ø Do not drive a car or operate machinery while taking the narcotic medication. Driving while under the influence of narcotic pain medication is dangerous and discouraged in all patients.
ACTIVITY
Ø When sleeping or resting, incline positions (ie reclining chair) and a pillow under the forearm may provide better comfort while decreasing swelling. Elevate the operative shoulder/arm whenever possible to decrease swelling Ø Wear immobilizer with abduction pillow except when doing exercises unless indicated by physician Ø Do not engage in activities which increase shoulder pain/swelling over the first 7-10 days following surgery (ie lifting or any repetitive shoulder activities). Ø NO driving until instructed otherwise by physician Ø May return to sedentary work (non-operative arm ONLY) or school 3-4 days after surgery, if pain is  
EXERCISE
Ø Begin shoulder post operative home exercise program 24 hours after surgery unless otherwise instructed Ø Discomfort and shoulder stiffness is normal for a few days following surgery – it is safe and, in fact, preferable to move your shoulder as demonstrated in the exercises. Ø Complete exercises 3-4 times daily until your first post-operative visit Ø Formal physical therapy (PT) will begin after your first post-operative visit if needed Ø DVT Prophylaxis: It is extremely uncommon to develop blood clots after shoulder surgery. Unless specified, we do not routinely recommend medication for DVT prophylaxis. We encourage early ambulation to improve venous blood flow to further limit this risk.  
EMERGENCIES**
Contact Dr. Sherman or Tammy at 573-884-4767 if any of the following are present:
Ø Painful swelling or numbness Ø Unrelenting pain Ø Fever (over 101° - it is normal to have a low grade fever for the first day or two following surgery) or chills Ø Redness around incisions Ø Color change in shoulder or arm Ø Continuous drainage or bleeding from incision (a small amount of drainage is expected) Ø Difficulty breathing Ø Excessive nausea/vomiting **If you have an emergency after office hours or on the weekend, contact the after hours number (573-882-4141)
and you will be connected to our orthopaedic surgeon on call or Dr. Sherman.
**If you have an emergency that requires immediate attention, proceed to the nearest emergency room.

FOLLOW-UP CARE/QUESTIONS
You will follow up in our office in 7 – 10 days after your surgery. At this time the sutures will be removed. Your
progress will be evaluated. You will be asked to continue your home exercise program or begin organized physical
therapy.
For questions or concerns prior to your post op visit you may contact Tammy at 573-884-4767 or email at
youngtl@health.missouri.edu. If you get her voicemail please leave a message and she will return your call as soon
as she can.

Source: http://www.mizzousportsdoc.com/wp-content/uploads/2012/06/Bankart-Post-Op-Instructions.pdf