Microsoft word - arthroscopic rotator cuff repair instructions.doc

300 Birnie Avenue, Suite 201, Springfield, MA 01107-1107 (413) 785-4666 • Arthroscopic Rotator Cuff Repair – Patient Instructions
John R. Corsetti, M.D.
Arthroscopic rotator cuff repair is a minimally invasive shoulder procedure, typically performed in a day-surgery setting using general anesthesia. In this operation, small metallic screws called suture anchors are used to reattach the torn tendon to bone. Though the technique differs favorably from the traditional open approach with reference to the incision length and postoperative pain, it is similar in that both techniques fundamentally involve reattachment of tendon to bone. As a result, patients who have undergone rotator cuff repair, with either the open or arthroscopic technique, benefit from a period of immobilization in the early postoperative period to maximize the chances for bone-to-tendon healing. The length of sling immobilization varies from three to six weeks depending on several factors, such as the quality of the repaired tendon tissue and the size and age of the tear. Your surgeon will design a rehabilitation program specific to the details of your anatomy and overall repair quality. Your specific program and rate of progress will be appropriate to the details of your particular surgical procedure. The following are general guidelines, and will often be modified to address the particulars of each repair. 1. Wounds/Dressing: Your surgical dressing will be changed prior to your departure from the surgery
center. The procedure was performed using continuous fluid irrigation. As a result, it is extremely common to experience some degree of fluid leakage from the portals for up to 72 hours. A sterile dressing should be applied to cover each wound until no drainage occurs, after which the wounds may be left open to air. The portal sites should be kept dry until two days after the sutures have been removed, and the shoulder should not be soaked in a hot tub or Jacuzzi until 10 days after surgery. Increasing drainage, cloudy drainage, or increasing redness around the portal sites should be reported to your physician. 2. Physical Therapy/Sling Use: You should schedule your first physical therapy appointment no more
than twenty-one days after surgery. Specific instructions for the physical therapist will be written on your physical therapy prescription immediately after surgery, and the prescription will be given to you before you leave the surgery center. It is critical that you bring this prescription with you to your first physical therapy appointment. Patients awake from surgery wearing a sling on their operative arm. While the arm is allowed out of the sling for prescribed physical therapy, nearly all patients are asked to remain in the sling full time, including during sleep, for a six-week period. Most patients will begin physical therapy three to six days after surgery. Physical therapy in the early days after surgery will usually include elbow and wrist motion, not shoulder motion. Shoulder exercises are generally begun after preliminary healing of the repair has occurred, usually three to four weeks after surgery. Note that these are general guidelines; each patient will have a custom rehabilitation program that addresses the specific details of his or her repair. 3. Pain Management: Patients undergoing arthroscopic shoulder surgery will usually have an interscalene
nerve block performed by the anesthesiologist prior to surgery. This nerve block greatly reduces postoperative pain for eight to 16 hours after surgery and significantly reduces the amount of oral pain medication necessary. Patients will be given prescriptions for Percocet and OxyContin to use after surgery, with the dosage printed on each bottle. Occasionally, an issue (such as an allergy or insurance issue) arises which mandates that we prescribe different medicines for postoperative pain control. These medicines should be taken as needed only for pain rather than at regular time intervals after surgery (but they may be used at regular time intervals if significant pain is present). Most patients use narcotic pain medicines for three to four weeks after surgery. All patients are tapered off medication by the six-week time point. Patients should avoid taking anti-inflammatory medications, such as Motrin, Naprosyn, and Celebrex, for the first four weeks after surgery, as these medications may retard the healing of the repair. 4. Driving: Patients should not operate a motor vehicle until they are out of their sling and have good
functional control of the extremity. This generally takes six to seven weeks from the time of surgery. 5. Return to Work: The return-to-work date is obviously highly individualized depending on the patient’s
specific work duties, availability of light duty, and particulars of his or her repair. At the conclusion of each postoperative office visit you will be given a work capacity note outlining which duties are safe for you to perform. Most patients have some work capacity, if only one-armed, by two to three weeks after surgery. Your physician will provide guidance regarding a safe level of activity. It is the responsibility of your employer to provide a work environment that adheres to the restrictions outlined. If such a work environment is not available, it is our expectation that the employer will hold the patient out of work. If an employer is willing and able to accommodate reasonable restrictions outlined by our office, patients will be released to work. 6. Questions: Dr. Corsetti, his nurse, and clinical assistant can be reached at (413) 233-1233.
Physician/physician assistant coverage is available 24 hours a day at (413) 785-4666. CLINICAL: SPORTS #118 arthro rotator cuff pt inst JRC 07-13 (CBJ)


Curriculum vitae

CURRICULUM VITAE Harrison C. Spencer, MD, MPH, DTMH Current Position: President and CEO Association of Schools of Public Health 1101 15th Street NW Suite 910 Washington, DC 20005 Telephone, Fax & e-mail: 202-296-1099 (Office tel) 202-296-1252 (Office fax) (e-mail) Home Address 2425 L Street NW Apt. 807 Washington, DC 20037 Education: Haverford College

Le miracle manichen

C’est en patience que se conçoit l’ébranlement du monde. * Cet article a été donné en conférence lors du Symposium « Mani », à Renova, Bilthoven, Hollande, le 7 mai 2005, et publié en hollandais par la Rozekruis Pers, Haarlem, dans les Actes du Colloque (septembre 2005). Introduction : Lorsqu’on parle aujourd’hui de manichéisme, on songe rarement à cet homme except

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