Post Operative Instructions
Open Subpectoral Biceps Tenodesis
SURGERY AND ANESTHESIA
The surgical procedure takes approximately 60-90 minutes and is done under general anesthesia. First, several small incisions are made around the shoulderjoint to accommodate the instruments.The arthroscope is attached to a camera to visualize and magnify the shoulderstructures. During the procedure, theentire shoulder is examined including all the ligaments, bones, and cartilage. Repairs and corrections are performed as necessary.A subacromial decompression is often performed along with the biceps tenodesis. This procedure is performed to alleviate pain from inflammation and/or bone spur formation. Using a shaving instrument, the inflamed tissue is removed and the bone spurs are smoothed down.An additional incision is then made in the axilla area for the biceps tenodesis and is approximately one inch in length. The torn biceps tendon is detached from its insertion site inside the shoulder and is cleaned up and reattached lower in the arm in the bicipital groove.
In most cases, anesthesia will offer to perform a nerve block prior to surgery. The purpose of the block is to help control the acute pain in the first 12-18 hours following surgery. The block is administered by the anesthesiologist in the pre-operative bay. It takes about 5-10 minutes and numbs the nerves of the operative shoulder and arm. The nerve block not only helps with post-operative pain, but also helps to decrease the amount of anesthesia needed during the surgical procedure.
Following surgery, the shoulder will be wrapped in a dressing and a special sling is placed to protect the arm. A small amount of bloody drainage on the dressing is not unusual in the first day or two. If this occurs, the dressing can be reinforced with clean 4X4 gauze and tape. The dressing is to remain in place for 48 hours and must stay completely dry. You may shower; however, the shoulder must be covered with plastic wrap before doing so. After 48 hours, you may remove the dressing down to the white tape strips that stick to the skin. These are Steri-strips and must remain in place. If the Steri-strips fall off before your first post-operative appointment, place Band-Aids over the incision sites and remaining Steri-strips. No baths, hot tubs, or swimming for 3 weeks following surgery to allow the incisions to fully close.
REST, ICE AND ELEVATION
Use an ice pack, bag of frozen veggies, or cold therapy unit for the first few days following surgery to help with pain control. Ice is helpful in reducing swelling which minimizes the requirements for narcotics. If using the Cold Therapy unit, follow the instructions given at the time of discharge and use the cooling system a minimum of 12 hours/day for the first few days. Continuous use is allowed and encouraged as long as it is not uncomfortable. Do not let the cooling pad touch the skin. There should always be a dressing or cloth between the skin and the cooling pad.Lying flat in bed will be uncomfortable for several days. Sleeping with your back elevated on several pillows can be helpful.
Shoulder surgery requires a sling for post-operative protection. The sling is to be worn for the first month following surgery. You may remove the sling to allow elbow, wrist and hand motion only. No movement at the shoulder joint. No lifting of any kind with the operative arm. You should sleep with the sling on.
You will be prescribed two medications following surgery: A pain medication and an anti-nausea medication.
- Do not drive or drink alcohol beverages while taking pain medications.
- Pain medication should be taken with food to help prevent any stomach upset. You may also take the prescribed anti-nausea medication.
- Often pain medications will cause constipation. Eat high fiber foods and increase your water intake. You may also purchase a stool softener at any pharmacy and follow the recommended directions on the bottle.
- You should resume taking your normally prescribed medications unless otherwise directed.
POST-OP APPOINTMENT AND PHYSICAL THERAPY
Your first post-operative appointment will be 7-10 days following surgery. At this appointment, we will check your incision sites to be sure they are healing properly as well as your range of motion and your overall post-operative progress. You will also be given a prescription for physical therapy to begin as soon as possible. Appointments for physical therapy should be twice a week for 3-4 months. We recommend that you call to schedule those appointments prior to surgery since physical therapy offices fill quickly.
You may resume driving a vehicle when you have stopped your narcotic pain medication and you are cleared by Dr. Novak.
Please contact the office by calling 703-810-5223 for any of the following symptoms:
- Fever greater than 101.5 degrees F for 24 hours.
- Severe pain unresponsive to narcotic medication.
- Excessive bleeding or vomiting.
- Numbness, loss of color, or coolness to touch in hand.
- Redness or swelling in the calf that does not resolve overnight.
- Difficulty breathing or shortness of breath, CALL 911.