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Pre-operative Instructions:
 Do not eat or drink anything after midnight the night before your surgery.
 Please discontinue aspirin five days prior to your surgery when possible to minimize  Please discontinue the use of anti-inflammatory medicines such as Motrin®, Aleve®, Advil®, and Ibuprofen 10 days before your surgery, if possible, to minimize bleeding.  You may take anti-inflammatory medicines such as Celebrex®, Mobic®, or Bextra® prior to surgery because these medicines do not affect your bleeding time or clotting capability.  If you take a diet medication that contains phentermine (Adipex®) you must discontinue use of it three weeks prior to surgery.  Please discontinue the use of any herbal supplements two weeks before your surgery to minimize anesthetic risks. Some herbs are biologically very important. The following specific herbs should definitely be discontinued prior to surgery: valerian, echinacea, ephedra, ginkgo, kava, garlic, ginseng, and St. John’s wort.  Anesthesia: The type of anesthesia used is between you and the anesthesiologist. Local anesthesia alone is not recommended for most patients due to inadequate pain control during the procedure.  If you are over the age of 55 or have any significant medical problems such as hypertension, diabetes, or heart disease, please contact your primary care physician to discuss what your risks may be of sustaining a medical complication during or after surgery. We will be happy to refer you for a pre-operative medical consultation when necessary as well.  Make certain that you arrange for someone to drive you home the day of surgery
Surgery:
 Surgery is done very effectively as an outpatient/inpatient depending on your
 Surgical time is usually between one to three hours after induction of anesthesia, positioning, and sterilely preparing the operative shoulder.  A sling or crutches will be provided to you on the day of surgery by the hospital or  Time in the recovery room immediately after surgery is usually between one and two
Post-operative Instructions:
 Pain is significant but manageable with narcotic pain medications for the first few
days. Narcotic pain medications may be necessary for up to four weeks for the
average person. You may also take anti-inflammatory medicines with the narcotic
medicines after surgery. Be aware that use of narcotic pain medication may
cause constipation. You may use over-the-counter stool softeners or laxative
as needed. Drinking large amounts of fluids will help with this as well.
 Pain control: Pain is usually controlled by the combined use of a cooling device, narcotic medication, anti-inflammatory medication, and sometimes a pain pump. The typical medicines prescribed depend on the surgical procedure performed. As soon as you feel discomfort at home, the numbing shot in your shoulder (nerve block) or leg is beginning to wear off. At that time you should take the pain medicine even if the pain is not severe. Even if your surgery is accomplished arthroscopically, you can expect significant pain the first few days after surgery. It is better to take the pain medicines as prescribed to minimize discomfort. You may also take anti-inflammatory medicines (Aleve®, Advil®, Ibuprofen) but not Tylenol® because your narcotic medications already contain Tylenol®.  Showering: You may bathe 48 hours after surgery but please keep the bandages on and your surgical area dry. (Use a plastic bag or plastic wrap or bathe in a bathtub).  Sling/crutches: A sling or crutches may be necessary for up to three to six weeks after your surgery depending on the extent of your surgery and the recommendations of your physician. It is very important to remain in the sling or use your crutches at all times until further instructed by your surgeon.  Icing: Postoperatively, an ice bag can be placed on top of the dressing and is recommended to reduce swelling, decrease pain, and decrease inflammation. After the first 48 hours, it is no longer necessary to use this continuously but only as needed for pain and swelling.  Driving time: Driving may be accomplished when you are no longer taking narcotic pain medications. As long as you wear your sling as instructed by your doctor and are no longer taking narcotics, you may drive if you are comfortable doing so. Driving with automatic transmission (as compared to manual transmission) is recommended. Most people do not drive after the surgery for at least 10 days.  What about bleeding? Do not be alarmed if you see some bloody drainage on the outside of your dressing. It is normal to have some bleeding, even after arthroscopic surgery. You may reinforce your dressing with additional gauze pads or wraps, but try not to remove the initial dressing until 48 hours after your surgery.  Physical therapy: Physical therapy visits will be needed twice a week for up to four months depending upon the individual. Therapy is extremely important to achieve the best result possible from surgery. We will schedule your therapy visits within the first one to two weeks after surgery.  When will I have full range of motion? The amount of time varies depending upon the individual and the type of surgery performed. Most people have full range of motion by 12 weeks after surgery.  Swelling: Significant swelling is normal for the first week after surgery.  Healing time: Recovery after any surgery takes time for the tendons to heal and time for your shoulder/knee strength to return to normal. Your skin sutures or staples are usually removed within two weeks after surgery.  Return to work: For a sedentary, desk type of job, one can generally expect to return to work in one to two weeks. Reduced hours may be necessary initially. For a moderately strenuous job one can expect to return around six to 10 weeks. For a strenuous job with no light duty available, return to work time can be up to four to six months after surgery.  Out of Work Forms: Our office does charge for completion of disability and FMLA forms, the cost is $10.00 per form. Please provide our office with any forms from work that need to be addressed. The time required to complete these forms is reduced if you answer the non-medical questions (name, address, employer information, date of injury, etc.) prior to turning them over to us. We ask that you allow our staff seven to 10 days to complete these forms.  Surgical complications: Most patients hopefully will experience no complications and enjoy a rewarding return to regular activities. However, like most surgical
procedures, post-operative complications can occur. These complications include
infection, medical complications from anesthesia, blood clots, severe loss of motion
necessitating additional surgery, re-rupture of the repair, residual pain, or nerve
injury. In the event that you have a post-operative complication and feel that
you need to go to the emergency room or are instructed to go by the on-call
physician at 803-227-8000, Dr. Holmes requests you to go to Providence
Northeast Hospital, 120 Gateway Corporate Blvd., Columbia, SC 29203.
We hope that your experience with the Sports Medicine Center of Moore Center for Orthopedics is as pleasant as possible. Dr. Holmes is board-certified by the American Board of Orthopaedic Surgery and fellowship-trained in Sports Medicine and the arthroscopic treatment of knee, shoulder, elbow, and ankle disorders. It is his ambition to return you to activities that you enjoy in the most minimally invasive manner possible utilizing both nonsurgical and surgical methods. Thank you for choosing the Moore Center for Orthopedics for your orthopedic needs. If you have any questions or concerns please contact our care team at 227-8177. Office Locations: Monday: 14 Richland Medical Park, Suite 200 Columbia, SC 29203 Tuesday and Thursday: 104 Saluda Pointe Dr., Lexington, SC 29072 Wednesday and Friday: Surgical days Hospital: Providence Hospital Northeast, 120 Gateway Corporate Blvd., Columbia, SC 29203

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