Message from your doctor…
Whether you or one of your family members or friends is considering biceps tenodesis, or are scheduled for surgery, I understand this can be a stressful time. You may have forgotten some of the information we discussed during our last visit, or forgot to ask me a specific question about what to expect. This site is designed to help us stay connected, and to answer some of the most common questions patients ask me about shoulder biceps tenodesis.
I want to make sure that both you and your family members have timely information at your fingertips during the days, weeks, and months following your surgery…so you can get back to enjoying the activities you love.
You will receive your prescription for pain medication before you leave the surgery center. Please take the medication(s) as directed. After the first day or two, as the pain lessens, you may decrease the frequency with which you take the medication. Remember, the medications are not necessarily meant to completely eliminate your pain, only to make it more bearable.
Narcotic pain medications can cause constipation; you may wish to use an over-the-counter stool softener to help prevent this.
If you are having minimal pain and would like to switch to a milder medication, please take Tylenol/acetaminophen (extra strength or regular). Do not take Tylenol and norco together (this would be too much acetaminophen). Do not exceed more than 4000mg of Tylenol/acetaminophen in a 24 hour period. Try to avoid medications such as Advil, Aleve, Motrin, or Ibuprofen for about 3 months after surgery- some studies show that these medications could slow healing of your surgical repair.
Use ice or a cold therapy unit as much as possible for the first 48 hrs, then as frequent as needed. For example, 20 minutes of ice/machine to shoulder 5 times daily after the first 48 hrs would be helpful for pain and swelling.
You will have a soft dressing applied over your incisions. It is meant to absorb any leaking blood or fluid from the joint, and to protect from infection. Leakage immediately after surgery is normal and actually helps to drain some of the fluid that accumulates in the joint during surgery. The dressings may become moist or blood-stained; this is normal and usually not a cause for alarm.
You may remove your dressing 48 hours after your surgery to take a shower. For showering, you may remove your entire sling and let your arm rest at your side. Under the surgical dressing, you may have steri-strips over your incisions (small white strips of tape). Please leave them in place until they fall off on their own or until they are removed at your first post-op appointment. You may let soap and water gently wash over your incisions, but do not scrub them. Pat them dry with a towel, then recover each of the incisions with a band-aid if desired. You may not soak your shoulder in a bathtub or go into a pool or hot tub until incisions are well healed (usually takes a few weeks).
Therapy typically starts 3-7 days ater surgery. The timing for when you begin physical therapy will be individualized based on your surgery. If you are going to a facility other than ATI, please ask your therapist to visit www.healthy-txt.com/drmehta for Dr. Mehta’s protocols.
WHEN TO CALL
Please call our office at (630) 584-1400 if you develop a fever greater than 101°F, increasing pain that is not responding to pain medication, redness around incisions or shoulder, increased swelling, persistent bleeding or drainage, or drainage other than clear fluid or blood. If it is after hours, the answering service will contact the physician assistant on call.
It is normal to develop bruising to the operative arm. Some people have bruising across the chest all the way down to the hand. It can also be normal to develop swelling to the arm and hand. Gravity tends to pull fluid down the arm. Your body will be able to reabsorb this fluid but it may take a few weeks. If the swelling becomes increasingly painful and more tender to the touch, please let our office know.
You will be receiving a post-operative phone call from the surgical staff within a few days after surgery to check on you and assist you with any concerns.
Please do not attempt driving for about 3-4 weeks after surgery. This is for your safety, as well as other drivers- please do not attempt to drive with only one hand. Reasons for no driving post operatively: A quick, reactive motion of the shoulder while driving could damage your surgical repair. Secondly, you should not drive while taking any narcotic pain medications.
For safety reasons, do not drive with the sling on.
The sling should be worn at all times when you are up and walking around. While you are sitting/resting, you may remove the sling as long as your upper arm/shoulder stays near your body. You may take off the entire sling up to 3 times daily to bend and gently move your elbow while keeping your shoulder near your body. But, avoid full extension of the elbow for about 1 month (to protect the biceps).
The sling is typically worn for 3 weeks total for an isolated biceps tenodesis. If you also had a rotator cuff repair or labral repair, the sling will be needed for 6 weeks to protect all repairs.
PLEASE WATCH SLING VIDEO BELOW (SCROLL DOWN) FOR MORE DETAILED INFO
MOTIONS TO AVOID
Do not lift shoulder out in front of body, out to your side, or reach behind your back until your physical therapist has progressed you to that point in therapy. It is ok to carefully bend your elbow and use your hand to do things like typing (as long as your shoulder stays near your body). For example, you should put a computer keyboard in your lap instead of reaching out on a table for your keyboard). Initially in therapy, your therapist will do “passive motions,” which means your muscles won’t be doing the work. This protects your surgical repair and allows your body to heal.
You should not lift anything until progressed in therapy or by Dr. Mehta.
You may wear the sling for comfort to sleep after surgery, but this is optional. Some patients find it more comfortable to sleep upright (in a recliner chair) for a few days to weeks after surgery- this is optional.
RETURN TO WORK
This depends on the nature of your job. If you have a desk job or can work from home, you may be able to do computer/phone work within 1 week of surgery. However, you may not drive yourself to work for 3-4 weeks.
If you have a labor-intense job, or job that requires heavy lifting/repetitive use of your arm, you may need to be off work for months. You will have restrictions for 3-4 months after your biceps tenodesis. Some employers allow light-duty, and we can give you work restriction notes at each post operative visit if necessary.
MOST COMMON QUESTIONS
Proximal Biceps Tenodesis
How should I be using my sling?
The sling should be worn at all times when you are up and walking around. While you are sitting/resting, you may remove the sling occasionally as long as your upper arm/shoulder stays near your body. Typically the sling will be worn for 3 weeks total for an isolated biceps tenodesis. However, the use of the sling may be individualized based on your surgery. Some patients will wear the sling for up to 6 weeks to protect other combined surgical repairs.
If you have an “arc” sling (with waist portion): The waist strap should be on when you are up walking. Wearing the waist strap to sleep is optional. The purpose of the waist strap with the small bar that extends is to hold the shoulder in a slightly “abducted” position, which allows for less tension on the rotator cuff and labrum during the healing process.
What motions should I avoid/what motions are safe?
You may gently bend your elbow, keeping your upper arm near the body. You should avoid fully extending (straightening) your elbow until your surgeon and physical therapist progress you to this point. Fully straightening the elbow too soon will pull on the surgical repair of the biceps and could cause damage to the repair. Do not lift shoulder out in front of body, out to your side, or reach behind your back until your physical therapist has progressed you to that point in therapy. It is ok to use your hand to do things like typing (as long as your shoulder stays near your body). For example, you should put a computer keyboard in your lap instead of reaching out on a table for your keyboard).
Initially in therapy, your therapist will do “passive motions,” which means your muscles won’t be doing the work. This protects your bicep repair and allows your body to heal.
When can I drive?
Please do not attempt driving for about 4 weeks after surgery. This is for your safety, as well as other drivers- please do not attempt to drive with only one hand. Reasons for no driving post operatively: A quick, reactive motion of the shoulder while driving could damage your surgical repair. Secondly, you should not drive while taking any narcotic pain medications.
How should I be sleeping?
Please try to wear the sling while you are sleeping for 4 weeks after surgery- this provides good support to the shoulder. If you have an “arc” sling (which has a waist strap portion), you do NOT need to sleep with the waist strap attached. You may remove the sling to sleep if you are too uncomfortable, but try to keep your shoulder near your body (placing pillows around and behind the shoulder may help). Some people find it more comfortable to sleep upright (in a recliner chair) for a few days to weeks after surgery- this is optional.
We know you are eager to return to your sports and hobbies. We want to guide you safely through that process. Please use the following as a guide.
6 weeks post-op: Putting
3 months post-op: Chipping, pitching, and half-swings with your short irons
4-5 months post-op: Full but gentle swings with irons
6 months post-op: Full play with no restrictions
3 months post-op: jogging, light dribbling drills
4-5 months post-op: Free-throws, passing drills, “shooting around,” but no contact
6 months post-op: No restrictions
3 months post-op: Jogging and light throwing drills
4-5 months post-op: Agility/plyometric training with the guidance of a professional
6 months post-op: No restrictions
3 months post-op: Jogging and light throwing drills (with guidance of physical therapist)
4-5 months post-op: Throwing/batting drills
6 months post-op: No restrictions
Please follow the instructions of your physical therapist. Once you are nearing the end of physical therapy (typically 3 months post-op), your therapist can create a safe “return-to-lifting” program. Physical Therapists and Athletic Trainers can outline a specific plan for you.
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