General Medical Check-up

For individuals who have a history of certain medical conditions, (e.g. heart ailments, lung disease, etc.) a visit to the primary care physician may be recommended. Thisgives your doctor an opportunity to identify any potential health risks and correct them prior to surgery. In some cases surgery needs to be postponed while further testingor treatment is initiated.

Herbal Supplements/Weight Loss Products/Blood Thinners:The use of any weight loss products or herbal supplements or blood thinners including Warfarin, Ecotrin, Disprin, Xarelto, Pradaxa or anti-inflammatories must be discontinued 1 week prior to surgery. These productscan interfere with bleeding control and anesthetic medications.

Pre-admission: Our office will arrange for a visit to the pre-admission clinic to assist in the administrative and pre-operative arrangements

Planning before your surgery o The night before surgery: You should not eat or drink anything after midnight. This is a precaution to avoid anaesthetic complications. o The day of surgery:Check-in: You will have to register at the hospital on the day of surgery. The specific time and location will be given to you during your office visit or by mail. Please be prompt! Failure to arrive on time unnecessarily delays not only your surgery but those who are having surgery after you. If you are significantly late your surgery will be cancelled. You will be asked to arrive at 06:00 to allow for the registration process,pre-operative testing, and consultation with the anesthesiologist. After you have registered a nurse will check you into the hospital ward area. She (he) will ask you several questions relating to your past health and take your temperature, blood pressure, etc. You will then be asked to change into a hospital gown.

Anesthesia Immediately before surgery the anaesthesiologist will discuss the details of your anaesthetic. In many cases we will ask the anaesthesiologist to administer an interscaleneblock. This technique involves an injection of local anesthetic into the base of your neck once you’re asleep. The medication numbs those nerves which supply the shoulder and arm and hand. The benefit is two-fold. First, the block lowers the dose of anaesthetics required to keep you asleep. Secondly, the numbness lasts an average 12 hours (6-30hr) after surgery, which means you have no pain during this time. You may or may not be able to move your fingers or you may experience motor paralysisof the entire upper extremity. Occasionally the nerve which stimulates the diaphragm can also be affected. This may give you the sensation that you can’t take a deepbreath. This sensation fades as the block wears off. The block does wear off and is not permanent. Any questions you have regarding anaesthesia should be addressed to the anaesthesiologist.

Surgery After you have been prepared, the nurse from the operating room will take you to the surgery area. You will be asked to wear a surgical cap to cover your hair. After being checked in a second time you will be wheeled into the operating room (Please note that you will be asked many of the same questions on several occasions. This is merely toprevent any important information from "slipping through the cracks".) The surgical team is composed of the surgeon, his assistant(s), 2 to 3 nurses or surgical technicians and the anesthesiologist. The temperature in the room is typically lower than normal and warm blankets will be provided. Once the anesthesiologist is prepared he will administermedicine which will make you feel relaxed. Afterwards, more medicine will cause you to fall asleep. At this point the anesthesiologist will proceed with an interscalene blockand/or general anesthetic. Surgical time varies from case to case but we will make a time estimate for your family so they can plan appropriately. After surgery Dr. van den Berg will talk to family members to update them on your surgery. Please make sure that family members are available at this time.

What to expect after surgery: When you awaken from the anesthetic you will be in the recovery room. A nurse will be assigned to monitor your progressand address your needs. If you have had a block you willnotice that your shoulder and arm are paralyzed. Don’tpanic! This is an expected result of the block. After youhave stabilized you will be transferred to your room. Itis only at this time that your family members will be ableto see you.

Sling/Brace Wear After surgery you will be given a sling. The purpose of thesling is to protect the tendon repair. The sling must beworn at all times 6 weeks (in the case of a rotator cuff repair or 2w in the case of a decompression only), except during therapy, exercises and showering. You may loosen the sling and useyour arm for light waist level activity with the arm at the side (eating, washing your face, putting in contacts, usinga keyboard). You may bend your elbow as tolerated. You may not lift your arm away from your body, liftheavy objects, or perform forceful repetitiveactivities.If you have had a biceps tenodesis you should not bend your elbow against resistance or attemptto use your hand for twisting motions (unscrewing jar topsetc).

Driving You should not drive until your shoulder is out of thesling and you have full control of your shoulder muscles.Until that time you may not have the ability to reactrapidly in an emergency situation. You should refrainfrom driving for 6 weeks.

Follow-up visits You will have an appointment to see Dr. van den Berg14 daysafter surgery. During this visit your dressing will beremoved and your shoulder will be examined by Dr.Van den Berg. Following the exam you will see the therapist toreview your exercise program and to add other exercises ifappropriate. Most patients are taught a home exerciseprogram which they can do on their own. You will thenreturn for subsequent visits at 6 weeks and 5 months. At each visityour shoulder will be re-examined and if necessary youwill see the therapist to update your home exerciseprogram.

Work You may return to work within 1-2 weeks if you have asedentary job. If you have a job which requires manualwork (factory, construction, etc.) then you may return towork after 6-8 weeks. Return to full dutymanual work will be based on your specific job and yourprogress in rehabilitation. The range is 3-6 months.