Pre-Operative Instructions

Take a few minutes to read about your orthopedic procedure. Our goal is for you to feel prepared and comfortable with the procedure. If you have further questions please call us at 731-424-5480. 

Shoulder Arthroscopy Information and Instructions

What is Shoulder Arthroscopy?

A shoulder arthroscopy is used to diagnose and treat shoulder injuries. It can be used to diagnose problems with ligaments, tendons, inflammation, fractures, and the presence of loose objects. It is a minor surgery, which is usually done as an outpatient. During this surgery, the doctor makes several small incisions (cuts) on the top of the shoulder and inserts an arthroscope (a small tube-like lighted instrument) into the shoulder. This allows the doctor to see the entire shoulder joint. Small instruments can also be inserted through the arthroscope that can be used, in some cases, to repair certain injuries or problems.

What do I need to do before my surgery?

  • Shower the night before your surgery and in the morning before you come to the
  • hospital with the special soap you will be given.
  • Do not eat or drink anything after midnight the night before your surgery.
  • Please do not chew gum. (This raises the level of acid in your stomach.)
  • Take a shower the morning of your surgery.
  • You may brush your teeth and rinse your mouth as long as you do not swallow any water.
  • If you take medicine for your heart, blood pressure, or asthma you may take this with a small sip of water before you come to the hospital. If you take medicine and/or insulin for diabetes you need to ask your doctor if you should take this.
  • Remove all fingernail polish.
  • Remove all jewelry including body piercings.
  • Do not wear any makeup.

If you will be checking into the hospital on the day of your surgery:

  • Wear comfortable, loose fitting clothes that are easy to put on. Your shirt should be loose fitting through the sleeves and shoulders and button up the front.
  • Bring all medicines that you are taking to the hospital with you.
  • Do not bring valuables or large amounts of money with you to the hospital.
  • Have a responsible adult drive you to the hospital, stay during your surgery, and drive you home. You will not be allowed to drive yourself home.

What can I expect the day of surgery?

  • If you are checking into the hospital on the day of your surgery, after you have been to the Admitting Office, you will be taken to a room. This may not be the room where you will be taken after surgery.
  • You will be given a hospital gown and asked to remove all of your clothes including underwear and socks. Put on the gown opening in the back.
  • You will be asked to remove all jewelry, glasses, hairpieces, contact lenses, dentures, prosthesis, and hearing aids.
  • You will be asked questions about your medical history. Many of these will be the same questions that you have already been asked. Please know that we need to ask these again so that we can give you the best possible care.
  • You may go straight to the operating room or you may go to the Pre-Anesthesia Unit (PAU). If you go to the PAU, you will be there for about one hour before your surgery.
  • Your nurse will tell your family where to wait.
  • You will be asked several times on which shoulder the doctor is going to operate. This shoulder will have a mark placed on it with a special pen.
  • You will have an area on your upper chest as well as your shoulder and upper arm shaved and washed. It may be wrapped in sterile towels.
  • You will have an IV (needle in your arm for fluids) started and you will be given medicine that will help you relax.
  • Someone from anesthesia will talk with you about your health history and the type of anesthesia that will be used.
  • You will be taken to the operating room. This room will be cold and your nurse will give you a warm blanket.
  • The operating room staff will include your doctor, his assistant, an anesthetist (the person who will put you to sleep), a circulating nurse, and a scrub nurse. All of these people are there to care for you and no one else.
  • You will have sticky pads placed on your chest so that the staff can watch your heart. A blood pressure cuff will be placed on your arm so that your blood pressure can be checked. A device called a pulse oximeter will be put on your finger. It will tell how much oxygen is in your blood.
  • The anesthetist will put a soft mask over your face. This will give you plenty of oxygen. 
  • You will be given medicine in your IV that will relax you to the point of sleep. You will not wake up during your surgery and you will not feel pain.
  • After your surgery starts, the nurse will call your family and tell them how you are doing.
  • The nurse will call your family at least one time an hour. How long the surgery will take will depend on how much repair the doctor needs to do. This surgery usually takes from thirty minutes to two hours.
  • When the surgery is over, anesthetist will give you medicine that will help you to wake up. You will go to the Recovery Room. You will be in this room for 30 minutes to an hour. The doctor will talk with your family. 
  • You will have your blood pressure, pulse, temperature, and oxygen level checked. The nurse will check your dressing for any signs of bleeding and will feel of the pulses and temperature in your hand and wrist.
  • When you wake up, you may have on a shoulder immobilizer that was put on at the end of your surgery. This is sometimes used to keep your shoulder still after surgery. If your doctor wants you to wear a shoulder immobilizer, you will be taught how to use it.
  • If you are in pain or if you feel sick to your stomach please tell the nurse so that you can be given medicine. 
  • When you are awake you will be taken to your room. 
  • Call for the nurse to help you the first time that you need to get out of the bed. Do not try to get up without help.
  • When you are fully awake, if you are not sick to your stomach, you will be given something to eat and to drink.
  • You will be asked to go to the bathroom and empty your bladder (make water).
  • After you eat, drink, and empty your bladder, you will, most likely, be able to go home.
  • You will not be allowed to drive yourself home.

What should I do when I go home?

  • Your doctor will give you guidelines to follow. Be sure to follow his or her instructions.
  • Your doctor will tell you how to care for your wound and how long to leave on your dressing. Keep your dressing clean and dry. Do not take a shower until after your dressing has been removed. Do not swim or take a tub bath until your wounds are completely healed.
  • If you have been given a shoulder immobilizer or arm sling, you will be instructed how to use it. It is important that you wear it as instructed.
  • Do not drive or operate machinery until your doctor tells you that it is safe to do so.
  • Do not drink alcohol for at least 24 hours.
  • Do not lift anything weighing more than a few ounces with your affected arm until after your follow-up appointment.
  • You will be given exercises to do on your shoulder. Do these as the doctor tells you.
  • Be sure to keep your follow-up appointment with your doctor at his office after surgery.

Call your doctor if:

  • Your temperature is above 100.5° twice.
  • You notice any bleeding or drainage on your dressing.
  • You have any redness or swelling in the area of your surgery.
  • You have numbness in your arm or hand or if you notice a change in the color of your fingers.
  • You have pain not relieved by your pain medicine.
  • You have any other questions or concerns.

Knee Arthroscopy Information and Instructions

What is Knee Arthroscopy?

Knee arthroscopy has become one of the most common procedures used to diagnose and treat knee injuries. It is a minor surgical procedure that is done on an outpatient basis. The doctor makes several small incisions (cuts) around the knee and then inserts the arthroscope (a small tube-like instrument) into your knee. This allows the doctor to see the entire knee joint. In many cases he will also be able repair some injuries. 

Why would one need a knee arthroscopy?

  • You can injure a knee through a sports injury, a fall, or other kind of accident. Or an arthroscopy might be needed due to a gradual deterioration of the bone or cartilage in the knee joint. This may be caused by daily “wear and tear” or by arthritis.
  • Your doctor might recommend an arthroscopy if you are having problems with your knee such as pain, swelling, being unable to put full weight on your knee, or feeling a “pop” in the knee.

What will my doctor do before my knee arthroscopy?

You will be seen by a doctor that specializes in problems of the bones (an orthopedic doctor). This is the only type of doctor that does Knee Arthroscopies. The doctor will talk with you about your symptoms, find out how long you have been having the problem, and examine your knee. He will also talk with you about your other health problems. Following the exam, the doctor may order other tests. These may include:

  • X-rays of the knee: These are done to provide a view of the bones to determine if a break (fracture) has occurred.
  • Magnetic Resonance Imaging (MRI): This test can provide an X-ray view of ligaments and the surrounding tissue.
  • Arthrogram: In this test, dye is injected into the knee and X-rays are taken to look for tears in the ligaments and surrounding tissue damage.

Knee arthroscopy can be used to diagnose problems with ligaments or tendons (the connective tissue in the knee), inflammation, fractures, the presence of loose tissues or objects, and degenerative joint disease.
By using an arthroscope instead of making a large incision, your recovery is less painful. You will also return to daily activities sooner and with less discomfort.

Where is the operation done? How long does it take?

The surgery may be done at the hospital or at the West Tennessee Surgery Center. Your doctor will tell you where to go. The entire procedure, usually takes about one to one and a half hours. This does not include the time going to surgery or waiting for the surgery to begin.

What do I need to do before my surgery?

  • Shower the night before your surgery and in the morning before you come to the hospital with your soap UNLESS given a special soap.
  • Do not eat or drink anything after midnight the night before your surgery.
  • Please do not chew gum. (This raises the level of acid in your stomach).
  • You may brush your teeth and rinse your mouth as long as you do not swallow any water.
  • If you take medicine for your heart, blood pressure, or asthma, you may take this with a small sip of water before you come to the hospital. If you take medicine and/or insulin for diabetes, you need to ask your doctor if you should take this the morning of your surgery.
  • Remove all fingernail polish.
  • Remove all jewelry including body piercings.
  • Do not wear any makeup.
  • If you will be checking into the hospital on the day of your surgery:
    • Wear comfortable, loose fitting clothes that are easy to put on.
    • If you have crutches at home that you will be using after your surgery, bring them to the hospital with you.
    • Bring all medicines that you are taking to the hospital with you.
    • Do not bring valuables or large amounts of money with you to the hospital.
    • Someone must drive you home. You will not be allowed to drive yourself home.

What can I expect the day of surgery?

  • If you are checking into the hospital on the day of your surgery, after you have been to the Admitting Office, you will be taken to a room. This may not be the same room where you will be taken after surgery.
  • You will be given a hospital gown and asked to remove all of your clothes including underwear and socks. Put your gown on with the opening in the back.
  • You will be asked to remove all jewelry, glasses, hairpieces, contact lenses, dentures, prosthesis, and hearing aides.
  • You will be asked questions about your medical history. Many of these will be the same questions that you have already been asked. Please know that we need to ask these again so that we can give you the best possible care.
  • You may go straight to the operating room or you may go to the Pre-Anesthesia Unit (PAU).
  • Your nurse will tell your family where to wait.
  • You will be asked several times which leg the doctor is going to operate on. This leg will have a mark placed on it with a special pen.
  • Your leg will be washed with a special soap and then shaved.
  • You will have an IV (needle in your arm for fluids) started and you will be given medicine that will help you relax.
  • You will be taken to the operating room. This room will be cold and your nurse will give you a warm blanket.
  • You will have sticky pads placed on your chest so that the staff can watch your heart. A blood pressure cuff will be placed on your arm so that your blood pressure can be frequently checked. A device called a pulse oximeter will be put on your finger. It will tell how much oxygen is in your blood.
  • After your surgery starts, the nurse will call your family and tell them how you are doing.
  • After your surgery is over, your doctor will call and talk to your family to let them know how you are doing.
  • You will have your blood pressure, pulse, temperature, and oxygen level checked. The nurse will check your dressing for any signs of bleeding and will feel of the pulses in your feet.
  • When you wake up, you may be wearing a knee immobilizer that was put on at the end of your surgery. This is sometimes used to keep your knee still after surgery. If your doctor wants you to wear a knee immobilizer, you will be taught how to use it.
  • If you are in pain or if you feel sick to your stomach please tell the nurse.
  • When you are awake you will be taken to your room.
  • You will have a large bandage on your leg and you will not be able to bend it easily.
  • Please call for the nurse to help you the first time that you need to get out of the bed. Do not try to get up without help.
  • When you are fully awake, if you are not sick to your stomach, you will be given something to eat and to drink.
  • You will be asked to go to the bathroom and empty your bladder (make water).
  • After you eat, drink, and empty your bladder, most people are discharged to home. You will not be allowed to drive yourself home.

Knee Arthroscopy Discharge Instructions

In the first 24 hours after surgery:

  • It is important to have someone to drive you home and to stay with you the first 24 hours at home.
  • Do not drive or operate machinery.
  • Do not make important decisions or sign legal documents.
  • Do not drink alcoholic beverages.

Activity:

  • Keep the operated leg elevated on one to two pillows placed lengthwise (not just under the knee) for at least 48 hours after surgery. This will reduce pain and swelling.
  • Put only as much weight on your surgical leg as advised by your doctor. Crutches are recommended for walking after surgery. Use your crutches as instructed.
  • If your doctor wants you to use a knee immobilizer, you will be taught how to use it and told when you can stop using it.
  • Daily knee exercises are important for the return of a functional and healthy knee. Your doctor will talk to you about what exercises to do and when you should begin doing them. Your exercises may include:
    • Knee bending exercises
    • Quad sets
    • Straight leg raises
    • Calf pumps
  • Do not engage in activities that increase the pain or swelling in the knee.

Wound and dressing care:

  • Keep your dressing clean and dry.
  • Change and remove your dressing as instructed by your doctor.
  • Use a plastic bag to cover your dressing if you wish to shower or bathe. (Do not put the affected leg in the tub).
  • Notify your doctor immediately if your incision becomes wet or bloody.

Pain control:

  • Ice packs should be used for the first 24-48 hours after surgery to reduce pain and swelling.
  • Take your pain medicine as prescribed. Do not drink alcohol while taking this medicine.
  • When taking your pain medicine, you may feel dizzy or lightheaded. Be careful when moving around and climbing stairs. Stand up slowly.
  • Take your pain medicine 30 minutes before doing your exercises to decrease your pain.
  • Do not drive or operate machinery while taking your pain medicine.

Keep your follow-up appointment with your doctor. Follow-up visits are important for your doctor to note your progress, change bandages, check for any problems, and evaluate your progress.

  • Call your doctor before your appointment if you have:
  • Severe pain not relieved by your pain medicine.
  • An increase in numbness or swelling of the leg.
  • Color changes of your affected foot or leg.
  • Swelling, drainage, or bleeding that gets worse in the area of the incision.
  • Signs of infection such as redness, drainage that is foul smelling, or drainage that is green or yellow.
  • Chills or temperature above 100.5° twice.
  • Any other questions or concerns.

Carpal Tunnel Syndrome (CTS) Treatment Information

What is Carpal Tunnel Syndrome (CTS)?

The carpal tunnel is an opening in your wrist that is surrounded by bones and ligaments.
One of the nerves to your hand (the median nerve) passes through this opening. In Carpal Tunnel Syndrome, the tissues around this nerve swell, causing pressure on the nerve. This causes pain, numbness, and tingling in the wrist, hand, or fingers. With repetitive movements, the nerve remains irritated and the symptoms may get worse. The hand that you use the most is usually affected although you may have this problem in both wrists and hands.

What causes Carpal Tunnel Syndrome?

The exact cause of CTS is not known. It is often caused by a combination of problems. Some things that may lead to CTS are:

  • Jobs that cause you to repeatedly move your wrist or hand in the same direction.
  • This is especially true if you have to use a lot of force or if you use machines or tools that vibrate.
  • Some hobbies such as knitting, needlepoint, and computer games.
  • Jobs that require your hands to stay in abnormal positions for long periods of time.
  • Some diseases such as:
    • Diabetes
    • Some types of arthritis
    • Kidney failure
    • Some bone and muscle problems.
  • An injury to your wrist.
  • Women are more likely than men to have carpal tunnel syndrome.

What are the symptoms?

The symptoms vary from person to person and they may get worse over time. Symptoms may include:

  • An abnormal feeling in the hands including numbness and tingling. Most often, the symptoms start in the index, middle, and ring fingers. You may have these symptoms in one or both hands.
  • You may not be able to move your hand or wrist in all directions, or moving it certain directions may cause pain.
  • The pain may be worse at night.
  • Some patients lose the ability to tell if their hands are hot or cold.
  • You may have less strength in your hands or may have a tendency to drop things.
  • You may feel like your hands or wrists are swollen even if they do not appear to be swollen.

How is Carpal Tunnel Syndrome diagnosed?

Usually CTS is diagnosed based on the symptoms that you are having and your description of what makes your symptoms better or worse. There is no specific test that diagnoses CTS. The doctor will often look for three symptoms during his examination:

  • Pain that runs down to the tips of the fingers when the wrist is tapped.
  • Pain when the hands are held back to back with the fingers pointing down and the wrists forming a ninety-degree angle and held for one minute.
  • Weakness in the thumb when it is raised up or down.

Certain types of nerve conduction studies can also be used to see how well the nerve signals move up and down the median nerve.

What is the treatment for Carpal Tunnel Syndrome?

Some cases of CTS are mild and will resolve on their own. The doctor may give you a brace to keep your wrist from moving. It is usually recommended that this brace be worn at all times when you first begin using it. After the initial treatment period, some patients may only need to wear the brace at night or when doing a repetitive activity.

The use of ice packs or alternating hot and cold packs may be recommended. Certain exercises of the hands and wrists may be helpful. Medicines may be used to decrease the swelling and irritation. In addition to medicines taken by mouth, the area can be injected with a steroid medicine to decrease the inflammation.

Smoking is discouraged since it slows down blood flow and will make symptoms worse. It is recommended that you use good posture: keeping your back straight and not rounding your shoulders. If your CTS is related to your work activity, the doctor may suggest things that you can do to change your work environment and help decrease the stress to your wrist. If the CTS is related to a disease such as diabetes or arthritis, treating these problems may make the CTS better.

If these treatments do not work, surgery may be needed to release the nerve that is compressed. Surgery is often recommended if you have had severe symptoms for more than six months or if the CTS is causing you to lose muscle strength in your thumb. There are several different types of surgery that can be done to treat CTS. Ask your nurse for a copy of the teaching sheet “Carpal Tunnel Release Surgery." 

Talk with your doctor about your treatment options.

NONDISCRIMINATION NOTICE STATEMENT
West Tennessee Healthcare (WTH) does not exclude, deny benefits to, or otherwise discriminate against any person on the grounds of race, color, national origin, age, religion, disability, Limited English Proficiency or sex, including discrimination based on gender identity, sexual orientation, sex stereotyping or pregnancy in admission to, participation in, or receipt of the services and benefits under any of its programs and activities, whether carried out by WTH directly or through a contractor or any other entity with which WTH arranges to carry out its programs and activities.

For further information about this policy, contact Amy Garner (731) 660-1188.