Shoulder Arthroscopy

Biceps Tendonitis, Partial Biceps Tear, Biceps Subluxation and

Biceps Rupture
By Alan M. Reznik, MD, MBA

Post Operative instructions after a Biceps Tenodesis

Day 1:  The Day of Surgery: Maintain dressing, adding 4x4 bandages if needed for drainage through the dressing. Use ice pack for 20 minute periods throughout today. (Do not place ice directly on skin to avoid frostbite.) Keep pillow sling on at all times. Move fingers and wrist often. Expect some swelling, if you have any change in skin color or sensation in arm, notify our office. You will begin simple exercises the day of surgery.  They should be done every day for the first week post-op, to maintain blood flow and help prevent blood clots.

Hand Squeezing and Wrist range of motion exercises tonight .   (See exercise list) The arm sling must remain on at all other times, including bedtime.

When sleeping , most patients find that sleeping in a semi-upright position in a recliner or propped up on pillows on a couch is much more comfortable than trying to lie in bed for the first few weeks after shoulder surgery.  I do not recommend trying to sleep in bed for at least the first 2 weeks.

Day 2:  The Day after Surgery: Same as Day 1

Day 3: Starting about 48 hours after surgery : Continue same activities, including using ice for 20 minute periods as needed.  You should remove your dressing. You may remove the sling to shower today, supporting the affected arm with the opposite hand.  You may wash the skin around the incisions. When washing the under arm, do not use a large amount of soap.  It may dry out the skin and cause a rash. After a short shower, dry the shoulder well and place Band-aids over incisions. Some of the prep solutions are yellow in color – do not be surprised if it will not come off with soap and water. Sometimes only nail polish remover works.

Day 3- 4: Start Therapy with a physical therapist: This is to help avoid a frozen shoulder. The range of motion will be limited at first and the exact rehab protocol will depend on the status of your rotator cuff. The size and type of any associated rotator cuff tear will alter the rehab program. You should not do any resisted elbow flexion exercises for at least six weeks post op. You can do additional exercise only as the therapist instructs. Do not try to speed the process by doing more than asked because you can risk disrupting the repair . You cannot fool Dr. Reznik or Mother Nature. Overdoing it and creative mistakes become obvious very quickly. To avoid complications, follow the therapy guidelines and keep all your postoperative follow-up appointments with your physician. These appointments are required to monitor your progress.

Physical Therapy:

Physical Therapy is v ital to your recovery of good shoulder function. It will include a graduated activity and exercise program to increase muscle strength and motion while protecting the repair.

Your physical therapy will begin 3-4 days after surgery.  The physical therapist will guide you in your shoulder rehabilitation program. It is very important for you to start therapy when recommended. To avoid complications, postoperative follow up appointments with your physician are also required to monitor your progress.

General Instructions for all Rotator Cuff Repair and
Biceps Tenodesis Patients:

Diet: You may resume a regular diet when you return home. Most patients start with tea or broth, adding crackers or toast, then a non-spicy sandwich. If you become nauseated, check to see if one of your medications is upsetting your stomach, most narcotics can. If your stomach feels acidy, try Tums, Zantac or Pepcid AC to settle your stomach and drink plenty of clear liquids.

Pain Control: Take medication as prescribed by Dr Reznik.  Please call our office with any questions regarding your medication . Take with food to avoid stomach upset. After surgery, some patients will see some swelling. Use an ice pack over the dressing throughout the first 24 hours after surgery and then for 20 minute periods as needed for comfort and to reduce swelling.

Dressing:  The dressing is to remain clean and dry.  After 48 hours you may remove the dressing and the yellow Xeroform gauze strips (the small yellow tapes). You may then shower with the dressings off. Pat the incisions dry, using care not to rub the scabs off and then cover each incision with a plain Band-Aid. Do not use creams or ointments on the incisions. This delays early scab formation and healing.

Sling: Patients are to wear the pillow sling at all times ( including while at sleep ) for 3 weeks. Move fingers and wrist often. Expect some swelling.  Use Ice pack for 20 minute periods throughout the first 24 hours after surgery and then as needed.  After the first three weeks, patients should wear the sling (with the pillow removed) when going outside of their home for the following 3 weeks completing a total of 6 weeks of sling use. This will help to alert others of your surgery, remind them it is not healed yet and help them avoid the affected arm during this healing period.

Lungs: After surgery you are encouraged to deep breathe and cough frequently (at least 3-4 times per day). This will reduce mucous from building up in your lungs, and will reduce the risk of developing a post anesthetic pneumonia.

Blood Clots: Patients at high risk for blood clots include:

Those with long car or train commutes or planning any air travel (these trips should be avoided in the 1 st 6 weeks post op)
May be overweight: BMI >30*
Have a history of having cancer
Females on birth control pills
Males over the age of 40

These patients should be taking 1 aspirin per day for 6 weeks after surgery unless allergic to aspirin.

*BMI  or Body Mass index  is a number calculated from a person’s weight and height. BMI provides a reliable indicator of body composition. A muscle/fat ratio if you wll. The index is used to screen for weight categories that may lead to health problems : BMI

Dental Work: You cannot have any routine dental work (including cleaning) for at least 3 months after your surgery, or you risk infecting the suture anchors. After 3 months, you may see the dentist, but for one year from date of surgery, you will need to take antibiotics before and after dental work. Call our office and Dr. Reznik will give you a prescription.

Driving:  Patients cannot drive until they are off all pain medications, completely out of the sling, and can easily place hands at 13: position of the steering wheel and can move hands freely from the 9:00 – 3:00 position.

Airline Flights: Patients may fly 3 weeks after surgery on short flights (up to 2 hours) only and should in general wait 6-8 weeks for longer flights. You should get up and walk frequently to avoid blood clots and take an aspirin (unless allergic). You cannot carry any luggage for 3-4 months with the operated arm.

Returning to Work:  Patients with small tears and/or low demand work can usually return to work within 3 weeks. They will still have restrictions on lifting and overhead use. Patients with higher demand jobs or repetitive arm use need at least 6 weeks off. Any heavy labor with overhead lifting can require at least 4-6 months before returning to work, they still may have restrictions up to one year. 

Exercises - Do three times each day as directed

Starting Day 1:

Hand Squeezes or Grip Strengthening: Using a small soft rubber ball or soft sponge, squeeze your hand. When in the shower, you can use a sponge filled with water. Do this for 3-5 sets of 10-20 repetitions each day. If this is too easy, later in the rehab course you can use a grip strengthener.

Wrist Range of Motion: Roll your wrist in circles for 30 seconds after each round of grip exercises.

Day 3 add:

Elbow Range of Motion: Turning your palm inward, towards your stomach, flex and extend the elbow as comfort allows.  This will decrease pain and prevent elbow stiffness.

Day 4 add:

Pendulum Exercise: Holding the side of a table with your good arm, bend over at the waist, and let the affected arm hang down.  Swing the arm back and forth like a pendulum. Then swing in small circles and slowly make them larger. Do this for a minute or two at a time, rest, then repeat for a total of 5 minutes, 3 times per day

Not before Day 7-10 add:

Wall Walking: Stand facing a blank wall with your feet about 12 inches away.  “Walk” the fingers of the affected hand up the wall as high as comfort allows. Mark the sot and try to go higher next time. Do at least 10 repetitions, 3 times per day.  When more comfortable and stronger (not before three weeks) do these exercise sideways, with the affected side facing the wall. Do not let the hand drop down from the wall- walk your fingers down as well as up. Dropping the arm will strain the repair and be painful. If having weakness on the way down, feel free to use the other arm to help.

Biceps Curls: Curl the arm up and down 12 times; rest for one minute and repeat for a total of 3 sets of 12. When comfortable, try it holding a very small can. In a few days you can increase can size, but  only as comfort allows. This exercise should not be painful. If painful, decrease or eliminate the weight.

To monitor your progress and avoid complications after surgery, postoperative follow up appointments with your therapist and your physician are mandatory.

8/4/09