ACL Reconstruction Guidelines for Dr. Surface’s Patients

Several different procedures can be performed during knee arthroscopy and therefore each patient may have specific instructions, depending on the exact surgery performed. These instructions are to be used as a guide for your recovery and may be tailored to each individual patient. If there are specific instructions needed for you, we will explain them to you prior to discharge from the hospital.

  1. Resume your pre-op diet and medications unless specifically told otherwise.

  2. Activity:

    Take it easy. Go ahead and go about the things you need to do when you feel like it, however allow yourself time to rest and recover. Remember, arthroscopic surgery is generally a “big surgery done through small incisions”, and, as such tends to fool people in regards to their level of recovery.

    Typical knee arthroscopic surgery allows early return to walking. ACL reconstruction cases are slightly different. Weight bearing on the operative leg may be allowed the same day of surgery, but usually this is not the case. You may bear weight specifically based on technical factors occurring during surgery. You and/or your family will be informed of the amount, if any, you may be allowed to put weight on your leg. Mechanically, the ligament will typically not tolerate full weight bearing for several weeks after surgery. Therefore crutches or a walker are used. Once the ligament heals enough, you may discontinue the use of the aids. You will be instructed when you may stop the crutches or a walker. Despite how your knee may feel, do not ignore these instructions as you may damage the reconstruction.

    Bracing of the knee is used after surgery. It will be set at specific ranges of motion, based again, on technical aspects of the surgery. The brace allows for motion within a pre-set range determined the day of surgery. Exercise the knee with brace in place, allowing for the motion set by the brace. Sleep in the brace until informed otherwise.

  3. Bandage/Incision Care

    A large bandage is applied at the end of surgery. This is done because frequently drainage occurs post-op. This is normal. Water is used during the operation to make room to do the job. At the end of the case, not all of this water is removed, and it tends to drain out during the time you are home. This drainage has some blood in it. It will look like cherry kool aid! It frightens some people, but is entirely normal. I place a large bandage to soak up this water. If your bandage stays relatively clean, leave it alone for a couple of days prior to changing. You can change the bandage anytime needed. Most times people tend to change the bandage too often, however. In general, use common sense, when it looks as though it needs changed, go ahead. Go to smaller and smaller bandages as you heal. Lots of patients end up with band aid type dressings in a short period of time.

    When you change your bandage, clean the area with a little peroxide, dry it, and then apply a new dressing. Any sterile bandage such as gauze will work fine. You may apply antibiotic cream if you have it, but I do not consider this important enough to recommend you purchase this medicine. Keep the area clean and dry for 5 days. Then you may shower the area, let water runoff the incision, dry it, a little peroxide and a new bandage. You can shower, but you must keep this area dry during the first 5 days. After your stitches or staples come out at the first office visit, you then may get the area wet under water in a bath. Expect some swelling, some redness, and even some discoloration or bruising during your early recovery. This is worrisome to lots of patients, but once again, entirely normal and even expected.

    You will be given a prescription for antibiotics to take for a few days after surgery. This is done as an added safety measure. Please finish all the antibiotics as prescribed to allow for their full effectiveness, and to decrease the chance of developing resistant bacteria from not completing the whole course of the prescription.

  4. Pain Management

    You will be given one or more prescriptions for pain medication. Take this medicine as you need it. The prescription is written to allow for some leeway in the dose allowed. As your pain subsides, take a smaller dose and/or take the medicine less frequently. The chance of nausea is decreased by not taking the medicine on an empty or overly full stomach. Do not take other people’s prescriptions. Do not drive or perform other important or potentially hazardous tasks while taking the pain medicine. Do not drink alcohol while taking your pain medicine. Generally it is safe and recommended to take an anti-inflammatory medication such as ibuprofen or Aleve with your prescription if you are not allergic. Do not take any Tylenol (acetaminophen) containing medications with your prescription.

    Ice the area. This will decrease swelling and pain. Use common sense with the ice. Apply it frequently to the area with some breaks in between. An effective and inexpensive method is to use bags of frozen peas! Keep a couple of bags around, apply one until it thaws, place it back in the freezer and get out the other one, alternating in this way. It sounds goofy, but works well.

    During the time of your operation, we usually give a “numbing” medicine (local anesthetic) either in the form of a block by the anesthesiologist, or I will inject the medicine around the surgical site. This works to decrease your pain significantly. There is a major drawback in that these medicines “wear off” abruptly. When the medicine stops working it can occur rapidly with a dramatic increase in pain. To avoid this, an hour or so after you get home take one of your pain pills, even if it does not seem needed. This will allow your body to have some pain medicine on board when the numbing meds wear off. Sometimes these local anesthetics last for a long time, and you may need to repeat the smallest dose of your prescription medication once or twice before the numbing effect is gone. Do this technique unless directed otherwise.

    With ACL reconstruction, I frequently add anti-nausea and anti-muscle spasm medicine to your regimen on a case-by-case basis. If prescribed, take these medicines at their lowest effective dose.

    You may have an allergy to codeine and still get a medicine that sounds like, or is spelled similarly to codeine. Do not be troubled by this. Often prescription pain medicines have names that have "codone” in them. This does not mean that you are automatically allergic because of a previous allergy to codeine despite what you may hear. People can be allergic to BOTH types of medicines, but just because the name is similar, doesn’t mean you cannot take the medicine prescribed. Phillip and Phyllis sound a lot alike, maybe they act the same way, but each is used to describe a completely different entity.

    I attempt in every case to give an amount of medication needed for your surgery. I realize everyone is different in their pain needs, and that you may need more medication. Not all medicines work the same for every patient, and therefore some people will use more than others. Keep in mind that your pain will dramatically decrease over the first few days. Also be aware that our policy is that we do not call in narcotic pain prescriptions.

    As you are aware, significant, needed legislation has limited the amount of pain medication you can receive. I will give you the amount of medication that over 20 years experience has led me to feel you need....and no more. I will treat you with compassion regarding your pain, but please understand that decisions regarding your pain meds are always made in your best interest.

  5. Work

    Every job is different of course, so each person’s ability to go back to work depends on several factors. During the initial post-op period, you have a legitimate reason to be off work until the first office visit. At that time please inform us of your intentions, and your employer’s willingness/reluctance for your return. If you must/want, or are required to return to work prior to your first post-op visit, you may, as long as you can adhere to the restrictions outlined above. We will complete the needed paperwork to make it happen when you come to the office. The long term return to your pre-op status will be tailored to your individual needs as it relates to healing and job requirements.

  6. Driving

    ACL reconstruction surgery requires individualized return to driving guidelines. We will discuss this further at your office visit. Some generalities are outlined below. Do not drive while taking your pain medicine. You should not drive until the crutches are gone. You may have to wait for the brace to be removed as well depending on your range of motion and recovery after surgery. When you first resume driving, your car should be an automatic, and you take short trips only. Keep in mind the activity restrictions outlined above. Also remember there are inherent liabilities you will be subject to if you drive after knee surgery. You will be considered by many to be less than fully capable to handle traffic situations in the post-op period. The ultimate decision to drive or not is yours. If there is any doubt in your mind---you should not drive.

  7. Forms

    Short-term disability, family medical leave act (FMLA), school excuses, and other forms will be filled out after they are brought to the office. You should not give them to me or others at the time of your surgery to fill out as they are more likely to be misplaced.

  8. Follow-Up Appointment

    Unless otherwise directed, you need to be seen in 2-3 weeks. Call as early as you can to make the appointment to increase the likelihood of getting the time of day that you need.

  9. Emergencies/Problems

    Call our office number for assistance as you need. Please bear in mind that we must prioritize these calls in terms of their emergent nature based on the information given. I may be in surgery or otherwise unavailable for short periods of time. Because of these factors, it may seem that it takes a while to get back to you. Please do not feel as though you are unimportant to us, just understand the nature of calls require us to make a decision as to what order they are addressed. If you need more urgent attention, please call back. If needed return to the hospital for emergent problems. www.summitorthopedicswv.com is a resource that may provide answers to some of your questions.

  10. Thank you for your trust in me as your surgeon!

Knee Arthroscopy Guidelines for Dr. Surface’s Patients

Several different procedures can be performed during knee arthroscopy and therefore each patient may have specific instructions, depending on the exact surgery performed. These instructions are to be used as a guide for your recovery and may be tailored to each individual patient. If there are specific instructions needed for you, we will explain them to you prior to discharge from the hospital.

  1. Resume your pre-op diet and medications unless specifically told otherwise.

  2. Activity:

    Take it easy. Go ahead and go about the things you need to do when you feel like it, however allow yourself time to rest and recover. Remember, arthroscopic surgery is generally a “big surgery done through small incisions”, and, as such tends to fool people in regards to their level of recovery.

    Typical knee arthroscopic surgery allows early return to walking. Weight bearing on the operative leg is usually allowed the same day of surgery. You may bear weight right away unless specifically instructed otherwise. Mechanically, in these cases, the knee will tolerate your walking on it the same day, but pain is the limiting factor. In other words, your knee can put up with it the first day, but you may not, due to discomfort. Therefore crutches or a walker are used to control your discomfort. Once the discomfort decreases you may discontinue the use of the aids. Keep in mind that you do not have to quit using crutches or a walker “cold turkey”. You may go back and forth for a while until your knee feels better.

    Certain surgeries on the knee require special limits on your activity for a period of time. Examples include ACL reconstruction and knee cap realignment. In these examples you will have a brace in place, there will be instructions for the brace, as well as specific instructions for the amount and when you may bear weight on the knee.

  3. Bandage/Incision Care:

    A large bandage is applied at the end of surgery. This is done because frequently drainage occurs post-op. This is normal. Water is used during the operation to make room to do the job. At the end of the case, not all of this water is removed, and it tends to drain out during the time you are home. This drainage has some blood in it. It will look like cherry kool aid! It frightens some people, but is entirely normal. I place a large bandage to soak up this water. If your bandage stays relatively clean, leave it alone for a couple of days prior to changing. You can change the bandage anytime needed. Most times people tend to change the bandage too often, however. In general, use common sense, when it looks as though it needs changed, go ahead. Goto smaller and smaller bandages as you heal. Lots of patients end up with band aid type dressings in a short period of time.

    When you change your bandage, clean the area with a little peroxide, dry it, and then apply a new dressing. Any sterile bandage such as gauze will work fine. You may apply antibiotic cream if you have it, but I do not consider this important enough to recommend you purchase this medicine.

    Keep the area clean and dry for 5 days. Then you may shower the area, let water runoff the incision, dry it, a little peroxide and a new bandage. You can shower, but you must keep this area dry during the first 5 days. After your stitches or staples come out at the first office visit, you then may get the area wet under water in a bath.

    Expect some swelling, some redness, and even some discoloration or bruising during your early recovery. This is worrisome to lots of patients, but once again, entirely normal and even expected.

    You will be given a prescription for antibiotics to take for a few days after surgery. This is done as an added safety measure. Please finish all the antibiotics as prescribed to allow for their full effectiveness, and to decrease the chance of developing resistant bacteria from not completing the whole course of the prescription.

  4. Pain Management:

    You will be given one or more prescriptions for pain medication. Take this medicine as you need it. The prescription is written to allow for some leeway in the dose allowed. As your pain subsides, take a smaller dose and/or take the medicine less frequently. The chance of nausea is decreased by not taking the medicine on an empty or overly full stomach. Do not take other people’s prescriptions. Do not drive or perform other important or potentially hazardous tasks while taking the pain medicine. Do not drink alcohol while taking your pain medicine. Generally it is safe and recommended to take an anti-inflammatory medication such as ibuprofen or Aleve with your prescription if you are not allergic. Do not take any Tylenol (acetaminophen) containing medications with your prescription.

    Ice the area. This will decrease swelling and pain. Use common sense with the ice. Apply it frequently to the area with some breaks in between. An effective and inexpensive method is to use bags of frozen peas! Keep a couple of bags around, apply one until it thaws, place it back in the freezer and get out the other one, alternating in this way. It sounds goofy, but works well.

    During the time of your operation, we usually give a “numbing” medicine (local anesthetic) either in the form of a block by the anesthesiologist, or I will inject the medicine around the surgical site. This works to decrease your pain significantly. There is a major drawback in that these medicines “wear off” abruptly. When the medicine stops working it can occur rapidly with a dramatic increase in pain. To avoid this, anhour or so after you get home take one of your pain pills, even if it does not seem needed. This will allow your body to have some pain medicine on board when the numbing meds wear off. Sometimes these local anesthetics last for a long time, and you may need to repeat the smallest dose of your prescription medication once or twice before the numbing effect is gone. Do this technique unless directed otherwise.

    You may have an allergy to codeine and still get a medicine that sounds like, or is spelled similarly to codeine. Do not be troubled by this. Often prescription pain medicines have names that have "codone” in them. This does not mean that you are automatically allergic because of a previous allergy to codeine despite what you may hear. People can be allergic to BOTH types of medicines, but just because the name is similar, doesn’t mean you cannot take the medicine prescribed. Phillip and Phyllis sound a lot alike, maybe they act the same way, but each is used to describe a completely different entity.

    I attempt in every case to give an amount of medication needed for your surgery. I realize everyone is different in their pain needs, and that you may need more medication. Not all medicines work the same for every patient and therefore some people will use more than others. Keep in mind that your pain will dramatically decrease over the first few days. Also be aware that our policy is that we do not call in narcotic pain prescriptions.

  5. Work:

    Every job is different of course, so each person’s ability to go back to work depends on several factors. During the initial post-op period, you have a legitimate reason to be off work until the first office visit. At that time please inform us of your intentions, and your employer’s willingness/reluctance for your return. If you must/ want, or are required to return to work prior to your first post-op visit, you may, as long as you can adhere to the restrictions outlined above. We will complete the needed paperwork to make it happen when you come to the office. The long term return to your pre-op status will be tailored to your individual needs as it relates to healing and job requirements.

  6. Driving:

    Do not drive while taking your pain medicine. In general you should not drive the first week after surgery. You may drive afterward if your car is an automatic, and you take short trips only. Keep in mind the activity restrictions outlined above. Also remember there are inherent liabilities you will be subject to if you drive after knee surgery. You will be considered by many to be less than fully capable to handle traffic situations in the post-op period. The ultimate decision to drive or not is yours. If there is any doubt in your mind---you should not drive.

  7. Forms:

    Short-term disability, family medical leave act (FMLA), school excuses, and other forms will be filled out after they are brought to the office. You should not give them to me or others at the time of your surgery to fill out as they are more likely to be misplaced.

  8. Follow-Up Appointment:

    Unless otherwise directed, you need to be seen in 2-3 weeks. Call as early as you can to make the appointment to increase the likelihood of getting the time of day that you need.

  9. Emergencies/Problems:

    Call our office number for assistance as you need. Please bear in mind that we must prioritize these calls in terms of their emergent nature based on the information given. I may be in surgery or otherwise unavailable for short periods of time. Because of these factors, it may seem that it takes a while to get back to you. Please do not feel as though you are unimportant to us, just understand the nature of calls require us to make a decision as to what order they are addressed. If you need more urgent attention, please call back. If needed return to the hospital for emergent problems. The website summitorthopedicswv.com is a resource that may provide answers to some of your questions.

Carpal Tunnel Surgery Guidelines for Dr. Surface’s Patients

Several different situation can occur during carpal tunnel release, and therefore each patient may have specific instructions, depending on the exact surgery performed. These instructions are to be used as a guide for your recovery and may be tailored to each individual patient. If there are specific instructions needed for you, we will explain them to you prior to discharge from the hospital.

  1. Resume your pre-op diet and medications unless specifically told otherwise.

  2. Activity:

    An immobilizing device, a splint, is needed to protect the surgery. Wear the device at all times except for changing clothes or bandages, or to perform any exercises recommended. This is very important, as it is needed to keep the carpal tunnel open during the healing process. After your office visit, you will need to wear the splint at night for three more weeks.

    Some exercises are allowed to preserve movement of the wrist without over-stressing the surgery site. You may bend the wrist back and forth during those brief times you have the splint off. Move your fingers a lot, even when the splint is in place. This will prevent stiffness, and the wrist and fingers will be limber, thereby making your recovery easier and faster.

    Do not move, lift, push, or pull more than 3 pounds until given the green light to do so.

    Take it easy. Go ahead and go about the things you need to do when you feel like it, however allow yourself time to rest and recover. Remember, modern surgery technology generally tends to fool people in regards to their level of recovery.

  3. Bandage/Incision Care:

    A large bandage is applied at the end of surgery. This is done because frequently drainage occurs post-op. This is normal. This drainage has some blood in it. It frightens some people, but is entirely normal. I place a large bandage to soak up this drainage. If your bandage stays relatively clean, leave it alone for a couple of days prior to changing. You can change the bandage anytime needed. Most times people tend to change the bandage too often, however. In general, use common sense, when it looks as though it needs changed, go ahead. Go to smaller and smaller bandages as you heal. Lots of patients end up with band aid type dressings in a short period of time.

    When you change your bandage, clean the area with a little peroxide, dry it, and then apply a new dressing. Any sterile bandage such as gauze will work fine. You may apply antibiotic cream if you have it, but I do not consider this important enough to recommend you purchase this medicine.

    Keep the area clean and dry for 5 days. Then you may shower the area, let water runoff the incision, dry it, a little peroxide and a new bandage. You can shower, but you must keep this area dry during the first 5 days. After your stitches come out at the first office visit, you then may get the area wet under water in a bath.

    Expect some swelling, some redness, and even some discoloration or bruising during your early recovery. This is worrisome to lots of patients, but once again, entirely normal and even expected.

    You will be given a prescription for antibiotics to take for a few days after surgery. This is done as an added safety measure. Please finish all the antibiotics as prescribed to allow for their full effectiveness, and to decrease the chance of developing resistant bacteria from not completing the whole course of the prescription.

  4. Pain Management:

    You will be given one or more prescriptions for pain medication. Take this medicine as you need it. The prescription is written to allow for some leeway in the dose allowed. As your pain subsides, take a smaller dose and/or take the medicine less frequently. The chance of nausea is decreased by not taking the medicine on an empty or overly full stomach. Do not take other people’s prescriptions. Do not drive or perform other important or potentially hazardous tasks while taking the pain medicine. Do not drink alcohol while taking your pain medicine. Generally it is safe and recommended to take an anti-inflammatory medication such as ibuprofen or Aleve with your prescription if you are not allergic. Do not take any Tylenol (acetaminophen) containing medications with your prescription.

    Ice the area. This will decrease swelling and pain. Use common sense with the ice. Apply it frequently to the area with some breaks in between. An effective and inexpensive method is to use bags of frozen peas! Keep a couple of bags around, apply one until it thaws, place it back in the freezer and get out the other one, alternating in this way. It sounds goofy, but works well.

    During the time of your operation, we usually give a “numbing” medicine (local anesthetic) either in the form of a block by the anesthesiologist, or I will inject the medicine around the surgical site. This works to decrease your pain significantly. There is a major drawback in that these medicines “wear off” abruptly. When the medicine stops working it can occur rapidly with a dramatic increase in pain. To avoid this, an hour or so after you get home take one of your pain pills, even if it does not seem needed. This will allow your body to have some pain medicine on board when the numbing meds wear off. Sometimes these local anesthetics last for a long time, and you may need to repeat the smallest dose of your prescription medication once or twice before the numbing effect is gone. Do this technique unless directed otherwise.

    You may have an allergy to codeine and still get a medicine that sounds like, or is spelled similarly to codeine. Do not be troubled by this. Often prescription pain medicines have names that have "codone” in them. This does not mean that you are automatically allergic because of a previous allergy to codeine despite what you may hear. People can be allergic to BOTH types of medicines, but just because the name is similar, doesn’t mean you cannot take the medicine prescribed. Phillip and Phyllis sound a lot alike, maybe they act the same way, but each is used to describe a completely different entity.

    I attempt in every case to give an amount of medication needed for your surgery. I realize everyone is different in their pain needs, and that you may need more medication. Not all medicines work the same for every patient, and therefore some people will use more than others. Keep in mind that your pain will dramatically decrease over the first few days. Also be aware that our policy is that we do not call in narcotic pain prescriptions. As you are aware, significant, needed legislation has limited the amount of pain medication you can receive. I will give you the amount of medication that over 20 years experience has led me to feel you need....and no more. I will treat you with compassion regarding your pain, but please understand that decisions regarding your pain meds are always made in your best interest.

    The symptoms of carpal tunnel syndrome resolve after surgery at different rates for different patients. You may notice improvement in symptoms very quickly, but do not be alarmed if it takes longer. Remember, it took a while for this condition to develop in your wrist, and it may take a while to recover.

  5. Work:

    Every job is different of course, so each person’s ability to go back to work depends on several factors. During the initial post-op period, you have a legitimate reason to be off work until the first office visit. At that time please inform us of your intentions, and your employer’s willingness/reluctance for your return. If you must/want, or are required to return to work prior to your first post-op visit, you may, as long as you can adhere to the restrictions outlined above. We will complete the needed paperwork to make it happen when you come to the office. The long term return to your pre-op status will be tailored to your individual needs as it relates to healing and job requirements.

  6. Driving:

    Do not drive while taking your pain medicine. In general you should not drive the first week after surgery. You may drive afterward if your car is an automatic, and you take short trips only. Keep in mind the activity restrictions outlined above. Also remember there are inherent liabilities you will be subject to if you drive after surgery. You will be considered by many to be less than fully capable to handle traffic situations in the post-op period. The ultimate decision to drive or not is yours. If there is any doubt in your mind---you should not drive.

  7. Forms:

    Short-term disability, family medical leave act (FMLA), school excuses, and other forms will be filled out after they are brought to the office. You should not give them to me or others at the time of your surgery to fill out as they are more likely to be misplaced.

  8. Follow-Up Appointment:

    Unless otherwise directed, you need to be seen in 2-3 weeks. Call as early as you can to make the appointment to increase the likelihood of getting the time of day that you need.

  9. Emergencies/Problems:

    Call our office number for assistance as you need. Please bear in mind that we must prioritize these calls in terms of their emergent nature based on the information given. I may be in surgery or otherwise unavailable for short periods of time. Because of these factors, it may seem that it takes a while to get back to you. Please do not feel as though you are unimportant to us, just understand the nature of calls require us to make a decision as to what order they are addressed. If you need more urgent attention, please call back. If needed return to the hospital for emergent problems. www.summitorthopedicswv.com is a resource that may provide answers to some of your questions.

  10. Thank You for trusting in me to perform your surgery.

Shoulder Arthroscopy Guidelines for Dr. Surface’s Patients

Several different procedures can be performed during shoulder arthroscopy and therefore each patient may have specific instructions, depending on the exact surgery performed. These instructions are to be used as a guide for your recovery and may be tailored to each individual patient. If there are specific instructions needed for you, we will explain them to you prior to discharge from the hospital.

  1. Resume your pre-op diet and medications unless specifically told otherwise.

  2. Activity:

    An immobilizing device such as a sling is needed to protect the surgery. Wear the device at all times except for changing clothes or bandages, or to perform any exercises recommended.

    Pendulum exercises are designed to allow some limited movement of the shoulder without over-stressing any repair done. These exercises are best thought of as movement of the arm like an elephant’s trunk. The arm is dangled by your side and allowed to move gently back and forth, side to side, and in small circles without lifting the arm in any significant way. Begin these exercises right away and do them several times daily. This will prevent stiffness, and the shoulder will be limber and ready to begin specific rehab when the time is right. This maneuver is how you change your shirt or do underarm care: let the arm dangle by your side, lean forward slightly allowing space to occur between your arm and chest. This will “open” your armpit to allow cleaning/antiperspirant as well as easy removal/replacement of a shirt.

    Do not actively move the arm otherwise until given the green light to do so.

    Take it easy. Go ahead and go about the things you need to do when you feel like it, however allow yourself time to rest and recover. Remember, arthroscopic surgery is generally a “big surgery done through small incisions”, and, as such tends to fool people in regards to their level of recovery.

  3. Bandage/Incision Care:

    A large bandage is applied at the end of surgery. This is done because frequently drainage occurs post-op. This is normal. Water is used during the operation to make room to do the job. At the end of the case, not all of this water is removed, and it tends to drain out during the time you are home. This drainage has some blood in it. It will look like cherry Kool Aid! It frightens some people, but is entirely normal. I place a large bandage to soak up this water. If your bandage stays relatively clean, leave it alone for a few days prior to changing. You can change the bandage anytime needed. Most times people tend to change the bandage too often, however. In general, use common sense: when it looks as though it needs changed, go ahead. Go to smaller and smaller bandages as you heal. Lots of patients end up with band aid type dressings in a short period of time.

    When you first change your bandage, be very careful removing it to prevent accidental removal of the surgical skin glue that is used in most cases to close the incisions. The bandage, at times, will stick to the skin glue, and if you are not careful, you may pull it off with the old dressings. The skin glue allows for a sealed incision that inhibits bacteria, and allows you to shower the area the next day. Sometimes the glue may seem discolored or dirty. This is normal for it to be that appearance, so do not feel as though it should be removed. Look for this material right up against your skin. You may apply a new dressing over the glue. Any sterile bandage such as gauze will work fine. I do not recommend you apply antibiotic cream to these areas.

    Keep the area clean and dry. If you have this glue closure on your incisions, you may shower the area the day after surgery, let water runoff the incision, dry it, and apply a new bandage. If you have regular stitches or staples, You can shower, but you must keep this area dry during the first 5 days. After your stitches or staples come out at the first office visit, you then may get the area wet under water in a bath.

    Expect some swelling, some redness, and even some discoloration or bruising during your early recovery. This is worrisome to lots of patients, but once again, entirely normal and even expected.

    You will be given a prescription for antibiotics to take for a few days after surgery. This is done as an added safety measure. Please finish all the antibiotics as prescribed to allow for their full effectiveness, and to decrease the chance of developing resistant bacteria from not completing the whole course of the prescription.

  4. Pain Management:

    You will be given one or more prescriptions for pain medication. Take this medicine as you need it. The prescription is written to allow for some leeway in the dose allowed. As your pain subsides, take a smaller dose and/or take the medicine less frequently. The chance of nausea is decreased by not taking the medicine on an empty or overly full stomach. Do not take other people’s prescriptions. Do not drive or perform other important or potentially hazardous tasks while taking the pain medicine. Do not drink alcohol while taking your pain medicine. Generally it is safe and recommended to take an anti-inflammatory medication such as ibuprofen or Aleve with your prescription if you are not allergic. Do not take any Tylenol (acetaminophen) containing medications with your prescription.

    Ice the area. This will decrease swelling and pain. Use common sense with the ice. Apply it frequently to the area with some breaks in between. An effective and inexpensive method is to use bags of frozen peas! Keep a couple of bags around, apply one until it thaws, place it back in the freezer and get out the other one, alternating in this way. It sounds goofy, but works well.

    During the time of your operation, we usually give a “numbing” medicine (local anesthetic) either in the form of a block by the anesthesiologist, or I will inject the medicine around the surgical site. This works to decrease your pain significantly. There is a major drawback in that these medicines “wear off” abruptly. When the medicine stops working it can occur rapidly with a dramatic increase in pain. To avoid this, an hour or so after you get home take one of your pain pills, and repeat the dose every 4-6 hours even if it does not seem needed. This will allow your body to have some pain medicine on board when the numbing meds wear off. Sometimes these local anesthetics last for a long time, and you may need to repeat the smallest dose of your prescription medication several times before the numbing effect is gone. Do this technique unless directed otherwise.

    You may have an allergy to codeine and still get a medicine that sounds like, or is spelled similarly to codeine. Do not be troubled by this. Often prescription pain medicines have names that have "codone” in them. This does not mean that you are automatically allergic because of a previous allergy to codeine despite what you may hear. People can be allergic to BOTH types of medicines, but just because the name is similar, doesn’t mean you cannot take the medicine prescribed. Phillip and Phyllis sound a lot alike, maybe they act the same way, but each is used to describe a completely different entity.

    I attempt in every case to give an amount of medication needed for your surgery. I realize everyone is different in their pain needs, and that you may need more medication. Not all medicines work the same for every patient, and therefore some people will use more than others. Keep in mind that your pain will dramatically decrease over the first few days. Also be aware that our policy is that we do not call in narcotic pain prescriptions.

    As you are aware, significant, needed legislation has limited the amount of pain medication you can receive. I will give you the amount of medication that over 25 years experience has led me to feel you need....and no more. I will treat you with compassion regarding your pain, but please understand that decisions regarding your pain meds are always made in your best interest..

  5. Work:

    Every job is different of course, so each person’s ability to go back to work depends on several factors. During the initial post-op period, you have a legitimate reason to be off work until the first office visit. At that time please inform us of your intentions, and your employer’s willingness/reluctance for your return. If you must/want, or are required to return to work prior to your first post-op visit, you may, as long as you can adhere to the restrictions outlined above. We will complete the needed paperwork to make it happen when you come to the office. The long term return to your pre-op status will be tailored to your individual needs as it relates to healing and job requirements.

  6. Driving:

    Do not drive while taking your pain medicine. In general you should not drive the first week after surgery. You may drive afterward if your car is an automatic, and you take short trips only. Keep in mind the activity restrictions outlined above. Also remember there are inherent liabilities you will be subject to if you drive with a sling in place. You will be considered by many to be less than fully capable to handle traffic situations in the post-op period. The ultimate decision to drive or not is yours. If there is any doubt in your mind---you should not drive.

  7. Forms:

    Short-term disability, family medical leave act (FMLA), school excuses, and other forms will be filled out after they are brought to the office. You should not give them to me or others at the time of your surgery to fill out as they are more likely to be misplaced.

  8. Follow-Up Appointment:

    Unless otherwise directed, you need to be seen in 2-3 weeks. Call as early as you can to make the appointment to increase the likelihood of getting the time of day that you need.

  9. Emergencies/Problems:

    Call our office number for assistance as you need. Please bear in mind that we must prioritize these calls in terms of their emergent nature based on the information given. I may be in surgery or otherwise unavailable for short periods of time. Because of these factors, it may seem that it takes a while to get back to you. Please do not feel as though you are unimportant to us, just understand the nature of calls require us to make a decision as to what order they are addressed. If you need more urgent attention, please call back. If needed return to the hospital for emergent problems. summitorthopedicswv.com is a resource that may provide answers to some of your questions by going to the “links” page and connecting to one of the available websites.

  10. Thank you very much for entrusting your care to me!

Trigger Finger Post-Op Guidelines for Dr. Surface’s Patients

Several different techniques can be performed during the treatment of trigger fingers, and therefore each patient may have specific instructions, depending on the exact surgery performed. These instructions are to be used as a guide for your recovery and may be tailored to each individual patient. If there are specific instructions needed for you, we will explain them to you prior to discharge from the hospital.

  1. Resume your pre-op diet and medications unless specifically told otherwise.

  2. Activity:

    Take it easy. Go ahead and go about the things you need to do when you feel like it, however allow yourself time to rest and recover. Do no lifting, pushing, or pulling greater than 3 pounds until specifically allowed.

    Movement of the operated upon fingers is encouraged to begin the same day of surgery. You may begin right away unless specifically instructed otherwise. Most often pain is the limiting factor, but you may begin very slowly and proceed gradually moving the fingers more and more. The most common problem we encounter after trigger finger surgery is finger stiffness. I cannot emphasize how important this is. Keep in mind that this movement should be directed as though you are attempting to squeeze something with your fingers, followed by full straightening of them as far as you can. In other words, slow, steady FULL movement of the fingers is better than wiggling them back and forth. As you get stronger, you can actually squeeze something in your hand....the best is silly putty. PLEASE make certain to FULLY bend your finger all the way down, and straighten all the way out! Do this, even if you must use your other hand to help. This full movement must be achieved within the first week after trigger finger release.

    If there are special limits on your activity for a period of time, you will have specific instructions upon leaving the hospital.

  3. Bandage:

    To account for the expected swelling after surgery, it is important for you to ice and elevate the area. This is especially true the first few days post-op. This will speed up healing, and decrease pain.

    A large bandage is applied at the end of surgery. This is done because frequently drainage occurs post-op. This is normal. This drainage has some blood in it. It will look like cherry kool aid! It frightens some people, but is entirely normal. I typically place a large bandage to soak up this. Once you change your bandage, you may use Band-Aids to cover.

    At bandage changes, clean the area with a small amount of peroxide and replace. You may apply antibiotic ointment to the area.

    Keep the area clean and dry. You can shower, but you must keep this area dry with a bag or other device for 4-5 days. After your stitches come out at the first office visit, you can get the hand under water.

    Expect some swelling, some redness, and even some discoloration or bruising during your early recovery. This is worrisome to lots of patients, but once again, entirely normal and even expected.

    You may be given a prescription for antibiotics to take for a few days after surgery. Please finish all the antibiotics as prescribed to allow for their full effectiveness, and to decrease the chance of developing resistant bacteria from not completing the whole course of the prescription.

  4. Pain Management:

    You will be given one or more prescriptions for pain medication. Take this medicine as you need it. The prescription is written to allow for some leeway in the dose allowed. As your pain subsides, take a smaller dose and/or take the medicine less frequently. The chance of nausea is decreased by not taking the medicine on an empty or overly full stomach. Do not take other people’s prescriptions. Do not drive or perform other important or potentially hazardous tasks while taking the pain medicine. Do not drink alcohol while taking your pain medicine. Generally it is safe and recommended to take an anti-inflammatory medication such as ibuprofen or Aleve with your prescription if you are not allergic. Do not take any Tylenol (acetaminophen) containing medications with your prescription.

    Ice the area. This will decrease swelling and pain. Ice WILL work even in the presence of a bandage. Do not leave the ice in place for extended periods. An effective and inexpensive method is to use bags of frozen peas! Keep a couple of bags around, apply one until it thaws, place it back in the freezer and get out the other one, alternating in this way. It sounds goofy, but works well.

    During the time of your operation, we usually give a “numbing” medicine (local anesthetic) either in the form of a block by the anesthesiologist, or I will inject the medicine around the surgical site. This works to decrease your pain significantly. There is a major drawback in that these medicines “wear off” abruptly. When the medicine stops working it can occur rapidly with a dramatic increase in pain. To avoid this, an hour or so after you get home take one of your pain pills, even if it does not seem needed. This will allow your body to have some pain medicine on board when the numbing meds wear off. Sometimes these local anesthetics last for a long time, and you may need to repeat the smallest dose of your prescription medication once or twice before the numbing effect is gone. Do this technique unless directed otherwise.

    You may have an allergy to codeine and still get a medicine that sounds like, or is spelled similarly to codeine. Do not be troubled by this. Often prescription pain medicines have names that have "codone” in them. This does not mean that you are automatically allergic because of a previous allergy to codeine, despite what you may hear. People can be allergic to BOTH types of medicines, but just because the name is similar, doesn’t mean you cannot take the medicine prescribed. Phillip and Phyllis sound a lot alike, maybe they act the same way, but each is used to describe a completely different entity.

    I attempt in every case to give an amount of medication needed for your surgery. I realize everyone is different in their pain needs, and that you may need more medication. Not all medicines work the same for every patient and therefore some people will use more than others. Keep in mind that your pain will dramatically decrease over the first few days. Also be aware that our policy is that we do not call in narcotic pain prescriptions. As you are aware, significant, needed legislation has limited the amount of pain medication you can receive. I will give you the amount of medication that over 20 years experience has led me to feel you need....and no more. I will treat you with compassion regarding your pain, but please understand that decisions regarding your pain meds are always made in your best interest.

  5. Work:

    Every job is different of course, so each person’s ability to go back to work depends on several factors. During the initial post-op period, you have a legitimate reason to be off work at least until the first office visit. At that time please inform us of your intentions, and your employer’s willingness/reluctance for your return. If you must/want, or are required to return to work prior to your first post-op visit, you may, as long as you can adhere to the restrictions outlined above. We will complete the needed paperwork to make it happen when you come to the office. The long term return to your pre-op status will be tailored to your individual needs as it relates to healing and job requirements.

  6. Driving:

    Do not drive while taking your pain medicine. In general you should not drive the first week after surgery. You may drive afterward if your car is an automatic, and you take short trips only. Keep in mind the activity restrictions outlined above. Also remember there are inherent liabilities you will be subject to if you drive after surgery. You will be considered by many to be less than fully capable to handle traffic situations in the post-op period. The ultimate decision to drive or not, is yours. If there is any doubt in your mind---you should not drive.

  7. Forms:

    Short-term disability, family medical leave act (FMLA), school excuses, and other forms will be filled out after they are brought to the office. You should not give them to me or others at the time of your surgery to fill out as they are more likely to be misplaced.

  8. Follow-Up Appointment:

    Unless otherwise directed, you need to be seen in 2-3 weeks. Call, or make your appointment at summitorthopedicswv.com as early as you can to increase the likelihood of getting the time of day that you need.

  9. Emergencies/Problems:

    Call our office number for assistance as you need. Please bear in mind that we must prioritize these calls in terms of their emergent nature based on the information given. I may be in surgery or otherwise unavailable for periods of time. Because of these factors, it may seem that it takes a while to get back to you. Please do not feel as though you are unimportant to us, just understand the nature of calls require us to make a decision as to what order they are addressed. If you need more urgent attention, please call back. If needed return to the hospital for emergent problems. The website summitorthopedicswv.com is a resource that may provide answers to some of your questions.

  10. Thank you for allowing me to take care of you!

Wrist Fracture Guidelines for Dr. Surface’s Patients

Several different procedures can be performed during the treatment of wrist fractures, and therefore each patient may have specific instructions, depending on the exact surgery performed. These instructions are to be used as a guide for your recovery and may be tailored to each individual patient. If there are specific instructions needed for you, we will explain them to you prior to discharge from the hospital.

  1. Resume your pre-op diet and medications unless specifically told otherwise.

  2. Activity:

    Take it easy. Go ahead and go about the things you need to do when you feel like it, however allow yourself time to rest and recover. Do no lifting, pushing, or pulling greater than 3 lbs until specifically allowed.

    Movement of the fingers is encouraged to begin the same day of surgery. You may begin right away unless specifically instructed otherwise. Most often pain is the limiting factor, but you may begin very slowly and proceed gradually moving the fingers more and more. The most common problem we encounter after wrist fractures is finger stiffness. I cannot emphasize how important this is. Keep in mind that this movement should be directed as though you are attempting to squeeze something with your fingers, followed by full straightening of them as far as you can. In other words, slow, steady FULL movement of the fingers is better than wiggling them back and forth. As you get stronger, you can actually squeeze something in your hand....the best is silly putty. If your elbow is free, please bend it back and forth to decrease swelling. The same goes for your shoulder. You may do these exercises, and replace your arm back into a sling as needed.

    Certain surgeries on the wrist require special limits on your activity for a period of time. In these examples you will have specific instructions for the amount and when you may move the fingers.

  3. Bandage/Splint/Cast Care:

    We place a cast or splint at the end of surgery, depending on technical factors. This device needs to be left in place. To account for the expected swelling after surgery, it is important for you to ice and elevate the area. This is especially true the first few days post-op. This will speed up healing, and decrease pain.

    A large bandage is applied at the end of surgery. This is done because frequently drainage occurs post-op. This is normal. This drainage has some blood in it. It will look like cherry kool aid! It frightens some people, but is entirely normal. I typically place a large bandage under the splint or cast to soak up this. Keep the area clean and dry. You can shower, but you must keep this area dry with a bag or other device. After your stitches or staples come out at the first office visit, you may or may not be allowed to get the area wet.

    Expect some swelling, some redness, and even some discoloration or bruising during your early recovery. This is worrisome to lots of patients, but once again, entirely normal and even expected.

    You may be given a prescription for antibiotics to take for a few days after surgery. Please finish all the antibiotics as prescribed to allow for their full effectiveness, and to decrease the chance of developing resistant bacteria from not completing the whole course of the prescription.

  4. Pain Management:

    You will be given one or more prescriptions for pain medication. Take this medicine as you need it. The prescription is written to allow for some leeway in the dose allowed. As your pain subsides, take a smaller dose and/or take the medicine less frequently. The chance of nausea is decreased by not taking the medicine on an empty or overly full stomach. Do not take other people’s prescriptions. Do not drive or perform other important or potentially hazardous tasks while taking the pain medicine. Do not drink alcohol while taking your pain medicine. Generally it is safe and recommended to take an anti-inflammatory medication such as ibuprofen or Aleve with your prescription if you are not allergic. Do not take any Tylenol (acetaminophen) containing medications with your prescription.

    Ice the area. This will decrease swelling and pain. Ice WILL work even in the presence of a cast. With a cast or splint, you can leave the ice in place for extended periods without danger. An effective and inexpensive method is to use bags of frozen peas! Keep a couple of bags around, apply one until it thaws, place it back in the freezer and get out the other one, alternating in this way. It sounds goofy, but works well.

    During the time of your operation, we usually give a “numbing” medicine (local anesthetic) either in the form of a block by the anesthesiologist, or I will inject the medicine around the surgical site. This works to decrease your pain significantly. There is a major drawback in that these medicines “wear off” abruptly. When the medicine stops working it can occur rapidly with a dramatic increase in pain. To avoid this, an hour or so after you get home take one of your pain pills, even if it does not seem needed. This will allow your body to have some pain medicine on board when the numbing meds wear off. Sometimes these local anesthetics last for a long time, and you may need to repeat the smallest dose of your prescription medication once or twice before the numbing effect is gone. Do this technique unless directed otherwise.

    You may have an allergy to codeine and still get a medicine that sounds like, or is spelled similarly to codeine. Do not be troubled by this. Often prescription pain medicines have names that have "codone” in them. This does not mean that you are automatically allergic because of a previous allergy to codeine, despite what you may hear. People can be allergic to BOTH types of medicines, but just because the name is similar, doesn’t mean you cannot take the medicine prescribed. Phillip and Phyllis sound a lot alike, maybe they act the same way, but each is used to describe a completely different entity.

    I attempt in every case to give an amount of medication needed for your surgery. I realize everyone is different in their pain needs, and that you may need more medication. Not all medicines work the same for every patient and therefore some people will use more than others. Keep in mind that your pain will dramatically decrease over the first few days. Also be aware that our policy is that we do not call in narcotic pain prescriptions. As you are aware, significant, needed legislation has limited the amount of pain medication you can receive. I will give you the amount of medication that over 20 years experience has led me to feel you need....and no more. I will treat you with compassion regarding your pain, but please understand that decisions regarding your pain meds are always made in your best interest.

  5. Work:

    Every job is different of course, so each person’s ability to go back to work depends on several factors. During the initial post-op period, you have a legitimate reason to be off work at least until the first office visit. At that time please inform us of your intentions, and your employer’s willingness/reluctance for your return. If you must/want, or are required to return to work prior to your first post-op visit, you may, as long as you can adhere to the restrictions outlined above. We will complete the needed paperwork to make it happen when you come to the office. The long term return to your pre-op status will be tailored to your individual needs as it relates to healing and job requirements.

  6. Driving:

    Do not drive while taking your pain medicine. In general you should not drive the first week after surgery. You may drive afterward if your car is an automatic, and you take short trips only. Keep in mind the activity restrictions outlined above. Also remember there are inherent liabilities you will be subject to if you drive after knee surgery. You will be considered by many to be less than fully capable to handle traffic situations in the post-op period. The ultimate decision to drive or not is yours. If there is any doubt in your mind---you should not drive.

  7. Forms:

    Short-term disability, family medical leave act (FMLA), school excuses, and other forms will be filled out after they are brought to the office. You should not give them to me or others at the time of your surgery to fill out as they are more likely to be misplaced.

  8. Follow-Up Appointment:

    Unless otherwise directed, you need to be seen in 2-3 weeks. Call, or make your appointment at summitorthopedicswv.com as early as you can to increase the likelihood of getting the time of day that you need.

  9. Emergencies/Problems:

    Call our office number for assistance as you need. Please bear in mind that we must prioritize these calls in terms of their emergent nature based on the information given. I may be in surgery or otherwise unavailable for periods of time. Because of these factors, it may seem that it takes a while to get back to you. Please do not feel as though you are unimportant to us, just understand the nature of calls require us to make a decision as to what order they are addressed. If you need more urgent attention, please call back. If needed return to the hospital for emergent problems. The website summitorthopedicswv.com is a resource that may provide answers to some of your questions.

  10. Thank you for allowing me to be Your Surgeon!