The Shoulder

How well do you know your shoulder?

The shoulder is a ball and socket joint formed by two bones, the humerus and the scapula (shoulder blade). Additional bones in the shoulder provide support.

Shoulder Anatomy and DiagramThe shoulder joint has four muscles and their tendons which provide support and allow for a wide range of motion within the joint. These are called the rotator cuff muscles.

Between the humerus and the scapula is a cuff of cartilage called the labrum. The labrum works to stabilize the ball of the humerus in the socket of the scapula.

Within the shoulder joint there are bursae. Bursae work to provide spacing, cushioning, and lubrication within the joint. Ideally, bursae allows for a friction free, pain free movement.

Brand Names vs Trade Names

It is common to be prescribed medications by your physician after surgery. Pain, anti-inflammatory, anti-nausea, and antibiotic medications are the most common.

However, in today’s marketplace, there is a large amount of brand and trade names for each medication which can cause confusion. Here is a list of commonly prescribed medications (at the surgery center) with both their brand and trade names.

Pain Medications

Brand Name

Common Trade Names

Hydrocodone

Vicodin, Lortab, Lorcet, Norco, Anexsia, Hycet

Oxycodone

Percocet, Endocet, Oxycontin, Roxicodone

Morphine Sulfate

Duramorph, MS Contin, Avinza, Roxanol

Fentanyl

Sublimaze, Duragesic, Actiq, Fentora, Haldid

Hyromorphone

Dilaudid, Palladone, Exalgo

Tramadol

Ultram, Ultracet

Codeine

There are no trade names for codeine, but many medications contain codeine. The most common is Tylenol with Codeine, commonly called T2’s, T3’s, or T4’s.

 

Anti-Inflammatory Medications

Brand Name

Common Trade Names

Ketorolac

Toradol, Sprix, Acular

Celebrex

Celecoxib

Indocin

Indomethacin

Mobic

Meloxicam

Voltaren

Diclofenac

 

Anti-Nausea Medications

Brand Name

Common Trade Names

Ondansetron

Zofran

Metoclopramide

Reglan

Aprepitant

Emend

Decadron

Dexamethasone

 

Antibiotic Medications

Brand Name

Common Trade Names

Cefalexin

Cefadal, Derantel, Mecilex, Medoxine, Keflex, Ceporex

Cefazolin

Ancef, Cefacidal, Cefamezin, Cefrina, Elzogram, Faxilen, Gramaxin, Kefzol, Kefol, Kefzolan, Kezolin, Novaporin, Reflin, Zinol, Zolicef

Clindamycin

Cleocin HCL, Dalacin, Clindacin

Arthro, Lapro … what?

Clarifying confusing surgical terminology:

Arthroscopic Surgery –

The word “arthroscopy” comes from the Greek words ‘arthro’ and ‘scope’, meaning ‘joint’ and ‘look’, respectively. When an arthroscopy is performed, a camera is inserted into the joint through an incision approximately one centimeter. The camera is attached to a light source and displays a picture of the inside of the joint on a television screen in the operating room. The surgeon uses fluid to expand the joint, aid in visibility, and clear the joint of debris. One or more other incisions are made to insert instruments that are used to treat a variety of conditions such as a torn meniscus or torn rotator cuff. This type of surgery is commonly referred to as a scope.

Laparoscopic Surgery –

The word “laparoscopy” comes from the Greek words ‘laparo’ and ‘scope’, meaning ‘flank’ or ‘abdominal wall’ and ‘scope’, respectively. When a laparoscopic surgery is performed, a camera is inserted into the abdominal wall through an incision approximately one centimeter. Again, the picture is displayed on a television screen in the operating room. Unlike arthroscopic surgery, the surgeon will use gas to increase visibility within the abdomen instead of fluid. One or more other incisions are made to insert instruments that are used to treat a variety of conditions such as an appendectomy (appendix removal) or cholecystectomy (gallbladder removal). This type of surgery is commonly referred to as a minimally invasive surgery or a keyhole surgery.

What Pain Medications Will I Receive After My Surgery?

Recovery time will be faster and more tolerable with the use of pain medication.

Upon admission, a pre-operative nurse will discuss allergies and past pain medications with each patient. This is done to understand what medications have or have not worked in the past for that particular patient.

The OSMS surgeons most commonly use Vicodin (Hydrocodone) and Percocet (Oxycodone). Both of these narcotics are controlled substances. This means that they are not able to be called into a pharmacy. Therefore, it is recommended that all patients discuss their pain control options with their physician at their pre-operative appointment. This allows time for a prescription to be written, dropped off, and picked up at your pharmacy before your day of surgery.

After your surgery, while patients still have an IV, they are able to receive IV narcotics to get pain to a tolerable level. Once the patient is more awake and able to tolerate a small snack and beverage, the nursing staff can administer oral narcotics to take before the patient goes homes. The goal is for patients to have a ride home with minimal discomfort.

Physical dependency can occur with several weeks of narcotic use. Therefore limiting your usage to a short time period over the initial few days of recovery will minimize your chances of developing a dependency. Additionally, stopping the pain medication gradually will make the recovery period more tolerable.

Side Effects of Oral Narcotics:

Constipation: It is recommended to take to a stool softener when starting the use of narcotics such as Colase, Metamucial, Miralax, etc. Also increasing daily fluid intake of water as well as increasing daily fiber consumption of fruits and vegetables will assist with preventing constipation.

Drowsiness: It is not recommended to drive or operate heavy machinery while taking narcotics.

Nausea/Vomiting: It is recommended to take narcotics with food.

– Rare and severe side effects include difficulty breathing or chest pain. Call 911 if this happens.

Individuals with health conditions, including depression, head injuries, thyroid disorders, and kidney or liver disease may not be able to take narcotics. Please discuss these conditions with the physician prior to surgery.

At times, you may experience breakthrough pain and may need to supplement your narcotic with an anti-inflammatory (Ibuprofen, Motrin) medication. If recommended by the physician, it is safe to take Motrin 800mg every 8 hours with your narcotic. Please discuss this with the physician as it does depend on your normal daily medication regimen.

Infections After Surgery

How common are they, can they be treated, and what can I do to help prevent them?

An infection that occurs after surgery is called a Surgical Site Infection or SSI.

How common are they?

While they do occur, they are not common. On average, 1 to 3 out of every 100 patients develops a SSI. Symptoms of a SSI include redness and pain around the surgical area, drainage of cloudy fluid from the surgical wound, or fever.

Can they be treated?

Yes, they are treated with antibiotics. The type of antibiotic used will depend on the type of infection. In rare cases, the patient will require another surgery after a SSI.

What can I do to help prevent them?

Hospitals and Surgery Centers follow many protocols and guidelines to reduce the chance of infection, but patients can help prevent infections as well by:

– Correctly informing the surgeon about medical problems such as allergies or diabetes.

– Quit smoking. Patients who smoke have a higher chance of infection.

– Not shaving near the surgical site. Razors can irritate the skin which can increase the chance of infection.

– Do not allow family members or friends who visit to touch the surgical wound.

– Always clean your hands before and after dressing your wound.

– Avoid submission in water such as baths, pools, hot tubs, and lakes until cleared by the surgeon.

– Do not allow animals or pets to come in contact with the wound until cleared by the surgeon.

– Call your surgeon as soon as you notice symptoms of a possible infection.

If you have additional questions, please ask your doctor or nurse.

Weight Bearing Restrictions After Surgery

Often after surgery on the hip, knee, or ankle the physician will order specific weight bearing restrictions.

NWB – Non Weight Bearing

TT – Toe Touch Weight Bearing <10lbs

WBAT – Weight Bearing as Tolerated

If these restrictions are ordered by the physician, they will be reviewed with you before you are discharged home. Additionally, if you are NWB or TT weight bearing status, some form of assistive device such as crutches, a cane, walker, wheel chair, or knee scooter will be recommended. If deemed necessary, these assistive devices would be ordered by the physician and accommodations made at BOSC. 

Medical Terminology Deciphered: NPO

NPO…what?

NPO is a medically approved abbreviation that means NOTHING BY MOUTH. The abbreviation is based on the Latin translation of nil per os meaning nothing by mouth.

Prior to scheduled surgery, it is recommended that the patient has nothing by mouth (no food or fluid) for a minimum of six hours and preferred eight to 12 hours prior to surgery start time.

NPO status is used prior to surgery to help prevent ASPIRATION PNEUMONIA. By definition, aspiration pneumonia is when food or fluid from your stomach is aspirated or inhaled into your lungs which can cause an infection and lead to pneumonia.

Here at BOSC, our nurses sympathize for our patients on the day of their scheduled surgery when they are beyond hungry. Please know that your best interest is behind the NPO status and as soon as patients are able, they will be given something to eat and drink.  

Aspirin & Surgery

health-icons-15It is often recommended that you stop taking aspirin five days prior to your scheduled surgery date. This is done to help prevent bleeding complications and prevent excessive bruising. This is true for both adult aspirin (325mg) as well as low dose aspirin (81mg).

In contrast, many times after surgery it is recommended to start taking aspirin (if you do not take aspirin on a regular basis) for approximately 14 days to help prevent blood clots. This is due to the anticoagulant properties of aspirin.

Note* Aspirin regimen is prescribed on an individual basis and needs to be confirmed by your physician.

BOSC Featured for 0 Infection Rate

beckers

An article in today’s Becker’s ASC Review featured BOSC for being a champion in infection control for maintaining a zero infection rate year to date. Interim Administrator Amanda Sosnosky explains BOSC’s protocols and procedures to maintain this standard. Find the article here. 

 

 

 

 

Things to Know if Your Child is Having Surgery

The Night Before Surgery

Be sure to eat a balanced supper.

Stop food and water intake at the determined time.

Give your child a bath or shower with an antibacterial soap such as Dial or the Hibicleanse soap provided by our Prepare RN.

Have your child sleep in clean pajamas and clean sheets.

The Day of Surgery

Do not allow your child to eat or drink anything, this includes chewing gum.

Bring along your child’s favorite toy as well as extra clothes, diapers, blankets, etc. Often times, stuffed animals are allowed to accompany your child during surgery.

The parents and/or guardians need to accompany the child and are required to stay at the surgery center from admission to discharge.

It is encouraged that other young children or siblings remain at home with responsible family members.

Often times after surgery the parents or guardians are brought to the recovery room prior to the child waking up. This allows both the parents or guardians and the RN to comfort the child when they wake.

Upon discharge, it is recommended that both parents or guardians are present; one to sit in the back and tend to the child and one to drive home.

The Days Following Surgery

Be aware that your child can feel tired, restless, or irritable 24-48 hours after anesthesia and that your child should not be left alone.

Pain medication will be provided in appropriate doses for your child based on their weight. However, as a parent or guardian it is your responsibility to assess pain in an age appropriate manner as well as administer pain medication when needed.

Encourage fluid intake and easy to digest foods. Monitor that your child is eliminating on a regular interval.

A Registered Nurse from the surgery center will contact you the next day to see how your child is doing, however if you need anything, you can always call the office.