Frequently asked questions

1. When can I drive?
2. How long will the operation take?
3. How long will I be off work?
4. How should I look after my wound, when can I bath or shower?
5. How will I know if my wound is becoming infected?
6. What painkillers should I take?



1. When can I drive?
Deciding when you can return to driving has two considerations:

  • Will the act of driving impact or impair the healing process and perhaps compromise the final outcome of your surgery.

  • Are you safe to drive, ie. perform an emergency stop or similar.

It depends on what you drive (automatic/ manual/ power steering), the conditions you are driving in (bad weather/ night/ poor roads), how long the journey. Once your arm is strong enough and has enough range of motion to physically go through the motions of driving, it is also important to consider reaction times. As with most return to activity advice it is best to follow a graduated return, increasing the duration and intensity as comfort allows. Considerations based particular on surgery/ injury .

Shoulder replacement

The main consideration following shoulder replacement surgery is the healing of the tendons, in general tendon healing takes 6-8 weeks, getting stronger to the 3 month mark. As a guide it will be at least 6-8 weeks and then a gradual increase in activity/ driving.



Arthroscopy (key hole shoulder surgery)

If you have had arthroscopic shoulder surgery where no tendon or ligaments have needed repair, immediate movement is encouraged and you can drive once physically able. On average most people return to driving around 1 month following surgery. If a ligament or tendon has been repaired, you need to wait till the tendon/ ligament has healed, around 6-8 weeks and then a graduated increase in activity.



Hand surgery


Carpal tunnel decompression - usually wait till wound healed and sutures out 10-14 days. The scar remains tender 6-8 weeks and depends on what you drive (power steering, gear change). Most people start gentle driving around 2 weeks following surgery.
Dupuytrens contracture - usually wait till wounds healed and hand comfortable, around 2-3 weeks, longer if skin graft used to close wound.



2. How long will the operation take?

"
You want a good operation not a quick operation"

Patients are usually off the ward for 2-3 hours.
Not all this time is surgery, time is spent putting you to sleep and waking you up in recovery after the operation.
The operating time itself is variable.

3. How long will I be off work?
General timescales for return to driving and work
 

Procedure work non manual work manual Driving

Arthroscopic subacromial decompression +- ACJ excision

 6 weeks 85% within 3 months  4 weeks
       
Carpal tunnel decompression      2 weeks
       
Shoulder replacement (Resurfacing, Copeland, Hemiarthroplasty)     6-8 weeks
       



4. How should I look after my wound, when can I bath or shower?
This depends on several things, essentially you should keep the wound clean and dry until the sutures (stitches) come out.
The dressing has been placed in a sterile environment and is best left intact for 5 days. Only change the dressing earlier if specifically instructed to, or if it is soaked through, moist or you are worried your wound might be becoming infected (see below).
If dry or only lightly stained with dry blood the dressing is best left sealed till 5 days after your operation.
Following arthroscopic procedures it is not uncommon for wounds to leak fluid for a few days, change dressings when they are moist or soaked through.
If I have used absorbable sutures and totally buried the sutures (subcuticular monocryl) under the skin, you can shower day 5 and bath day 10 post op.
Often over the top of a wound I will apply steristrips (butterfly sutures). These small tapes take the tension off the wound edges. They normally come off with dressing changes or fall off on their own. If not all off after 2 weeks shower or bath to loosen them up and gently peel them off.
If you have stitches that are not absorbable that stick out through the skin (nylon, prolene) it is best to keep the wound clean and dry till they come out usually around 10-14 days after your surgery.
It is not the end of the world if you get your dressing or stitches wet, simply remove the wet dressing pat the wound dry with a clean towel and re dress. If you really have to you could shower and allow clean running water over conventional sutures after 5 days, it is probably safest though to wait till all the sutures are out.

5. How will I know if my wound is becoming infected?
Following the surgery as a whole the pain discomfort and swelling should be improving. You should be concerned and seek medical advice if things change specifically if you notice.
 

  • Swelling around the wound

  • Discolouring, increasing redness around the wound

  • Puss, increased discharge from the wound

  • Smelly odour

  • High temperature


6. What painkillers should I use?


Advice below is for patients on no regular medication.
If you are on a lot of regular medication it is a good idea to speak to your medical practitioner about the choice of pain killers.
There are essentially 4 groups of painkillers. As with most things in life you have to work out what is right for you.

Some painkillers will have the same active ingredient yet different names, read the fine print as to the contents eg. Voltarol is the trade name for diclofenac sodium, Co-codomol contains paracetamol and codeine.

The four main goups of pain killer are:

  1. Paracetamol

  2. Non Steroidal anti-inflammatory drugs NSAID's

    • Ibuprofen, brufen, nurofen

    • Votarol, diclofenac sodium

    • Naproxen, Naprosyn

    • Aspirin (high dose 300mg)

  3. Opiates or opioids (morphine/ codeine compounds)

  4. Other


  5. All the pain killers above work in different ways and act on different places hence can be used in isolation and in combination. It is possible to mix all the above medication as long as they are in their pure form and using only one kind from each group. Read the insert and what the tablet is made up of. The "co "tablets ( Co dydramol, co codomol, co proxomal) are combination drugs usually paracetamol mixed with a drug from the opioid group. Some over the counter preparations of ibuprofen may contain paracetamol and or codeine.

    1. Paracetamol
    Standard dose for an adult is 1 Gram of paracetamol every six hours ie 2 * 500mg tablets 4 times a day (Max 8 * 500mg tablets per day).
    Paracetamol in the standard doses is pretty safe and has very few side effects.

    2. NSAID's - (Non Steroidal Anti inflammatories)

    NSAID's are very good for muscle, bone and joint pain.
    The main side effects and complications of NSAID's in the short term is on the stomach (indigestion, heartburn and ulcers), long term use is associated with kidney damage.
    Asthma may be made worse by NSAID's, patients with severe brittle asthma are probably better off avoiding NSAID's.
    Some NSAID's are associated with increased risk of heart problems.
    There are several different kinds of NSAID, no one NSAID is perfect for everyone. NSAID's softer on the stomach are available and it is possible to take medication to soften the effects of NSAID's on the stomach.
    Although they are very good for reducing pain from broken bones (fractures). NSAID's have been shown to slow down bone healing following fractures. For most fractures this is only a small effect, however if you have a fracture that is being slow to heal (unite) or a fracture of a bone that is known to be slow to heal, then they are best avoided or only used if the pain cannot be controlled with the other kinds of pain killers.
    No perfect NSAID exists for everyone and it is best to find the one that suits you.
    BEWARE NSAIDS thin the blood a little and increase the effect of warfarin and other blood thinning drugs (aspirin, clopidogrel, plavix) BEWARE if you have stomach ulcers, asthma, kidney problems angina or heart failure - consult your doctor.

    • Ibuprofen, brufen, nurofen - Over the counter NSAID, very good, safe and low side effect profile

      Standard dose 400mg 8 hourly best taken after meals.

    • Voltarol, Diclofenac - Slightly stronger than Ibuprfofen, still well tolerated. Long acting versions available and combination compounds to help protect the stomach

      Standard doses 50mg 8hourly or longer acting 75mg 12 hourly.

    • Naproxen, Naprosyn - Very good perhaps better choice for long term use (months/ years)

      Standard doses 250-500mg 12 hourly

    • Aspirin is about the same strength as paracetamol and is a weak NSAID. It is used more frequently in low doses (75mg) now to "thin the blood a little" more so than for its NSAID and pain killing action. Low dose aspirin can be taken with another NSAID, avoid taking high dose aspirin and another NSAID as the stomach and kidney side effects are magnified.

    • Cox 2 inhibitors - These are a subset of NSAID's said to be softer on the stomach. Recently they have been shown to significantly increase the risk of heart failure and heart attacks. The licence for several of them has been withdrawn


    3. Opiates/ opioids


    Morphine is s a kind of opiate, several derivatives are available of varying strength. The main complication and side effects of the opioid analgesics are: drowsiness, loss of concentration, nausea, vomiting and constipation. Generally the stronger the opioid in terms of pain killing effect the more the side effects. The body does get used to the opioids and the side effects of nausea do decrease. Anti-sickness medication may be prescribed to take with the stronger opioids like morphine. Ensure you actively take steps to avoid constipation. Drink lots of fluid increase the fibre in your diet, consider mild over the counter laxatives if becoming constipated. Patients often worry about developing addiction to morphine and the opioids. This is not normally a problem in the acute situation.

    • Codeine phosphate - Very good, safe at standard doses Nausea, drowsiness and constipation are common side effects. Standard dose 8mg to 60mg 6 hrly.

    • Tramadol - Very good, safe at standard doses. Best avoided if history of seizures (fits) or history of epilepsy. Some patients feel "spaced out", disconnected from the world.
      Standard dose 50mg to 100mg 6hrly

    • Morphine/ fentanyl pain patches - Pain patches very good for sustained long lasting pain control.


    4. Other

    In certain circumstances medication that "calms nerves down" might be used. Often types of antiepileptic medication.

    • Amitryptiline - Helps with pain and mild sedative to help patients struggling to sleep at night.

      Standard dose (for pain not epilepsy) 25 mg at night

    • Carbamazepine

      Standard dose 100mg 12hrly

    • Gabapentin - Gradually increase dose till effect noted. Avoid suddenly changing or stopping.

      Standard dose 100mg 8hrly for 3 days then increase by 100mg every 3 days till target dose met or taking 1800mg per day in divided doses.