Elbow Contracture Release

Nicholas K. Sablan, M.D.

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Post Operative Instructions after Arthroscopic or Open Elbow Contracture Release Helpful Hints & Important Precautions for Patients 

 

Diet 

  • You may resume clear liquids and light foods after surgery (jello, soup, etc.) 
  • Progress to your normal diet as tolerated as long as you are not nauseated. 

Medications: 

  • The first medication I use is Tramadol which is a narcotic pain medication. It will begin to work within 15 minutes after taking it with a maximal effect in one to two hours. Normally, Tramadol is taken 1 pill every 6 hours but if the pain is severe, 2 pills can be used every 4 hours. 
  • Common side effects of the medication are nausea, constipation, itching, and drowsiness. 
  • The best way to prevent nausea is to take the medicine with a little food, start with just one pill, and be patient while the medicine begins to work. Usually, after the first few doses the nausea will go away. I also prescribe an anti-nausea medication called Zofran (Odansetron) to be taken if you have persistent nausea after surgery. 
  • I strongly recommend you take an over-the-counter stool softener starting the day of surgery such as Colace 100 mg 1 tablet a day and a laxative such as Sennokot DS 2 tablets a day to avoid constipation. 
  • Take Benadryl one half hour before your narcotic if you experience itching. 
  • You will also be given a prescription for Naprosyn which is a strong anti-inflammatory medication. Take this twice a day with food in addition to the Norco. Both medications work synergistically in pain relief. Do not take if history of stomach ulcers or kidney dysfunction. 
  • Transition from Tramadol to Tylenol as your pain subsides. Patients with normal liver function should not consume more than 3000 mg of Tylenol per day. 
  • All non-narcotic medications will be called into your pharmacy prior to surgery. 

Bandages & Sling: 

  • Keep your post-operative splint clean and dry. You will have it removed in therapy within 2-3 days after your surgery so that we can begin range of motion exercises and static progressive splints. 
  • Your incisions are closed with absorbable or nonabsorbable stitches. Leave the steri-strips on as this helps the wound heal under less tension. 

Washing & Sling: 

  • You should be careful to keep the wound clean and dry for the first 48 hours after surgery. 
  • Beginning on the second day after surgery it is OK to shower as long as the incisions are kept dry with plastic wrap. Remove the wrap after showering. 
  • Do not take a bath until after the first post-operative visit. 
  • Avoid submerging your arm under water until two weeks after surgery. 

Ice & Activity: 

  • One important goal following surgery is to minimize swelling around your surgery site. The best way to achieve this is with the frequent application of ice. This is most important during the first 48 hours following surgery. The ice pack should be large (like a big zip-lock bag) and held firmly on the area of your surgery. Apply for 15 minutes every hour while awake if possible. 
  • Remember we did not do any repairs so you cannot hurt your elbow by moving it. I encourage you to move your arm as much as possible as this will improve your chances of an early recovery and decrease your chances of developing stiffness. 
  • Work on touching your hand to your nose and ear to keep your flexion and use your other hand to gently push your arm into extension. 
  • Occasionally I will order a CPM machine that will passively move your arm for you. Begin this after surgery when your splint is removed by the hand therapist. 
  • You may return to sedentary work only or school in 3-4 days after surgery if your pain is tolerable. 

Sleeping: 

  • Many patients have difficulty sleeping after elbow surgery. You may find that sleeping in a slightly upright position (ie reclining chair) with a pillow under your forearm will be your most comfortable position. Depending on your problem, I may want you to sleep with your splint in either flexion or extension. Make sure to have your pain under control before you sleep. 

Therapy and Splinting 

  • The goal of therapy is to first assess how your body responded to the surgical procedure. They help you feel comfortable with your surgery and make sure you aren't afraid to start doing things. Your therapist will start range of motion and strength exercises on your first visit. 
  • The hand therapist will assist you in maintaining the gains in motion that we obtained at the time of surgery. 
  • You will usually start hand therapy within 72 hours of having surgery. 
  • They will have you fitted for progressive static splints that you will alternatively wear to maintain flexion and extension. 

Follow up appointment: 

  • We try to give all of our patients a follow-up office visit at the same time we schedule your surgery. 
  • Typically I want to see my patients in the office 5 to 10 days after surgery. 

FOLLOW UP APPOINTMENT:  

What to watch out for: 

∞ Pain that is increasing every hour in spite of the pain medication 

∞ Drainage from the wound more than 2 days after surgery 

∞ Increasing redness around the surgical site 

∞ Pain or swelling around your surgery 

∞ Fever greater than 101.5 degrees. 

∞ Unable to keep food or water down for more than one day 

 

Nicholas K. Sablan, M.D.
postoperative instructions