Nicholas K. Sablan, M.D.

Medial or Lateral Epicondylitis Surgery

Post Operative Instructions after Medial or Lateral Epicondylitis Surgery Helpful Hints & Important Precautions for Patients

Diet

Medications:

Before surgery you will be offered a nerve block which helps greatly with pain control and decreases your need to take narcotic medications. It is important to begin taking your pain pills before this medicine wears off.
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, it can be used every 2 pills 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 2 tablets a day and a laxative such as Miralax to avoid constipation.
Take Benadryl one half hour before your narcotic if you experience itching.
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.
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 will work synergistically in pain relief. Do not take if history of stomach ulcers or kidney dysfunction.
All non-narcotic medications will be called into your pharmacy prior to surgery.

Bandages & Sling:

Your post-operative dressing should be kept clean and dry for the first 48 hours after surgery.
You can remove your dressing 2 days after surgery to shower. Leave the steri-strips in place. Cover the incision with Cling Wrap while showering. Replace your ACE wrap after showering.

You will have a sling placed after surgery. You can remove the sling as tolerated.

Ice & Activity:

One important goal following surgery is to minimize swelling around your surgery site. The best way to achieve this is with elevation of your elbow above the level of your heart. Try to avoid having your hand hanging down for extended periods of time.
I encourage 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.

I encourage you to move your wrist and fingers as much as possible as this will improve your chances of an early recovery and decrease your chances of developing stiffness.
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 with your arm elevated to avoid swelling will be your most comfortable position. Make sure to have your pain under control before you sleep.

Therapy

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 exercises on your first visit.
You may start therapy after your first post-operative visit.
Depending on the strength of your tendon, I will place you in a brace and discuss restrictions with your hand therapist.

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