How do I make an appointment?
Simply call us at during our working hours or you can request an appointment online using this form.
Do I need a referral to make an appointment?
Most medical specialists will accept only referred patients. This is mainly to try to ensure that the specialist you are seeing is appropriate for you and your condition. Check with your insurance company to see if a referral is necessary.
What to bring for your initial consultation?
For your initial consultation you will need to bring a referral letter from your physician if required.
Here is check list for your initial consultation:
- Driver’s License or a valid ID
- Insurance information
- Referral Letter (if required)
- Reports, X-rays, MRIs, CT scans, etc. and any other relevant information
- List of medications (if any)
We encourage you to come to your initial consultation with a written list of questions to ensure you don’t forget to ask them when you visit the doctor.
Are my medical records kept private and confidential?
Your medical file is handled with the utmost respect for your privacy. Our staff is bound by strict confidentiality requirements as a condition of employment regarding your medical records. We will not release the contents of your medical file without your consent.
How long do I need time off work after the surgery?
The post-operative recovery period varies based on the surgery. Generally, it is recommended patients take two weeks off work to recover from any surgery and to resume light duty following resumption of work. Your surgeon will give you specific instructions to follow for a successful recovery.
How long before I can resume driving?
You should wait at least one week before driving after surgery. The effects of anesthetic and surgery can affect judgment and reflexes during the first week following your surgery. Your surgeon will provide more specifics after considering your condition.
When can I resume exercise?
Your doctor will instruct you about post-treatment exercises – the type and the duration to be followed. You may be referred to a physical therapist to help with strengthening and range of motion exercises following surgery.
How do I contact after hours?
There will be a point of contact 24 hours a day for any concerns you may have. You will be provided with contact details following your treatment.
What are the non-surgical treatment options?
The non-surgical treatment options include rest, medications including analgesics and antibiotics, injections, and physical/occupational therapy.
Will physical therapy be required after surgery?
Getting full range of motion, strength, and flexibility back after surgery usually takes time. That is where pre-operative exercise, education, and post -operative physical therapy programs come in – to ensure you are physically and emotionally prepared for surgery and to maximize your recovery after surgery.
What are the risks associated with surgery?
As with any surgery, risks include reactions to anesthesia, bleeding, infection, stiffness and nerve damage. Your doctor will discuss the risks associated with your specific procedure.
When can I return to daily activities?
This varies depending on the type of procedure undergone, and can range from a few days to a few months. Return to all activities, sports and exercise can take up to four to six months. Your doctor will advise you depending on your health condition.
What can happen if surgery is avoided?
Some complications of not undergoing an orthopedic surgery for your condition include pain, loss of joint motion, joint weakness, numbness and an early onset of arthritis.
What are the most common injuries?
The most common orthopedic injuries are sprains and strains, fractures and dislocations. Injuries can occur when playing indoor or outdoor sports or while exercising. Sports injuries can result from accidents, inadequate training, improper use of protective devices, or insufficient stretching or warm-up exercises.
What are cold therapy devices (cryotherapy) and pain pumps? Are they necessary for surgery?
These devices can help decrease pain, swelling, and inflammation after surgery. Even without the devices, you will have numbing medication injected at the end of surgery which typically lasts 3-5 hours; this will give you enough time to return home and start taking your oral pain medications.
The cold therapy devices are sterile pads incorporated into the post-operative dressings; the pads are attached by rubber tubing to motorized “igloos” which circulate ice-cold water through the pads. This is a controlled method of applying ice to a post-operative wound. One can use a frozen bag of peas or corn kernels as well, but the penetration through the dressing may not be that high, and care must be taken to not get the dressings wet. The cold therapy devices may continue to be used for weeks after the surgery such as after physical therapy appointments.
The pain pumps are automated devices that infuse numbing medication (like novocaine) into the wound via a small catheter. These usually last for 2 days and are removed in the office on your first post-operative visit. The catheters are small as to not need a suture for closure.
Both of these devices may not be covered by many insurances, especially HMOs. Cash quotes from suppliers we use may be obtained by calling Sean Smith of HUB Medical at (866) 438 3868.
What occurs in my pre-operative visit?
This will take place a few days before the surgery date. If you are under 18 years of age, your parent or guardian must come with you to sign your operative consent. Please be prepared to inform the physician of any drug allergies or sensitivities.
When and how will my surgery be scheduled?
Please contact our surgical coordinator to discuss surgery dates and info.
Reasons to notify your physician
Changes in your general health will affect your surgery. If at anytime prior to your surgery any of the following conditions develop, please notify your physician.
- Symptoms of cold
- Fever and/or chills
Do not eat or drink anything after midnight unless otherwise instructed by your physician or the anesthesiologist. Your surgery may be canceled if you eat or drink after midnight or as instructed.
Take routine medications only as directed by your anesthesiologist or physician.
Leave all jewelry, money, watches and valuables with family. The hospital can not be responsible for your valuables.
Wear comfortable casual clothing that is easy to get on and off (drawstring-style sweat pants, boxer-style shorts, or loose clothing), and large enough to accommodate a large dressing. Button-top shirts that can be draped over your shoulder are usually best for shoulder surgery, as you may not be able to easily put your arm through a sleeve after surgery.
Post-operative braces or cold therapy devices delivered to you by a vendor please bring the day of surgery.
You may wish to bring reading material or crossword puzzles to occupy your time while you are in the hospital.
Arrange to have an adult (someone over 18) available to drive you home after discharge, and have someone stay with you at least 24 hours once you are home. You will not be allowed to leave the hospital alone.
You will be notified the day before surgery by phone the exact time to arrive on the day of surgery. In general, you must arrive 1 hour before your scheduled surgery time.
Day of Surgery
- Check in where you were directed on your pre-operative visit at least 1 hour prior to your operative time.
- You will be asked to change into a hospital gown, remove jewelry and contacts. (We suggest you leave your contacts out the day of surgery.)
- The nurses will check your (pulse, blood pressure and temperature), and ask you a few questions.
- Once this is completed you will be directed to a waiting area until the operating room notifies the nurses.
- You will then be taken to the operating room on a cart. The anesthesiologist talks with you briefly, an IV (needle inserted to give you fluids) is inserted, and final preparations are carried out.
Your family will be directed to waiting rooms. Medical staff will notify them when your procedure is completed, and how you are doing. They will be directed to the appropriate area once you have completed your recovery room stay.
When surgery is completed, you will be taken to the recovery room. The usual length of stay in the recovery room is 1 hour, but may be longer according to the surgical procedure and the type of anesthesia.
While you are in the recovery room, the nurses will be checking your blood pressure, pulse, respirations, and temperature frequently. They will also be checking the sensation and circulation in your surgical leg.
You may have a large bandage, a brace or an ice cuff on your knee.
After your stay in the recovery room you will be transferred to same an outpatient observation unit where staff During this final recovery stage your nurses review homegoing instructions, obtain prescriptions, and you may be seen by a physical therapist.
Discharge is based upon your recovery from the effects of anesthesia, and if your pain is under control. Your physician determines if you are ready for discharge. If additional observation is required, you may be admitted to the hospital.
What happens at home?
It is normal to feel drowsy for 24-48 hours after surgery and to require pain medication at regular intervals. These symptoms will gradually subside and each day you will feel less sleepy and painful.
Activity after surgery?
Crutches are used for a short time. It often takes anywhere from 1-3 wks for swelling to resolve. During this time we’d like you to use crutches as a precaution, or at least one crutch on the opposite side for 1 week. Put as much weight as tolerable on your knee unless told otherwise
Meniscus Repair patients – I typically will limit your weightbearing to 50% for 3 weeks, and have you use a knee immobilizer for ambulation for the first 3 weeks. I also limit the degree of knee flexion; I will be giving these instructions to your physical therapist.
Cartilage Repair patients – You will typically be non-weightbearing for the first 4-6 weeks pending healing of your joint. When standing, you may set your foot down, but do not place any weight on it while walking.
ACL patients – use your hinged knee brace at all times for 6 wks while ambulating. You may remove the brace to place your knee in the CPM machine. Daily knee exercises are important for the return of a functional and healthy knee (see below).Keep your leg elevated with a pillow under your calf (this will encourage full knee extension)
Shoulder patients – it is typically more comfortable for the first 1-2 wks to sleep in a recliner-type chair with pillows supporting the shoulder. Keep the shoulder brace on at all times unless instructed. For 3 times a day one may remove the sling portion to straighten the elbow to prevent stiffness, but do not attempt to move or elevate the arm more than 30 degrees away from your side. You may use your wrist and hand as much as you’d like for light activities at the waist level, or reachable with elbow flexion. You should not attempt to lift anything heavier than a can of soda.
I feel it is appropriate to remind you that although the external incisions are quite small, you have nonetheless had a major operative procedure within your joint. Scientific research has shown that shoulder rotator cuff or labral healing takes at least 6-8 weeks, and complete ACL healing can take 10-12 months. Complete healing and recovery will take several months; a graduated rehabilitation program specific to your surgery will be initiated after your first post-operative visit. I will supervise and modify this program as necessary, based upon your individual rate of healing and recovery.
CPM (Continuous Passive Motion device)
If this is ordered for you (typically ACL patients or Shoulder stiffness patients), it will be delivered usually the day after surgery.
The company representative will give instructions on how to operate the device.
You may place your knee or arm in the device (remove post-operative brace gently) for 4-6 hours a day.
Knee flexion can begin at 0-60 degrees. Shoulder elevation can begin at 0-75 degrees. Both can be increased as tolerable, 5-10 degrees/day.
You will typically use this device for 4 weeks post-op.
The bandage applied to your incisions may become moist or bloodstained, however this is normal and results from fluid (water) placed in the joint during surgery.
Keep your wound and bandage clean and dry. You may need to “sponge” bathe or use a bag to keep your dressing clean and dry till I see you in the office
Change any bandage immediately if it becomes wet or bloody.
Knee arthroscopy and shoulder arthroscopy – you may remove the dressings after 3 days and apply neosporine or other antibiotic ointment to the incisions and apply bandaids or sterile dressings to keep the wounds covered. If all the incisions are arthroscopic (one suture) you may shower after 3 days, but do not use a bath, Jacuzzi, or pool for 3 weeks. Re-apply dressings/bandaids after showering. If I made an “open” incision (more than one suture) keep dry for 2 weeks, or otherwise instructed.
ACL patients – keep the wound dry for 2 weeks post-op. For patients with pain pumps (see below), I typically have to return to the office 2 days after surgery to do the first dressing change and to remove the pain pump.
Applying ice or using the Cold Therapy device (see below) for the first 24-48 hours after surgery will reduce pain and swelling.
I typically prescribe Vicoden and Vistaril – the vistaril is for nausea which can occur with most narcotics (vicoden); for the first 1-2 days, taking the two medications together is the most effective, as the vistaril can also help potentiate the effects of the vicoden alone
You may also use Advil or Naprosyn over the counter for the first 3-5 days after surgery to supplement the above medications for pain.
The Pain Pump (if used) will automatically infuse numbing medication; most devices have a button or bulb to depress that gives an extra bolus of medication.
Elevating your extremity above heart level as much as possible will also reduce pain and swelling.
Elevate your extremity after exercises and always at night, with your extremity above heart level.
Take pain medication as prescribed.
Do not drink alcohol when you are taking this medication. Take medication 30 minutes before exercises.
Eventually pain subsides and Tylenol should control your pain.
Cold Therapy Devices
While these devices may be used for prolonged periods after surgery to control pain and swelling, it is typically good to turn the device off for 20 minutes and allow the knee or shoulder to “warm up” every 3 hours. If at any time there is increased tingling or numbness in the extremity while the cold device is on, or if there is a burning sensation or significant pain with the device on, you must turn off the device and call our office.
If your right leg or shoulder is operated on, you will NOT be safe to drive for probably 4 weeks post-op. Depending on the type of surgery, if more healing-time is required for strenuous activities (i.e. ACL, rotator cuff repair, knee replacement) safe driving may not be allowed till 6 weeks post-op.
Knee Rehabilitation program
Physical therapy will begin after your first post-operative visit. I will direct and modify your program based on your progress. Two commonly used exercises that you may begin immediately after surgery are quadriceps setting and straight leg raises. The swelling in your knee after surgery causes “inhibition” of the quadriceps (thigh) muscle from “working”. These exercises are designed to “re-activate” the quads – the sooner you regain the ability to contract and control these muscles, the sooner you will be able to wean yourself from crutches (provided there are no weight-bearing limitations).
Lie on your back with your knees straight, legs flat and arms by your side. Place your heel/lower calf area on a towel roll or soft chair so that the area behind your knee issuspended. Tighten the muscles on the top of the thigh (quadriceps), and at the same time push the back of the knee down and hold for 5 seconds. Increase the time you hold this contraction up to 15 seconds, then you can attempt to raise the heel. Hold for 5 seconds, relax 5 seconds. Repeat this exercise 6 times on a firm surface at least 4 times a day.
Straight leg raising
This exercise is as an extension of the quadriceps set above, and can be accomplished only after being able to hold a quadriceps set for at least 15-20 seconds with your heel on a towel roll. Lie on your back with your operative knee flat and straight. Keep the other leg bent with foot flat on the floor. Slowly raise your operative leg about 6 inches off the floor, keeping the leg as straight as you can. Hold for a count of 5 seconds, then lower the leg. Repeat this exercise 6 times on a firm surface at least 4 times a day. The goal is to be able to contract your quadriceps muscle then lift your leg straight in the air and hold for 10 seconds. Ultimately you want to increase your endurance to 30 seconds. The sooner you regain your quadriceps strength and control by doing these excercises, the sooner you will be able to ambulate without crutches and weakness.
Shoulder Rehabilitation Program
I will direct and modify your shoulder physical therapy program depending on the type of surgery you had and your progress. Here are some guidelines:
Shoulder Repair : (i.e. rotator cuff repair, labral repair, capsulolabral reconstruction, SLAP repair) will remain in a sling device for 3-4 weeks. During this time you may use your hand, wrist, and elbow for activities at the waist or table level. You may gently remove the brace 3 times a day to straighten your elbow out, otherwise, you must remain in the brace all times, including sleep. This brace helps protect the repair and ensure proper healing. Do not attempt to lift or elevate the arm more than 30 degrees from the side of your body. You may also squeeze a ball with your hand or squeeze your shoulder blades together and hold for 10 seconds, 3x/day. Physical therapy starts at 3-4 weeks under my direction, and typically involves assisted range of motion and gentle strengthening exercises for the next 3-5 wks. Do not attempt any exercises on your own without direction/clearance from the physical therapist or myself. See “Active Assisted” program below for safe home exercises, once you’ve reached this stage.
Shoulder “Cleanout”: (i.e. decompression, ‘spur’ removal, debridement, AC joint excision). You will typically be in a sling for comfort for the first 1-3 wks. Your physical therapy will begin within 1 week of surgery. You may begin “active assisted” exercises on your own at home everyday as soon as you are comfortable and pain allows. (see below)
Active Assisted Range of Motion Program: The goal in this phase is to regain motion without over-stressing tissues (rotator cuff and labrum) that are still healing. (it takes 6-8 wks to fully heal).
Shoulder blade shrugs and scapular squeeze – hold each position for 15 seconds, perform for 10 minutes, 5 times a day.
Table Slides – face a table, place your hand on a small folded towel, slide your hand across the table and reach as far as you can. If you move your chair slightly away from the table, this will enable you to lean your body forward to reach even further across the table. This simulates shoulder elevation. You can also turn your body 45 degrees so the table is partially to your side (as opposed to in front). Performing the same exercises in this position will “stretch” and loosen a different portion of your shoulder
Wall Slides/Climb – similar to Table Slides but performed vertically on a wall. Do not attempt until you are comfortable with Table Slides.
Clasped Hands Elevation – clasp your hands together, sit in a reclined chair or lie down, use your non-operated arm to lift the other over your head. Work towards the position of placing your hands behind your head. Once this is achieved, you can bring your elbow tips together and feel the “back” of your shoulder stretch, and spread your elbow tips apart to feel the “front” of your shoulder stretch. Ultimately, you can twist your palms upward and push both arms over your head to complete your motion.
Follow-up visits are necessary for your doctor to chart progress, change bandages, check for any complications and evaluate your rehabilitation progress.
Pain Pump patients typically follow up 2 days after surgery. Without no pain pump, you may follow up 7-10 days after surgery.
If the following occurs, contact us immediately:
Swelling, tingling, pain or numbness in your toes which is not relieved by elevating your knee above heart level for 1 hour.
Drainage that is foul smelling, green or yellow, or drainage where there was none before
Chills or temperature above 38.5° C (101.3° F). or if greater than 38° C (100.4° F) for 24 hours.
Bright red blood that does not stop and/or is soaking the dressing.