Once a diagnosis is established a treatment plan is initiated. For many diagnoses, this starts as a conservative attempt to make the patient better.
Activity Modification means changing the way certain activities are done so as to take the stress off the problem area. This sometimes requires a change in the level or type of one’s work. It could mean stopping certain sports activities for a time.
This is often a combination of formal therapy and exercises that the patient does at home. Therapy can be very important and should be approached very seriously. For many diagnoses, proper therapy is as important as the surgery itself. Correct instruction in exercises is given by the therapist and improvement is then monitored in subsequent sessions. Many patients will need to do much of the therapy while at home. This is particularly important. The duration of therapy is variable and depends on the nature of the problem as well as the individual patient’s response to treatment. Studies show that therapy started immediately after surgery results in improved outcomes.
Often an anti-inflammatory is used. These are aspirin-like medicines that both decrease inflammation and relieve pain. All medicines have side effects and the most common side effect of anti-inflammatories is irritation to the stomach. Because they decrease platelet function, they can also slightly increase the time it takes to stop bleeding if cut. Most of them are best taken with food on the stomach. Not all patients have the same response to anti-inflammatory drugs. There are now a new class of anti-inflammatories called Cox-2 inhibitors which have fewer stomach and bleeding side effects. Some of the newer medications can be quite expensive.
This is reserved as a last resort after other things have failed or can be predicted to fail due to the nature of the problem. When surgery is necessary the options and risks are explained to the patient. What type of treatment the patient receives is always left up to the patient after explaining the pros and cons of each option. Most orthopaedic surgery, when necessary, is not an emergency and therefore, the patient is encouraged to think about his/her decision carefully. If surgery is chosen, authorization from the insurance company is usually necessary. A second opinion is sometimes required by the insurance company and is encouraged, especially if it helps the patient better understand the diagnosis and the options for treatment.
The majority of our physician’s surgery is arthroscopic surgery and is done on an outpatient basis. Our physicians perform their own surgery, and assistants are used only to help hold positions or pass instruments. Our physicians assist in the education and instruction of various types of medical and paramedical students. These students may be present during clinic or surgery but do not affect the treatment rendered.
Following surgery, there will be a rehabilitation phase in which the patient will undergo therapy. The length and type of rehabilitation greatly depend on the type of problem. Initially after surgery, the patient will be seen by the therapist who will start the rehabilitation as well as check the surgical wounds. Two to three weeks after the surgical procedure, the patient will return to see their physician for a follow-up visit. A follow-up appointment will be made prior to this if the patient or therapist notice anything out of the ordinary that requires the physician’s attention.
Return to work or previous activities will depend on the nature of the problem and the type of treatment chosen. In general, patients are encouraged to return as quickly as possible to work as this often serves as an important aspect of the rehabilitation process. There may be modifications necessary to permit early return, but this is preferable to waiting until everything is “perfect”. Many sports activities will require some type of modification as well. A gradual return to pre-injury sports or work level is always better than a return to full activity without proper conditioning.