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Clinical Protocols


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Clinical Protocols

At this time, we see patients on Monday mornings, and operate Monday afternoons. Two options are available for those who choose surgery:

1. We can schedule the surgery at your convenience (more travel but time to plan and think about things).  

2. We can plan the surgery for the same day (more uncertainty but less travel, faster treatment). If this option is desired we have to plan ahead of time, and you cannot have had anything to eat or drink from midnight on (other than medications with a sip of water).

We also have to have a sense of your overall health ahead of time, typically with a phone interview. This option should clearly be expressed to us when you make your office appointment, if desired.

At your office visit we will ask for several pieces of information, as follows:

o Chest X-Ray: If you have had this already, we ask for the actual images on a disk.
o If you have had any testing on your neck or shoulder (MRI, CT), please bring the reports, although the images themselves are not needed.
o You do NOT need to bring results of normal nerve conduction studies or angiograms, although if abnormal the report would be helpful.
o If you have Venous TOS and have had a venogram, bringing the images will help.
o We ask for two self-assessment forms: You can fill these out ahead of time, but please do this fairly close to your appointment. 
     QuickDASH (Link to form)
     CBSQ (Link to form)

The office visit typically takes only 30 minute or less. In those with Neurogenic TOS, our objective is to assess the degree of suspicion that NTOS is present, obviously discuss the issues involved, and come up with a plan. Again, if you want to proceed with operation should it be indicated on the same day you are seen, please let us know in advance.

Surgery generally takes an hour to an hour and a half, and general anesthetic is typically required. You will be admitted to the hospital, and discharged when your pain is controlled with oral pain medications. You will be admitted by a hospitalist, who will be there throughout the day. I will see you once or twice a day. Pain control will be by means of a pain pump initially, with a valium-type and ibuprofen-type medication added for synergistic effects. Therapy in the hospital and for the first three to four weeks postoperatively will consist of gentle range of motion and flexibility only (no sling!), after which we’ll prescribe formal physical therapy for two to three months.

We will provide postoperative narcotics at discharge. South Carolina law only allows us to prescribe 5 days’ worth of narcotics. If you are local you will need to return for a refill, but if out of town you will need to see your primary care physician. We will provide narcotics for three to four weeks; if you need medication beyond this you will need to see your primary care physician or a pain control specialist. If you have required long-term narcotics prior to seeing us, please let us know so we can provide the appropriate dosing for your comfort.

In general, patients are still uncomfortable at their 3-4 week visit, but make substantial strides with physical therapy. Most patients have significant relief at three months (and are back to work, depending on occupation, between 1 and 3 months). However, essentially ALL patients continue to see improvement for up to one year.

We ask in all but extreme circumstances that you commit to return visits at 3 to 4 weeks, three months, and one year. This is critically important for both your care and to enable us to objectively assess your outcomes. Of course, in certain situations (extreme distance, financial need) we can discuss alternative follow-up plans in advance.

Move your arm  |  Take your medications  |  Be patient