The ultrasound guided percutaneous tenotomy allows what was once major surgery to be performed quickly through a small incision. Although post-procedure care will be tailored to fit your individual needs, the following guidelines are designed to help you and your physical therapist after the procedure. Progression is time and criterion-based, dependent on soft tissue healing, patient demographics and clinician evaluation. Contact Dr. Robert Engelen’s office at (801) 533-2002 if questions arise.
Things to avoid before and after your procedure
- Over the counter pain medicine like ibuprofen and naproxen: 10 days before and after your procedure,
- Diet: No need to fast before your procedure. You may eat normal meals before and resume regular diet when you are able.
Day of:
- Plan to have a driver take you home after the procedure.
- Bring a sling to the appointment or we will provide you with one upon leaving.
- Rest today, and protect the arm with a sling and elevate to reduce swelling.
Days 2-7:
- Activity restrictions:
- You may lift up to 5 lbs.
- You may begin non-repetitive use of the elbow and hand (grooming, dressing, eating and driving short distances)
- You may stop wearing the sling 3-5 days post-procedure as you are able.
- No sustained gripping like opening a jar.
- Rehab:
- Start gentle wrist, elbow and shoulder range of motion exercises and perform 3-5 times per day.
Progression 1:
- Activity restrictions:
- You may lift up to 10 lbs.
- Rehab:
- Continue range of motion exercises.
- You may begin isometric wrist and elbow strengthening
- Manual Therapy:
- May use soft tissue mobilizations around incision, avoiding direct pressure throughout progressions.
Progression 2:
- Activity restrictions:
- Progress as tolerated
- Rehab:
- Continue range of motion exercises.
- Progress to wrist and elbow isotonic strengthening with dumbbell wrist extension and flexion (start with 2 lb. dumbbell and progress as tolerated).
Progression 3:
- Activity restrictions:
- None
- Rehab:
- Increase intensity of isotonic strengthening under the supervision of your care team.
- Begin joint integrated strengthening like chest press, rows and hammer curls.
- Be sure to maintain a neutral wrist.
Progression 4:
- Rehab:
- Continue to increase intensity of strengthening exercise and begin sport/activity specific training under the supervision of your care team.
Progression 5:
- Rehab:
- Resume high impact sports like golf and tennis under the supervision of your care team.
- To be used as a general guide based on biologic tissue healing. This timeline does not consider the location and extent of diseased tissue as well as other intrinsic patient factors that may impact time to clinical healing.
- Basic load progression principles: Pain level < 3/10 with activity. Any pain associated with the activity should not persist into the following day. If pain persists then the load needs to be decreased
Bracing/discomfort:
- If you have a splint or brace, you may be instructed to wear it to reduce the stress on your elbow. If you were given a sling, you can wear it for the first 3-5 days for comfort. You should come out of the sling 3-5 times per day for range of motion exercises. You do not need to sleep in the sling. Do not drive while wearing the sling.
- Some pain after your procedure is expected for the first few weeks. Use an icepack on the painful area for 15 minutes as needed; in the first 2-3 days consider icing 3 times daily. If you are concerned about your pain, please contact our office.
Dressing:
- If a dressing was placed on you, remove it after 48-72 hours. Replace with a simple bandage.
- Sterile strip bandages can be removed when they begin peeling off or after 7 days. Keep bandages and procedure area clean and dry.
- Do not soak/submerge the incision site for 7 days. Showering is okay.
When to call your provider:
- If you notice increasing redness, warmth, pain, fever or drainage from the wound or if other problems concern you, call Dr. Engelen’s office at (801) 533-2002.