Umpqua Orthopedics - Orthopedic Roseburg Oregon
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MA Corner

                     "Welcome to our MA Corner" Our Medical Assistants answer commonly asked question   

Steroid Injections: FAQ

  • WHAT ARE STEROIDS?
    • Many orthopedic conditions such as arthritis, bursitis and tendinitis can cause inflammation which leads to pain and discomfort. Corticosteroids, or “steroids” mimic the effects of cortisol, a hormone produced in the body by the adrenal glands. It reduces the interaction between white blood cells in the immune response, resulting in reduced inflammation. These medications are powerful anti-inflammatories that act on irritated tissues to decrease pain and swelling. Examples of steroid medications include cortisone and triamcinolone. 
  • HOW DO STEROIDS WORK?
    • The goal of a steroid injection is commonly done to decrease inflammation. The steroid medication works directly on the involved tissue to reduce inflammation.
    • Injecting steroid medication into an area of inflammation can generally provide pain relief quickly and efficiently. Oral anti-inflammatories work indirectly, while a steroid injection delivers medication directly to the source.
  • WHAT HAPPENS AFTER AN INJECTON?
    • As with any injection or blood draw, you may feel pain after the injection. Icing the area for 20 minutes every few hours during the first 24 hours should help reduce pain. It is best to avoid activities for the first 3 days after the injection that put stress on the area, but your normal activities of daily living should not be effected. In addition to pain, side effects can include; flushing of the face, increased blood pressure and difficulty sleeping. You should contact our office if you have any concerns about side effects that may occur after a cortisone injection.
    • A local anesthetic or numbing medication (such as Lidocaine) may be mixed and injected with the steroid medication in order to decrease pain from the injection. In these cases, pain may diminish immediately, but may also recur to the same intensity as prior to the injection after several hours as the numbing medication is temporary (just like Novocain wears off at the Dentist office). This does not mean that the injection is not working. The maximal effect of the steroid injection may take 1-7 days.
    • Rarely do patients experience an increase in their pain several hours after the injection. But if this does occur, it is due to a “steroid flare”. A flare is a brief increase in inflammation. Simply use ice and rest the area overnight. You can also manage the discomfort by taking over-the-counter painkillers. Most steroid flares will resolve in 24-36 hours.
    • An infection following any injection is rare. Symptoms of an infection would include; increased pain, tenderness, warmth, redness and swelling at the injection site. Please contact our office immediately if these symptoms occur.
  • HOW LONG UNTIL THE EFFECTS OF THE INJECTION WORKS?
    • A cortisone/steroid injection will usually take 1-7 days to begin to have a positive effect, however it may take up to two weeks for the medicine to decrease the inflammation to a point where pain has improved.
  • CAN I DRIVE AFTER AN INJECTION?
    • Generally, yes. However, some injections can cause numbness to the limb, which can make driving difficult and in these cases we will ask that you come with a driver to your appointment.
  • HOW LONG DO RESULTS LAST?
    • Results of steroid injections can vary depending on the severity of the symptoms and severity of the medical condition. Symptom relief may last from several weeks to up to a year.
  • ARE STEROID INJECTIONS SAFE?
    • When utilized properly, steroid injections are safe and an effective form of pain control. However, multiple injections in the same area can produce adverse effects such as tissue atrophy, decreased healing potential, and degeneration of tendons and cartilage. You should contact your provider regarding repeating cortisone injections.
  • I AM DIABETIC, HOW WILL THIS EFFECT ME?
    • Steroid injections can raise blood sugar levels for a brief period of time. You should monitor your blood sugar carefully and adjust your insulin or other diabetic medication with direction from your Primary Care Provider and/or Endocrinologist. If your diabetes is poorly controlled, your provider may decide not to proceed with a steroid injection.

Surgery: FAQ

  • YOUR DOCTOR HAS RECOMMENDED SURGERY, NOW WHAT?
    • Prior to scheduling any surgery, we will need to check your insurance
    1. If your insurance requires a prior authorization, it may take a couple weeks before that determination is made.
    • Next you will be called by our office to set a date for surgery.
  • WILL I NEED TO HAVE LABS DONE FOR MY UPCOMING SURGERY?
    • If you are scheduled for a joint replacement surgery, you will have a pre op appointment at Mercy hospital prior to your surgery, labs and EKG will be done at that time.
    1. Our office will schedule your pre op appointment at Mercy, but if you need to make any changes their office can be reached at 541-677-6554.
    • If you are scheduled for any other type of surgery, you may need to have labs and EKG done for your procedure, depending on your medical history.  Our office will notify you of the need for labs and or EKG at the time of scheduling.
    • Lab work must be done within 30 days prior to your date of surgery.

  • WHERE DO I GO FOR MY BLOOD WORK / EKG PRIOR TO SURGERY?
    • You can have your blood work done at any outpatient lab of your choice
    • EKG’s can be done at Mercy, or you can check with your primary care office if they offer that service.
  • DO I NEED TO BE FASTING FOR MY BLOOD WORK?
    • No, pre-operative lab work does not need to be fasting.
  • DO I NEED A COVID TEST BEFORE SURGERY?
    • If you are scheduled for any surgery or procedure at Mercy or the Oregon Surgery Center, you may be required to have a COVID test.  If you are fully vaccinated and can bring in a copy of your vaccination card, you will not need a COVID test prior to surgery.  COVID rules are subject to change.
  • WHERE DO I GO FOR SURGERY?
    • You will be notified by our office where your surgery will take place.  If it is at Mercy Medical Center and you will need to check into the patient entrance on the day of your surgery.    If it is at the Oregon Surgery Center their office is located next to the ER entrance on the uphill side of Mercy hospital.  Oregon Surgery Center address is:   2801 Mercy Dr Suite 200.
  • WILL I NEED ADDITIONAL IMAGING PRIOR TO SURGERY?
    • If you are having a joint replacement surgery, you may need additional imaging such as a CT scan that will be used in preparation for your surgery.
  • WILL I NEED ANY OTHER APPOINTMENTS PRIOR TO SURGERY?
    • If you are having a hip or knee replacement surgery you will be required to attend a pre-operative joint training class put on by Mercy.  This is a one-time class that is located at 2460 NW Stewart Parkway.  You will receive a call to schedule before surgery.  If you need to reach them for the class appointment, please call 541-677-4361.
    • If you are having a joint replacement surgery you will have an appointment in our office with your surgeon just prior to surgery, to review tests, go over questions and make a final decision to proceed with surgery or not. 
  • DO I NEED ANY SPECIAL EQUIPMENT AFTER SURGERY?
    • If you are having a shoulder surgery you may have to wear a sling.
    1. The sling will be put on at the time of surgery
    • If you are having a hip or knee replacement surgery you will need to have a front wheeled walker. 
    1. Additional equipment may include a shower chair/ bath bench, sock aid reacher, raised toilet seat, cane, additional pair of compression socks.  
    • If you are having an outpatient surgery for your knee or ankle you may need a pair of crutches and / or a brace.

  • DO I NEED TO STOP MY MEDICATIONS BEFORE SURGERY?
    • You should stop any aspirin, anti-inflammatory medications (ibuprofen, naproxen) and vitamins/herbs 1 week prior to surgery.
    • If you are on blood thinners (Coumadin, Plavix, Eliquis etc..) you will need to stop these as well, but may need clearance to stop from your primary provider, or cardiologist.
    • You cannot use insulin or any other diabetic medications on the morning of surgery.
    • You can continue all other medications prior to surgery.
  • CAN I EAT OR DRINK PRIOR TO SURGERY?
    • No, you cannot have anything to eat or drink after midnight the day before surgery and nothing the morning of surgery. 
    • You may take your heart / blood pressure medication with a small sip of water the morning of your surgery, but do not take any other medications unless advised specifically by your surgeon to do so.

Brace: FAQ

KNEE BRACES:

  • WHAT IS A CUSTOM KNEE BRACE?
    • A custom knee brace is a brace that can be made to order for your specific knee condition and sizing.
    • Most common custom braces are for arthritis and or meniscal / ligament problems.  
    • Arthritis braces help to offload the pressure of the affected side of the knee where there is increased arthritis.
    • Meniscal / Ligament bracing can offer support and increased stability.
  • HOW DO I GET A CUSTOM BRACE?
    • If your doctor recommends a custom type brace for your diagnosis your knee will be measured in the office to help provide a better fit.
    • Most insurances will require a prior authorization for these custom braces.  We will submit necessary information to your insurance provider.
    • After insurance authorization is complete, your brace will be ordered by our office.   
    • Once ordered, the brace can take up to 5-10 business days to arrive.
    • Once the brace is in the office, you will be called to make an appointment for a brace fitting.
  • WHAT OTHER TYPES OF KNEE BRACES ARE AVAILABLE?
    • There are several other types of knee braces, from soft knee sleeves to more rigid hinged knee braces.  These braces can be helpful for a variety of knee conditions and can be fitted in the office same day.  You should discuss with your doctor which brace is right for you.
  • WHEN DO I WEAR MY KNEE BRACE?
    • Most knee braces are used for more vigorous/ physical activity.  Most braces do not need to be worn for sleeping or light activity.
  • CAN I WEAR MY BRACE OVER MY PANTS?
    • You should not wear your knee brace over heavy or loose fitting pants.    Your knee brace will fit better against your skin or over tight fitting pants.  
  • MY BRACE KEEPS SLIDING, WHAT CAN I DO?
    • Try to tighten the brace, especially the straps on the lower leg below the knee.  These straps are the most important to help with the brace sliding.  The upper leg straps above the knee should be tightened to comfort.
    • If you cannot get the brace to fit properly and it continues to slide down your leg, the brace may not be sized correctly and you should contact our office.
  • CAN I WASH MY BRACE?
    • Your brace can be hand washed with a cloth and mild, soapy water and air-dried.

LOWER EXTREMITY BRACING (FOOT, ANKLE):

  • WHAT KINDS OF INJURIES REQUIRE A WALKING BOOT?
    • A walking boot may be used for several different problems or injuries, including, but not limited to: ankle sprains, ankle or lower leg fractures, Achilles or calf muscle tears.
  • CAN I DRIVE WITH A BOOT ON?
    • In general, you should not drive with a boot on, especially if the boot is on your right leg.   
  • SHOULD I CONTINUE TO USE CRUTCHES WITH A BOOT?
    • If your doctor has advised you it is ok to weight bear as tolerated, you do not need to continue to use crutches.  If you have been advised to continue non weight bearing or partial weight bearing, you should continue to use crutches or other assistive devices (cane, walker) as tolerated.
  • DO I HAVE TO WEAR THE BOOT TO BED?
    • Most of the time you are able to remove the boot at night to sleep, if you are able to use supportive pillows around the leg to avoid too much movement.  There are times when you may have to wear the boot at all times, including at night, you will be advised of this by your doctor at the time of fitting in the boot.
  • CAN I TAKE A SHOWER WITH THE BOOT?
    • No, the boot will need to be removed to shower.  If you are unable to put weight on your leg you may need a shower chair or bench to shower safely.
  • HOW DO I CLEAN THE BOOT?
    • You can hand wash the inner liner with mild soap and allow to fully air dry.  Use a cloth to wipe down the hard outer shell of the boot.
  • WHAT BRACES ARE AVAILABLE FOR ANKLE SPRAINS?
    • There are different types of braces for different problems, these can include:
    1. Lace up ankle braces:  provide support and compression for ankle sprains and injuries that can be worn with most shoes for light activity, running or competitive sports.
    • Ankle stirrup braces: Also provide ankle support, but these braces are larger and more rigid than the lace up braces.  These braces have 2 semi rigid shells that conform to the inside and outside of the ankle and Velcro in place.
  • ARE FOOT AND ANKLE BRACES SIDE SPECIFIC?
    • All foot and ankle braces, including the walking boot, lace up and stirrup ankle braces can be worn on the right or left.  They are not side specific.
  • SHOULD I WEAR A SOCK WITH MY BRACE?
    • Yes, you should and can wear a sock under the walking boot or any of the ankle braces provided to you by our office.   This will help with hygiene as well as comfort and protect your skin from breakdown.
  • HOW TIGHT SHOULD MY BRACE BE?
    • The boot or ankle braces should be tight fitting (snug), but not uncomfortable.

UPPER EXTREMITY BRACING (HAND, WRIST, ELBOW AND SHOULDER):

  • WHAT ARE THE DIFFERENT HAND AND WRIST BRACES USED FOR?
    • There are several different braces for a variety of problems or injuries, some of these braces include:
    1. Wrist braces used for sprains or fractures to protect and immobilize the wrist.
    2. Thumb spica braces: a wrist brace with a thumb support to immobilize the thumb for strains, sprains, arthritis and fractures
    3. Short/ soft wrist braces used mostly for carpal tunnel syndrome
    4. Hand bracing used for hand fractures.
  • HOW LONG DO I WEAR MY BRACE?
    • This will depend on what you are using your brace for.  
    1. Fractures: you will generally have to wear your brace for most activity, except for showering.  Once healed, the brace will be slowly weaned.
    2. Strains, sprains, arthritis: you should wear your brace for more physical activity as tolerated.
    3. Carpal tunnel:  these braces are to be worn at night, and during the day when symptomatic. 

  • DO I SHOWER WITH MY BRACE ON?
    • No, they will need to be removed to wash or shower.
  • DO I SLEEP WITH MY BRACE ON?
    • Generally, you do not need to wear your brace at night.  However, if you are using your brace for carpal tunnel you do need to wear it at night.  Some braces used for fractures will also need to be worn at night, you will be instructed on use at the time of fitting.
  • HOW TIGHT DOES THE BRACE NEED TO BE?
    • All of the wrist, hand and elbow bracing should fit tight, but not feel uncomfortable or causing skin breakdown.

  • CAN UPPER EXTREMITY BRACES BE USED ON EITHER SIDE?
    • Hand and wrist braces are side specific and can only be worn on the right or left.
    1. There are bands used for tennis or golfers elbow and shoulder slings that are not side specific and can be used on either side.

  • WHAT ARE THE DIFFERENT TYPES OF SHOULDER SLINGS?
    • There are basic slings for support and immobilization of the arm for a variety of upper arm issues, most commonly used for fractures and dislocations.
    • There are larger, more complex shoulder slings that are used for post-operative recovery from shoulder surgery.

  • I HAVE A SHOULDER SLING I GOT AFTER SURGERY, HOW DO I PUT IT ON?
    • These shoulder slings have several straps and pieces.  If you did not receive the patient instruction handout at the time of surgery you can go to this website for instructions:  https://www.breg.com/education/
  • HOW LONG DO I NEED TO WEAR MY SLING AFTER SURGERY?
    • For most shoulder rotator cuff repairs and total shoulder replacement surgeries you may be in a sling for 6 weeks.
  • HOW DO I WEAR MY SHOULDER SLING?
    • The sling strap goes across your back, to the opposite shoulder and attaches to the front of the sling.  Your entire arm should be in the pocket of the sling with the elbow to the very back of the sling.  The sling should be supporting your hand and wrist.  Your hand should be at or above the level of your elbow.
  • CAN I WASH MY BRACE OR SLING?
    • You can hand wash your brace or sling with mild detergent and air dry.
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