Frequently Asked Questions

An orthopaedic surgeon who will give
the best care possible.

Dr James McLean is a highly skilled orthopaedic surgeon with a special interest in arthroscopic (key-hole) surgery, joint replacement surgery, and microsurgery. He has advanced sub-specialty training in shoulder and upper limb surgery and renders comprehensive patient care for problems of the shoulder, elbow, hand & wrist, and sports injuries.

Driving

Can I drive?

  • You must hold a valid drivers licence for the vehicle you plan to drive.
  • You must be able to control your vehicle in an emergency situation.
  • You should be able to confidently stand up in a court of law and testify to your capacity to drive.

Returning to safe driving

  • There is no legislation that covers surgery and driving.
  • A safe return to driving depends on the procedure you have had, your ability to drive and your recommended rehabilitation.

Please note, your normal car insurer may not cover you if:

  • you are involved in an accident and you are wearing a cast or a brace.
  • you are taking strong pain-relieving medications, such as sedatives that may impair your concentration or judgement.
  • you have had a fracture (broken bone) & there is recent x-ray evidence the break has not healed.
  • you have had "recent surgery".

The definition of “recent surgery” is not clearly defined. If unsure, contact your car insurer for clarification.

Additional information can be found on Pubmed – http://www.ncbi.nlm.nih.gov/pubmed/23450009

Deciding when you can return to driving has two considerations:

  1. Will the act of driving impact or impair the healing process and perhaps compromise the final outcome of my surgery?
  2. Am I safe to drive? (i.e. Can I safely control my vehicle in an emergency?)
  3. Am I capable of driving? (i.e. Do I have a temporary splint or disability that prevents me from driving?)
  4. Is my judgement impaired? (i.e. Am I taking strong pain-relieving medications that may interfere with my reaction time or judgement?)

A safe return to driving depends on:

  • What you drive (automatic / manual / power steering)
  • The conditions you are driving in (bad weather/ night/ poor roads)
  • How long the journey will be
  • The medications you are taking
  • The pain you are experiencing
  • The function you have lost
  • Your judgement and capacity to drive

Driving and opioids:

  • Immediately after your operation you will likely be taking pain-relieving medications that are sedatives (similar to alcohol).
  • These medications can interfere with your concentration, judgment and reaction time.
  • You should not drive while you are taking these medications.

Goals to aim for prior to returning to driving

  • A pain-free driving experience.
  • No requirement for a leg or arm splint to protect your limb from pain or injury, or to allow recovery.
  • Shoulder range of motion equivalent to 90 degrees of forward flexion and 90 degrees of abduction (general guide).
  • Elbow movement equivalent to near full extension.
  • Normal function of both hands and wrists.
  • Your upper limb strength should be almost equal to the other side and not compromised by pain, impingement or poor nerve / muscle function.
  • Once your arm is strong enough and has enough range of motion to physically go through the motions of driving, it is also important to consider your reaction time. Is it compromised in any way?
  • Your lower limb should not be in a cast or splint and you should not still be requiring crutches to mobilise.
  • Your lower limb should not be compromised by pain or poor nerve / muscle function.
  • As with most return to activity advice, it is best to follow a graduated return, increasing the duration and intensity, as comfort allows.

Testing your capacity to drive

  • Before attempting to drive on public roads, take your car to an empty car park and practise driving in a safe and controlled environment.
  • Once you can safely and repeatedly perform all of the emergency stop procedures and all the manoeuvres necessary for driving, you may consider returning to driving.

Considerations for particular surgeries

Shoulder replacement

  • The main consideration following shoulder replacement surgery is the healing of the tendons, which are normally cut to gain access to the joint.
  • In general, tendon healing takes 6-8 weeks and gets progressively stronger to the 3 month mark.
  • Returning to driving earlier than 8 weeks may compromise your surgery.
  • As a guide it will be at least 8-10 weeks before you will be able to drive and then a gradual increase in
    activity/ driving can be expected.

Arthroscopy (key-hole elbow & shoulder surgery)

  • If you have had key-hole surgery where no tendon or ligaments have needed repair, immediate movement is encouraged and you can drive once physically able. On average most people return to driving around 4 weeks following surgery.
  • If a ligament or tendon has been repaired, you need to wait until the tendon/ ligament has healed – normally around 8-10 weeks with a graduated increase in activity.
  • Returning to driving early after tendon surgery may compromise your outcome.

Minor surgery

  • Examples are “Carpal tunnel decompression”. Read our comprehensive guide to driving after carpal tunnel surgery here.
  • It is usually sensible to wait until the wound has healed to prevent the sutures from loosening and the wound opening.
  • This normally takes 10-14 days.
  • The scar may remain painful for 6-8 weeks and may cause pain when you try and drive.
  • Returning to driving depends on what you drive (power steering, gear changing).
  • Most people start gentle driving around 2 weeks following surgery.

Flying

When can I fly after my surgery?

Dr McLean has provided these recommendations as a rough guide. Please keep in mind that this material is a reference guide only and your recovery may be impacted by choosing to fly in the immediate post-operative period or with a fracture (broken bone).

Surgery will impact your physical and psychological ability to transit the airport, tolerate turbulence and sit comfortably in a chair for the required duration of the flight. A broken bone will significantly impact your ability to tolerate turbulence. The following factors should be considered and understood BEFORE choosing to book or board your flight.

Types of surgery

As a rough guide, before flying, you should allow:

  • 1-2 days after arthroscopic (keyhole) surgery.
  • 1-2 days after a plaster cast has been applied. NB.  If both your legs are in plaster, it is unlikely that you will be able to fly – Contact your travel operator or airline for advice
  • 4-5 days after simple, open surgery (i.e. wrist or hand surgery).
  • 14 days for more complicated open surgery (i.e. shoulder joint replacement surgery).
  • 14 days after surgery to stabilise a fracture (broken bone).
  • 3 months – total hip replacement (hip precautions minimise the risk of hip dislocation in the first 6 weeks after surgery & can not be met in standard aeroplane seats).

Please note – Surgery &/or a broken bone will also affect where you can sit on a plane and your ability to tolerate turbulence. These should be considered BEFORE you book your flight and board the plane.

Restrictions may also apply to flying with other medical conditions. Some general guidelines:

  • Abdominal (tummy) surgery – 4-5 days; and 10 days for more complicated abdominal surgery.
  • Brain or neurosurgery – 6 weeks.
  • Cataract or corneal laser surgery – 1-2 days; and 10 days for more complicated eye surgery.
  • Chest surgery (including coronary bypass graft) – 10 days provided there have not been any complications.
  • Colonoscopy – 1 day provided there have not been any complications.
  • Lung surgery – 3 months
  • Heart attack – 7-10 days provided there have not been any complications.
  • Heart failure – most people who have heart failure can still fly provided that the condition is stable and well controlled with treatment.
  • Pacemaker – People who have had a pacemaker or an implantable cardiac defibrillator (ICD) fitted may travel without problems once they are medically stable.
  • Retinal detachment – 6 weeks.
  • Carpal Tunnel – Read our guide to flying after carpal tunnel surgery.

Minor surgery

  • Examples are “Carpal tunnel decompression”. Read our comprehensive guide to driving after carpal tunnel surgery here.
  • It is usually sensible to wait until the wound has healed to prevent the sutures from loosening and the wound opening.
  • This normally takes 10-14 days.
  • The scar may remain painful for 6-8 weeks and may cause pain when you try and drive.
  • Returning to driving depends on what you drive (power steering, gear changing).
  • Most people start gentle driving around 2 weeks following surgery.

Things to check before you fly

If you’ve had any kind of major surgery, ask Dr McLean to clarify your restrictions and any help you may require, prior to booking your flight.

Airline – Each airline has its own regulations about flying after surgery. Check with your airline before you fly, particularly if you’ve had complex surgery. Also check the hand luggage restrictions with your airline. No airline will not allow you to sit in an emergency seat. You may have to purchase an extra seat (or upgraded seat) if you cannot sit normally (i.e. can not bend your knee or have a bulky sling on).  See our selected airline information page.

Insurance

Insured Patients

For patients with an appropriate level of health insurance, the insurer will cover all costs. However, different companies provide different rebates and there may be a gap for surgical care. Our staff can discuss this with you at the time of the consultation.

Uninsured Patients

For patients who do not have private health insurance and who require surgery, our staff can provide a quotation of expected costs. Please note, our staff can only provide you with an estimate of the expected costs because the actual treatment required may differ slightly from the proposed treatment.

WorkCover

Work Cover in the Northern Territory

NT WorkSafe is the statutory body that assists workers, and businesses in their understanding and obligations under the work health and safety act.

Important links:

Dr Mclean can provide a statement of fitness for work certificate, and assist with your return to work process.

Work Cover in South Australia

ReturnToWorkSA  regulates the South Australian Return to Work scheme, and provides work injury insurance that protects South Australian businesses and their workers in the event of a work injury.

Important links:

Dr Mclean can provide a statement of fitness for work certificate, and assist with your return to work process.

About WorkCover

WorkCover supervises and governs the Workers Rehabilitation and Compensation Act 1986 and the South Australian Workers Rehabilitation and Compensation Scheme that is established under this act. WorkCover SA is subject to the control and direction of Minister for Industrial Relations, The Hon. John Rau MP.

The WorkCover system functions to provide compensation for injury that occurs in the workplace. The statutory authority is funded by employers to manage the employees fund; assure coverage for work-related injury claims; inspect for entitlements; and oversees the rehabilitation until the worker is healthy and safe to return to work.

An injured worker may be entitled to compensation if:

  • The injury was caused by their work duties or happened in the course of their employment
  • Their employment contributed to a disease or illness, including psychological injury

Depending on the nature of the injury, a worker’s entitlements can include:

  • Weekly payments of income maintenance
  • Medical and associated costs reasonably incurred as a consequence of the injury or illness
  • Lump-sum compensation for non-economic loss (permanent impairment)

The majority of the workers who claim compensation for the treatment will experience nominal interruption and apprehensions. When measured in terms of recovery rate and outcomes across all workers compensation jurisdictions:

  • Almost 80% of injured workers progress candidly
  • Almost 20% exhibit levels of distress and disability, when investigated in relation to initial injury
  • And of the 20%, a further 5% of them proceed to exhibit apparently unequal outcomes where levels of long-term disability and distress cannot be justified by initial injury

The reasons for this difference in outcomes and recovery rates between compensable and non-compensable injuries appear convoluted and some are not well understood. The psychological, social and health provider factors may play a role in the recovery of an injured worker.

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