Transcript Post Surgical Rehabilitation

Chapter 28 and 29
Post Surgical Rehabilitation
Overview

Although many musculoskeletal
conditions can be treated
conservatively, surgical intervention is
often indicated in cases where a
sufficient traumatic or degenerative
injury has occurred.
Overview

The typical criteria for surgical intervention
includes:
– A failure to respond to a 4-6 month course of
conservative measures
– Severe levels of pain that significantly limit the
performance of daily activities and personal care
– Gross joint instability and abnormal joint
alignment with accompanying loss of function
Surgical complications

Some of the more serious postsurgical complications include:
– Infection
– Deep vein thrombosis
– Pulmonary embolus
– Poor wound healing
– Excessive scarring and adhesion
formation
Surgical procedures

The proposed advantages of
arthroscopic procedures over the
traditional open procedures include:
– Smaller skin incisions
– More complete inspection and access of
the surgery site
– The ability to treat intra-articular lesions
– Less soft-tissue dissection
Post-surgical Examination

History and Systems Review
– Details about the type of procedure performed
are noted, as well as the location, nature and
behavior of symptoms.
– The clinician asks about the patient’s current and
previous functional status, and discusses with
the patient, what their functional goals and
predicted outcomes are
– The clinician should determine whether any
circulatory and pulmonary complications exist
such as thrombophlebitis, pulmonary embolus,
or pneumonia.
Post-surgical Examination

Pain
– The patient’s pain level is recorded on a visual
analog scale

Integumentary integrity
– The clinician should observe and palpate the
incision, check the integrity and mobility of the
scar, and determine if the degree of edema,
crepitus, and tenderness is appropriate.
Abnormal redness, swelling, or increased heat
could indicate an infection, especially if
accompanied with a fever.
Post-surgical Examination

Range of motion (ROM)
– The range of motion of the involved
extremity can be assessed
– Where possible and appropriate, the ROM
is assessed actively. Otherwise the
clinician assesses the available passive
range of motion, taking care to not over
stress the healing structures.
Post-surgical Examination

Joint integrity and mobility
– A general examination of the healing area is
performed checking the musculature, the
tendons and the ligaments where appropriate.

Muscle performance
– Resisted testing can be performed on the
muscles of the upper and lower extremities that
are not directly related to the surgery site
– The clinician examines the patient’s ability to
perform isometric exercises pertinent to the
post-surgical protocol.
Post-surgical Examination

Function
– The clinician should determine the
patient’s level of functional independence,
noting which functional tasks (transfers,
bed mobility, and ambulation) the patient
is able to perform independently
– The patient should be provided with a
safe and efficient means of ambulation
where appropriate
Post-surgical
Rehabilitation

Amongst the key factors that must be considered in
the post-surgical rehabilitation are:
– The patient’s age
– The patient’s physical status, including weight, and other
medical conditions such as any history of cardiovascular or
peripheral vascular disease, or diabetes
– Social lifestyle of the patient
– Pre-operative joint contracture or muscle atrophy
– Type of surgery
– Method of fixation
– Surrounding soft tissues involved
– Degree of correction of biomechanical alignment
– Functional and recreational goals of the patient
Post-surgical
Rehabilitation

Acute phase goals:
– Control pain and inflammation
– Allow healing progression of surgical site and
help prevent complications
– Retard muscle atrophy and enhance dynamic
stability
– Minimize detrimental effects of immobilization
– Patient compliance with post-surgical restrictions
– Initiate restoration of range of motion
Post-surgical
Rehabilitation

Exercise hierarchy
–
–
–
–
–
PROM
AAROM
AROM
Sub-maximal isometrics in pain-free ranges
Sub-maximal isometrics throughout available
range
– Progressive resisted exercise
Post-surgical
Rehabilitation

Restore, maintain, or improve patient’s
cardiovascular status
– Use the extremities unaffected by the
surgical procedure
Post-surgical
Rehabilitation

Maintain range of motion and fitness
of the kinetic chain and remainder of
the body without detriment to the
healing of the surgical site
Post-surgical
Rehabilitation

Ensure patient safety and
independence
– Assistive devices
– Family support
– Home exercise program
Post-surgical
Rehabilitation

Functional phase goals
– Attain full range of pain free motion
– Restore normal joint kinematics
– Improve muscle strength to within normal
limits
– Improve neuromuscular control
– Restore normal muscle force couple
relationships