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Questions and Answers
What is a key indicator for progressing to the moderate protection/controlled motion phase of post-operative rehabilitation?
What is a key indicator for progressing to the moderate protection/controlled motion phase of post-operative rehabilitation?
- Full active range of motion
- Visible inflammation and tenderness
- Absence of pain at rest and some pain-free movement of the operated extremity (correct)
- Presence of significant pain at rest
What is NOT a typical feature of the minimum to no protection/return to function phase?
What is NOT a typical feature of the minimum to no protection/return to function phase?
- The joint capsule (if involved) should be clinically stable
- Full or almost full pain-free active range of motion is available.
- There is significant pain and limited range of motion is present. (correct)
- The phase generally begins around 6-12 weeks post-operation
When does the moderate protection/controlled motion phase typically begin after surgery?
When does the moderate protection/controlled motion phase typically begin after surgery?
- Immediately after surgery
- 12 weeks post-operation
- 4-6 weeks post-operation (correct)
- 1-2 weeks post-operation
Which of the following best describes the progression through post-operative rehabilitation?
Which of the following best describes the progression through post-operative rehabilitation?
How long can the return to function phase potentially last?
How long can the return to function phase potentially last?
What is the primary objective of capsule stabilization and reconstruction surgeries?
What is the primary objective of capsule stabilization and reconstruction surgeries?
What is the purpose of tendon transfer or realignment?
What is the purpose of tendon transfer or realignment?
What surgical procedure is used to improve range of motion and prevent progressive deformity?
What surgical procedure is used to improve range of motion and prevent progressive deformity?
What is the primary purpose of a fasciotomy?
What is the primary purpose of a fasciotomy?
Which of the following is NOT a method of capsule stabilization and reconstruction?
Which of the following is NOT a method of capsule stabilization and reconstruction?
Which of the following is NOT a typical indication for surgical intervention?
Which of the following is NOT a typical indication for surgical intervention?
During the preoperative examination, which of the following details regarding the skin is MOST important to note?
During the preoperative examination, which of the following details regarding the skin is MOST important to note?
Which of the following is a primary purpose of preoperative patient education?
Which of the following is a primary purpose of preoperative patient education?
What is the primary focus during the 'maximum protection phase' of postoperative rehabilitation?
What is the primary focus during the 'maximum protection phase' of postoperative rehabilitation?
Which of the following exercises is MOST appropriate to teach during the very early postoperative period?
Which of the following exercises is MOST appropriate to teach during the very early postoperative period?
In the pre-operative period, which of the following is a topic that a patient should be educated on?
In the pre-operative period, which of the following is a topic that a patient should be educated on?
Why is it important to check the mobility of a scar as it heals?
Why is it important to check the mobility of a scar as it heals?
What does the pre-operative gait analysis evaluate?
What does the pre-operative gait analysis evaluate?
In addition to pain and range of motion, what other key assessment is performed in the pre-operative examination and evaluation?
In addition to pain and range of motion, what other key assessment is performed in the pre-operative examination and evaluation?
What is the purpose of the muscle setting exercises in the maximum protection phase?
What is the purpose of the muscle setting exercises in the maximum protection phase?
What is essential for successful postoperative outcomes?
What is essential for successful postoperative outcomes?
How can the risk of pulmonary complications, such as pneumonia, be reduced post-surgery?
How can the risk of pulmonary complications, such as pneumonia, be reduced post-surgery?
What is a potential result of restricted motion from adhesions and scar tissue formation?
What is a potential result of restricted motion from adhesions and scar tissue formation?
What is a common sign of Deep Vein Thrombosis (DVT)?
What is a common sign of Deep Vein Thrombosis (DVT)?
What measure reduces the risk of joint subluxation or dislocation after surgery?
What measure reduces the risk of joint subluxation or dislocation after surgery?
Which condition is characterized by a sudden onset of breathlessness and chest pain?
Which condition is characterized by a sudden onset of breathlessness and chest pain?
When might medical testing be necessary for suspected DVT?
When might medical testing be necessary for suspected DVT?
What could excessive or premature weight bearing after surgery lead to?
What could excessive or premature weight bearing after surgery lead to?
What is the primary purpose of arthroscopic debridement and lavage?
What is the primary purpose of arthroscopic debridement and lavage?
Which procedure involves harvesting and processing chondrocytes in a lab?
Which procedure involves harvesting and processing chondrocytes in a lab?
What distinguishes joint replacement arthroplasty from excision arthroplasty with implant?
What distinguishes joint replacement arthroplasty from excision arthroplasty with implant?
Which of the following best describes the purpose of synovectomy?
Which of the following best describes the purpose of synovectomy?
What is a key outcome of arthrodesis?
What is a key outcome of arthrodesis?
Which surgical procedure transplants intact articular cartilage along with underlying bone?
Which surgical procedure transplants intact articular cartilage along with underlying bone?
In which procedure is fibrotic scar tissue filled during healing?
In which procedure is fibrotic scar tissue filled during healing?
What common goal do most arthroplasty procedures aim to achieve?
What common goal do most arthroplasty procedures aim to achieve?
What is a common precaution for a patient recovering from DVT post-hospitalization?
What is a common precaution for a patient recovering from DVT post-hospitalization?
Which method is NOT recommended to reduce the risk of DVT?
Which method is NOT recommended to reduce the risk of DVT?
What best describes the purpose of an arthroscopy?
What best describes the purpose of an arthroscopy?
Which is a key risk associated with the use of autografts?
Which is a key risk associated with the use of autografts?
What is an important aspect of managing acute DVT?
What is an important aspect of managing acute DVT?
Which procedure is specifically designed for ligament reconstruction but may involve an open surgical field?
Which procedure is specifically designed for ligament reconstruction but may involve an open surgical field?
What is a disadvantage of using synthetic grafts?
What is a disadvantage of using synthetic grafts?
What is a recommended position for the involved extremity during DVT management?
What is a recommended position for the involved extremity during DVT management?
Which of the following is NOT a common orthopedic surgery technique?
Which of the following is NOT a common orthopedic surgery technique?
Which statement about postoperative care for tendon repair is accurate?
Which statement about postoperative care for tendon repair is accurate?
Flashcards
Moderate Protection/Controlled Motion Phase
Moderate Protection/Controlled Motion Phase
A phase of post-operative rehabilitation where the focus is on gradually increasing stress and movement, while still protecting the healing tissues.
Minimum to No Protection/Return to Function Phase
Minimum to No Protection/Return to Function Phase
The phase of rehabilitation targeting full pain-free range of motion and stability of the joint, transitioning the patient back to their usual activities.
Time-Based and Criterion-Based Progression
Time-Based and Criterion-Based Progression
The idea that moving between rehab phases should consider not just time, but also pain level, range of motion, and strength achievements.
Range of Motion (ROM)
Range of Motion (ROM)
The amount of movement a joint can achieve.
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Strength
Strength
The strength of the muscles that move the joint.
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Incapacitating Pain
Incapacitating Pain
Severe pain that persists even when resting or moving.
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Marked Limitation of Motion
Marked Limitation of Motion
Limited ability to move a joint or body part.
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Gross Instability
Gross Instability
The joint or bone segment is unstable and wobbles easily.
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Joint Deformity
Joint Deformity
Malformation or abnormal positioning of a joint.
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Significant Structural Degeneration
Significant Structural Degeneration
Advanced wear and tear within a joint, often due to arthritis.
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Chronic Joint Swelling
Chronic Joint Swelling
Ongoing swelling around a joint.
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Failed Nonsurgical Management
Failed Nonsurgical Management
Non-surgical treatments like medication or physical therapy have failed to address the problem.
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Significant Loss of Function leading to Disability
Significant Loss of Function leading to Disability
Inability to perform daily activities due to joint pain or disability.
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Preoperative Examination
Preoperative Examination
A detailed assessment before surgery, including pain levels, range of motion, and functional status.
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Preoperative Patient Education
Preoperative Patient Education
Teaching the patient how to manage their recovery after surgery.
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Atelectasis
Atelectasis
A collapsed lung, often occurring after surgery.
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Deep Vein Thrombosis (DVT)
Deep Vein Thrombosis (DVT)
Blood clots that form in deep veins, often following surgery or prolonged immobilization.
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Pulmonary Embolism (PE)
Pulmonary Embolism (PE)
A blood clot that travels from its original location, often in the legs, to the lungs, blocking blood flow.
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Joint Subluxation
Joint Subluxation
A condition where a joint partially dislocates or comes out of place, often occurring after surgery.
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Restricted Motion from Adhesions
Restricted Motion from Adhesions
Stiffness and restricted movement due to scar tissue formation after surgery.
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ROM Exercises
ROM Exercises
Specialized exercises to improve range of motion after surgery, helping to prevent scar tissue formation.
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Continuous Passive Motion (CPM)
Continuous Passive Motion (CPM)
A device used to passively move a joint after surgery, improving blood flow and preventing stiffness.
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Excessive Weight Bearing
Excessive Weight Bearing
Premature weight bearing before tissues are fully healed, increasing risk of complications.
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Capsular Shift (Capsularrhaphy)
Capsular Shift (Capsularrhaphy)
A procedure that tightens the capsule surrounding a joint to reduce laxity and improve stability.
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Biceps Tendon Repair
Biceps Tendon Repair
A type of surgery to repair a tear in the biceps tendon, where the tendon is reattached to the bone. The arm is usually immobilized in order to allow the tendon to heal.
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Tendon Transfer or Realignment
Tendon Transfer or Realignment
A surgical procedure to move the attachment point of a muscle tendon unit to a different location. This can improve muscle function and range of motion.
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Muscle-Tendon Unit Release or Lengthening
Muscle-Tendon Unit Release or Lengthening
A surgical procedure to release or lengthen a muscle tendon unit, to improve range of motion or reduce pressure on nerves and tendons.
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Fasciotomy
Fasciotomy
A procedure that involves cutting or releasing fascia, the fibrous connective tissue that surrounds muscles. This can help reduce pressure on muscles, tendons, and nerves.
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Anticoagulants
Anticoagulants
Medications used to prevent blood clots from forming in high-risk patients.
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Arthrotomy
Arthrotomy
A surgical procedure that involves opening a joint to access its inner structures.
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Arthroscopy
Arthroscopy
A minimally invasive surgical technique using a small camera and instruments to see and repair structures inside a joint.
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Arthroscopically Assisted Procedures
Arthroscopically Assisted Procedures
A surgical procedure that combines arthroscopic and open techniques for more complex repairs.
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Robotic-Assisted Procedures
Robotic-Assisted Procedures
A surgical technique that uses a robotic arm to assist in joint surgery.
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Autograft
Autograft
A tissue graft taken from the patient’s own body.
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Allograft
Allograft
A tissue graft taken from a donor other than the patient, usually a cadaver.
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Synthetic Grafts
Synthetic Grafts
A synthetic material used as an alternative to a biological tissue graft.
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Arthroscopic Debridement and Lavage
Arthroscopic Debridement and Lavage
A surgical procedure to remove debris, such as inflamed tissue, loose cartilage, or bone fragments, from a joint using an arthroscope (a small camera and surgical tool inserted through a small incision).
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Synovectomy
Synovectomy
The surgical removal of the synovial lining of a joint, typically done to treat chronic joint inflammation, like in rheumatoid arthritis.
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Articular Cartilage Procedures
Articular Cartilage Procedures
A type of surgery that uses specialized instruments and techniques to promote healing of damaged cartilage in joints.
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Chondrocyte Transplantation
Chondrocyte Transplantation
A procedure where healthy cartilage cells are harvested from the patient, grown in a lab, and then transplanted back into the damaged area of the joint to promote cartilage regeneration.
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Osteochondral Autografts or Allografts
Osteochondral Autografts or Allografts
Involves transplanting a piece of healthy cartilage and bone from another part of the patient's body (autograft) or from a donor (allograft) to the affected joint.
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Arthroplasty
Arthroplasty
A broad category of surgical options for damaged joints, aimed at reducing pain and improving function.
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Arthrodesis
Arthrodesis
A procedure to fuse the bones of a joint together, eliminating motion and pain.
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Open Reduction and Internal Fixation of Fractures
Open Reduction and Internal Fixation of Fractures
A surgical procedure where a broken bone is exposed, realigned, and stabilized with internal fixation devices like screws, plates, or pins.
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Indications for Surgical Intervention
- Incapacitating pain at rest or with activity
- Marked limitation of motion
- Gross instability of a joint or bony segment
- Joint deformity or abnormal alignment
- Significant structural degeneration
- Chronic joint swelling
- Failed nonsurgical or previous surgical management
- Significant loss of function leading to disability
Considerations for Preoperative Management
- Preoperative examination and evaluation
- Pain - level of pain according to the patient
- Range of motion and joint integrity - active range of motion and passive range of motion
- Skin integrity - note scars from previous injuries or surgeries
- Muscle performance - muscle strength in affected areas
- Posture - observe any postural abnormalities that may affect range of motion and function
- Gait analysis - analyze gait characteristics (assisted devices, degree of weight bearing, etc.)
- Functional status - limitations and abilities
- Preoperative patient education: Methods and rationale
- Overview of the plan of care - expected during the postoperative period
- Postoperative precautions - precautions or contraindications to positioning, movement, or weight bearing that must be followed postoperatively
- Bed mobility and transfers - teach the patient how to move in bed and perform wheelchair transfers safely
- Initial postoperative exercises - teach the patient any exercises that will be started during the very early postoperative period
- Deep-breathing and coughing exercises, active ankle exercises, or gentle muscle-setting exercises of immobilized joints
- Gait training - teach patient to use supportive devices that may be needed
- Pain management - educate the correct use of cryotherapy for postoperative pain management
- Wound care - educate on the signs of infection and how to clean the incision site
- Extended preoperative exercise program - likelihood that learning will carry over and exercises will be performed correctly following surgery, and to increase the likelihood of achieving optimal postoperative functional outcomes
Considerations for Postoperative Management
- Postoperative examination and evaluation
- Check for signs of redness or tissue necrosis along the incision(s) and around sutures
- Palpate along the incision and not signs of tenderness and edema
- Palpate to determine evidence of increased heat
- Check for signs of drainage; note color and amount of drainage on the dressing
- Note the integrity of an incision across a joint during and after exercise
- As the incision heals, check the mobility of the scar
- Phases of postoperative rehabilitation
- Maximum protection phase - protection of operated tissues is paramount in the presence of tissue inflammation and pain; muscle setting exercises are indicated; few days to 6 weeks depending on the type of surgery and the tissues involved
- Moderate protection/controlled motion phase - intermediate phase when inflammation has subsided, pain and tenderness are minimal, and tissues are able to withstand gradually increasing levels of stress; begins 4-6 weeks postop and lasts an additional 4-6 weeks
- Minimum to no protection/return to function phase - full (or almost full) pain-free active range of motion should be available and the joint capsule (if involved) should be clinically stable; begins 6-12 weeks postop and may continue until 6 months postop or beyond
- Time-based and criterion-based progression - can vary dramatically depending on the procedure; determining the patient's readiness to advance from one phase of postop rehab to the next should be based on time, but also on the absence of pain, restoration of a particular amount of range of motion or level of strength
- Putting postoperative rehabilitation into perspective - key to successful postop outcomes is effective, long-term patient self-management
- Therapist-directed, early postop patient education followed by a home program of selected interventions
- Carefully taught and are periodically monitored and modified by the therapist during each phase of rehabilitation
Potential Postoperative Complications and Risk Reduction
- Pulmonary complications - risk of pneumonia or atelectasis (collapsed lung); early standing and ambulation following surgery may reduce the risk
- Deep vein thrombosis and pulmonary embolism - blood clots; risk can be reduced through patient education and exercise instruction
- Restricted motion from adhesions and scar tissue formation - movement of the operated area as early as possible after surgery with range of motion exercises or continuous passive motion within a safe range to help prevent contractures
- Failure, displacement, or loosening of internal fixation device - excessive or premature weight bearing prior to readiness from incompletely healed tissues, bone, or other structure
Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)
- DVT: signs and symptoms - dull aching or severe pain, swelling, or changes in skin temperature and color, specifically heat and redness
- PE: signs and symptoms - sudden onset of shortness or breath, rapid and shallow breathing, and chest pain located, at the lateral aspect of the chest, that intensifies with deep breathing and coughing; swelling in the lower extremities, anxiety, fever, excessive sweating, a cough, and blood in the sputum
- Reducing the risk of DVT – prophylactic use of anticoagulants therapy (high-risk patients), elevating legs when lying supine or when sitting, no prolonged sitting, initiate early ambulation, active “pumping” exercises, compression stockings
- Management of DVT - acute care management - administering anticoagulant medication, placing the patient on bed rest, elevating the involved extremity, and using graduated compression stockings; post-hospitalization precautions - typically continues on an anticoagulant medication for about 6 months, avoid contact sports, running, and skiing, mandatory helmet used during high “fall risk” activities
Common Orthopedic Surgeries
- Open procedures - incision of adequate length and depth through the necessary superficial and deep layers of skin, fascia, muscles, and joint capsule that allows the operative field to be fully visualized; arthrotomy - joint capsule is incised to expose joint structures
- Arthroscopic procedures - used as a diagnostic tool and a means of treating a variety of intra-articular disorders and are typically performed on an outpatient basis and often under local anesthesia; including ligament, tendon, and capsule repairs or reconstructions, joint debridement, meniscectomy, articular cartilage repair, and synovectomy; arthroscopically assisted procedures - uses arthroscopy for a portion of the procedures but also requires an open surgical field for selected aspects of the operative procedure; robotic-assisted procedures
- Tissue grafts - autografts, allografts, and synthetic grafts
- Muscle repair - muscle is re-opposed, sutured, and immobilized in a shortened position as healing begins
- Tendon repair - tendon is sutured, the repaired muscle-tendon unit is maintained in a shortened position, as with a complete muscle, longer immobilization period may be required due to the vascular supply to tendons is poor
- Ligament repair or reconstruction - joint is held in a position that places a safe level of tension on the sutured or reconstructed ligament during the healing process; immobilization varies with the site and severity of injury, and the type of repair or reconstruction that was done
- Capsule stabilization and reconstruction - designed to reduce capsular laxity and joint volume and restore or improve joint stability fall into several categories and are performed using open or arthroscopic approaches; capsularrpahy, capsular shifts, tightening, capsular reconstruction
- Tendon transfer or realignment - the distal attachment of the muscle-tendon unit is removed from its bony insertion and reattached to a different bone, to a different location on the same bone, or to adjacent soft tissues; muscle-tendon unit is then immobilized in a shortened position for a period of time
- Release, lengthening, or decompression of soft tissue - used to improve range of motion, prevent or minimize progressive deformity, or relieve pain; myotomy, tenotomy, fasciotomy
- Joint procedures - arthroscopy debridement and lavage, arthroscopic removal of fibrillated cartilage, unstable chondral flaps, and fragments of cartilage or bone from a joint; synovectomy, removal of the synovial lining of the joint in the presence of chronic joint inflammation (rheumatoid arthritis patients); articular cartilage procedures, abrasion arthroplasty, subchondral drilling, and microfracture, used to promote healing of small chondral defects; chondrocyte transplantation, designed to stimulate growth of hyaline cartilage for repair of articular cartilage focal defects and to prevent progressive deterioration of joint cartilage
- Arthoplasty - designed to relieve pain and improve function; excision arthroplasty, removes peri articular bone from one or both articular surfaces and filled with fibrotic scar tissue during the healing process; excision arthroplasty with implant - artificial implant is inserted to help in the remodeling of a new joint; interposition arthroplasty - resurfacing of a joint to provide a new articulating surface; joint replacement arthroplasty - total joint replacement is a common reconstructive procedure to relieve pain and improve function in patients with severe joint degeneration
- Arthrodesis - surgical fusion of the joint surfaces in the position of maximum function is achieved w/ internal fixation; pins, nails, screws, plates, and bone grafts
- Extra-articular bony procedures - open reduction and internal fixation of fractures, after exposing the fracture site during surgery, any number of internal fixation devices may be used to align and stabilize the bone fragments; after the fracture has healed, a secondary surgery may be necessary to remove some or all of the internal fixations devices because they tend to migrate over time; osteotomy, surgical cutting and realignment of bone; extra-articular procedure indicated for the management of impairments associated with a number of musculoskeletal disorders
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Test your knowledge on key indicators and phases of post-operative rehabilitation. This quiz covers surgical procedures, objectives, and recovery timelines essential for understanding the rehabilitation process. Perfect for healthcare professionals and students alike.