Post-Operative Rehabilitation Quiz
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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?

  • 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?

  • 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?

  • 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?

<p>Guided by time-based milestones, but also based on the absence of pain, restored ROM and adequate strength (B)</p> Signup and view all the answers

How long can the return to function phase potentially last?

<p>Until 6 months post-op or beyond. (C)</p> Signup and view all the answers

What is the primary objective of capsule stabilization and reconstruction surgeries?

<p>Improve joint stability by reducing capsular laxity and joint volume (C)</p> Signup and view all the answers

What is the purpose of tendon transfer or realignment?

<p>To reattach the muscle-tendon unit to a different location (C)</p> Signup and view all the answers

What surgical procedure is used to improve range of motion and prevent progressive deformity?

<p>Release, lengthening, or decompression of soft tissue (B)</p> Signup and view all the answers

What is the primary purpose of a fasciotomy?

<p>To release pressure on muscles, tendons, or nerves (D)</p> Signup and view all the answers

Which of the following is NOT a method of capsule stabilization and reconstruction?

<p>Myotomy (D)</p> Signup and view all the answers

Which of the following is NOT a typical indication for surgical intervention?

<p>Mild limitation of motion that does not affect daily activities (D)</p> Signup and view all the answers

During the preoperative examination, which of the following details regarding the skin is MOST important to note?

<p>Scars from previous injuries or surgeries (D)</p> Signup and view all the answers

Which of the following is a primary purpose of preoperative patient education?

<p>To prepare the patient for the expected postoperative course (C)</p> Signup and view all the answers

What is the primary focus during the 'maximum protection phase' of postoperative rehabilitation?

<p>Protection of the operated tissues (D)</p> Signup and view all the answers

Which of the following exercises is MOST appropriate to teach during the very early postoperative period?

<p>Deep-breathing and coughing exercises (B)</p> Signup and view all the answers

In the pre-operative period, which of the following is a topic that a patient should be educated on?

<p>Wound care, including signs of infection and cleaning techniques (C)</p> Signup and view all the answers

Why is it important to check the mobility of a scar as it heals?

<p>To identify possible joint stiffness from a scar tethering the skin (D)</p> Signup and view all the answers

What does the pre-operative gait analysis evaluate?

<p>The way they walk, including any needed supportive devices (C)</p> Signup and view all the answers

In addition to pain and range of motion, what other key assessment is performed in the pre-operative examination and evaluation?

<p>Muscle performance (A)</p> Signup and view all the answers

What is the purpose of the muscle setting exercises in the maximum protection phase?

<p>To prevent muscle disuse atrophy (D)</p> Signup and view all the answers

What is essential for successful postoperative outcomes?

<p>Effective, long-term patient self-management (A)</p> Signup and view all the answers

How can the risk of pulmonary complications, such as pneumonia, be reduced post-surgery?

<p>Early standing and ambulation (D)</p> Signup and view all the answers

What is a potential result of restricted motion from adhesions and scar tissue formation?

<p>Restricted motion (D)</p> Signup and view all the answers

What is a common sign of Deep Vein Thrombosis (DVT)?

<p>Dull aching or severe pain in the limb (A)</p> Signup and view all the answers

What measure reduces the risk of joint subluxation or dislocation after surgery?

<p>Patient education and exercise instruction (D)</p> Signup and view all the answers

Which condition is characterized by a sudden onset of breathlessness and chest pain?

<p>Pulmonary embolism (C)</p> Signup and view all the answers

When might medical testing be necessary for suspected DVT?

<p>To confirm or rule out the condition (B)</p> Signup and view all the answers

What could excessive or premature weight bearing after surgery lead to?

<p>Failure of internal fixation devices (B)</p> Signup and view all the answers

What is the primary purpose of arthroscopic debridement and lavage?

<p>To remove cartilage and bone fragments from a joint (D)</p> Signup and view all the answers

Which procedure involves harvesting and processing chondrocytes in a lab?

<p>Chondrocyte transplantation (D)</p> Signup and view all the answers

What distinguishes joint replacement arthroplasty from excision arthroplasty with implant?

<p>Joint replacement uses artificial implants to recreate the joint (B)</p> Signup and view all the answers

Which of the following best describes the purpose of synovectomy?

<p>To remove the synovial lining in chronic inflammation cases (C)</p> Signup and view all the answers

What is a key outcome of arthrodesis?

<p>Loss of joint motion (A)</p> Signup and view all the answers

Which surgical procedure transplants intact articular cartilage along with underlying bone?

<p>Osteochondral autografts (D)</p> Signup and view all the answers

In which procedure is fibrotic scar tissue filled during healing?

<p>Excision arthroplasty with implant (D)</p> Signup and view all the answers

What common goal do most arthroplasty procedures aim to achieve?

<p>Relieve pain and improve function (A)</p> Signup and view all the answers

What is a common precaution for a patient recovering from DVT post-hospitalization?

<p>Use of anticoagulant medication for about 6 months (B)</p> Signup and view all the answers

Which method is NOT recommended to reduce the risk of DVT?

<p>Prolonged periods of inactivity (A)</p> Signup and view all the answers

What best describes the purpose of an arthroscopy?

<p>A diagnostic and treatment tool for intra-articular disorders (C)</p> Signup and view all the answers

Which is a key risk associated with the use of autografts?

<p>Involvement of multiple surgical sites (B)</p> Signup and view all the answers

What is an important aspect of managing acute DVT?

<p>Administering anticoagulant medication and rest (A)</p> Signup and view all the answers

Which procedure is specifically designed for ligament reconstruction but may involve an open surgical field?

<p>Arthroscopically assisted procedures (D)</p> Signup and view all the answers

What is a disadvantage of using synthetic grafts?

<p>Consistently poor strength over time (A)</p> Signup and view all the answers

What is a recommended position for the involved extremity during DVT management?

<p>Elevated position (B)</p> Signup and view all the answers

Which of the following is NOT a common orthopedic surgery technique?

<p>Chemonucleolysis (A)</p> Signup and view all the answers

Which statement about postoperative care for tendon repair is accurate?

<p>The muscle-tendon unit should be immobilized flexed for better healing. (B)</p> Signup and view all the answers

Flashcards

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

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

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)

The amount of movement a joint can achieve.

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Strength

The strength of the muscles that move the joint.

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Incapacitating Pain

Severe pain that persists even when resting or moving.

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Marked Limitation of Motion

Limited ability to move a joint or body part.

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Gross Instability

The joint or bone segment is unstable and wobbles easily.

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Joint Deformity

Malformation or abnormal positioning of a joint.

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Significant Structural Degeneration

Advanced wear and tear within a joint, often due to arthritis.

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Chronic Joint Swelling

Ongoing swelling around a joint.

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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

Inability to perform daily activities due to joint pain or disability.

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Preoperative Examination

A detailed assessment before surgery, including pain levels, range of motion, and functional status.

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Preoperative Patient Education

Teaching the patient how to manage their recovery after surgery.

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Atelectasis

A collapsed lung, often occurring after surgery.

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Deep Vein Thrombosis (DVT)

Blood clots that form in deep veins, often following surgery or prolonged immobilization.

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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

A condition where a joint partially dislocates or comes out of place, often occurring after surgery.

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Restricted Motion from Adhesions

Stiffness and restricted movement due to scar tissue formation after surgery.

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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)

A device used to passively move a joint after surgery, improving blood flow and preventing stiffness.

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Excessive Weight Bearing

Premature weight bearing before tissues are fully healed, increasing risk of complications.

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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

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

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

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

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

Medications used to prevent blood clots from forming in high-risk patients.

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Arthrotomy

A surgical procedure that involves opening a joint to access its inner structures.

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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

A surgical procedure that combines arthroscopic and open techniques for more complex repairs.

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Robotic-Assisted Procedures

A surgical technique that uses a robotic arm to assist in joint surgery.

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Autograft

A tissue graft taken from the patient’s own body.

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Allograft

A tissue graft taken from a donor other than the patient, usually a cadaver.

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Synthetic Grafts

A synthetic material used as an alternative to a biological tissue graft.

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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

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

A type of surgery that uses specialized instruments and techniques to promote healing of damaged cartilage in joints.

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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

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

A broad category of surgical options for damaged joints, aimed at reducing pain and improving function.

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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

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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Study Notes

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.

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