Bonus Rehab Protocols + Red Flags

Question 1

Rule of 6

Explain the Rule of 6 with Rehab Protocol Themes

Answer 1

6wks
6-12wks
Up to 6mos

Question 2

Explain the jist of MAXimal Protection Phase

Answer 2

INITIAL post-op pd when protection of operated tissues is PARAMOUNT
- tissue inflamm + PAIN
- Few days–> 6wks

Why up to 6wks?–> bc healing time of bone and soft tissue ~8wks!

Question 3

Explain the jist of MODerate Protection Phase

Answer 3

PAIN LOWER!
Intermediate phase of rehab–Inflamm has subsided, pain/tender MINIMAL– tissues able to w/stand gradual inc’ing lvls of stress
- Typ begins ~6wks and cont’s additional 6wks

Question 4

Explain the jist of MINimal Protection Phase

aka Return to function/sports

Answer 4

Advanced phase–little to no protection of op tissues reqd
- To progress–> full (or almost) painfree AROM should be available AND jt capsule (if involved) should be clinically stable
- Begins 6-12wks post-op may continue until 6mos+

Question 5

MAX Protection phase Goals:

Answer 5

1. Edu in preparation for self-mgmt–safe pos’ing and limb mvmts–Precautions/Contraindications
2. DEC post-op pain, mm guard, spasm–modals (TENS), cold, heat
3. Prevent wound infx–wound care
4. MIN swelling– RICE
5. Prevent circ issues (DVT, PE, PNA)–active ex’s to DISTAL mm’s, Deep-breathing/coughing
6. Prevent stiffness/contractures–CPM, P/AAROM immediately post-op
7. Min mm atrophy across immob’d jts–MM setting aka Isometrics
8. Maint motion+strength ABOVE and BELOW operated site–active/resistive ex’s to NONop areas
9. Maint functional mobility while protecting op’d site– adaptive equip/ADs (UP w/ GOOD, DOWN w/ BAD)

Question 6

MOD Protection/Controlled Motion phase: Goals

Answer 6

1. Edu on monitoring/modifications to ex. program
2. GRADUALLY restore soft tissue/jt mobility– A/AAROM w/in limits of pain–Progress TO Grade III/IV jt mobs
3. Mobile scar– scar massage
4. Strengthen involved mm’s and improve jt stability
   - Multiple-against inc’ing resistance
   - Alternating iso’s + rhythmic stab= Stability
   - Dynamic ex’s against LIGHT resistance in OKC/CKC, Light functional acts.

Question 7

Progression of MM contractions?

Answer 7

START w/ Isometric THEN Concentric THEN Eccentric

Question 8

MIN protection/Return to function phase: Goals

Answer 8

1. Edu
2. PREVENT RE-injury/post-op comps
3. Restore FULL jt/soft tissue mob
4. MAXIMIZE mm performance, dynamic stab, NMSK control
5. Balance/coord. mvmt
6. Acquire or RElearn specific motor skills

Question 9

Practice!
73yo male Total Shoulder Arthro (TSA means RTC NOT involved). 1wk post-op AVOID what?

Answer 9

A: Passive ER to 45 degs
Rationale:
- ER allowed up to 30degs
Weeks 0-4:
- Elevation restricted to <120degs; ER restricted to <30degs
- Grade I/II mobs
- AROM scap/elbow
- AAROM in supine first 3wks, Week 4– transition to sit/stand
- NO active IR for @ least 6 weeks (protect subscap repair)
- Pendulums OK
- Light, NWB isometrics in scapular plane

Question 10

Precautions after TSA

Answer 10

2 Forms of Shoulder Arthro:
1. TSA (RTC INtact)
2. Reverse TSA (rTSA)–RTC involved– rTSA full ROM not expected

IF rTSA
- sling needed 4-6wks

IF TSA
- sling weaned off same day as sx

Question 11

Total Hip Arthro Precautions
Posterior vs Anterior (the avoid FABER one)

REMEMBER: you want to AVOID dislocating!! Use concave/covex rule

Answer 11

Posterior:
- AVOID: Hip flex >90 (knees LOWER than hips), ADD past midline, IR– ESP first 6wks
- Bed pos’ing w/ ADD wedge immediately

Anterior:
- AVOID: Hip flex >90, Hip EXT, ADD, ER past neutral
- AVOID: Combo mvmt of FABER

Question 12

Precautions w/ ACL Reconstruct
CKC vs OKC

Answer 12

CKC:
- When squatting maintain UPRIGHT pos
- Up to 6wks: AVOID CKC bw 60 to 90degs of knee flexion

OKC:
- Resistance applied ABOVE knee initially
- AVOID resisted, OKC knee ext (SAQs) bw 45 or 30degs to full EXT @ least 6wks, maybe 12wks
- NO resistance to distal tib during quad strengthening

Progress Ex MORE gradually if HS tendon graft vs BPTB graft

Question 13

Red Flags

S/S aka Key Words

Answer 13

• Constant pain which does NOT change w/ position change or meds==> Systemic disorder

Refer! Some may need 911!

Question 14

Wells Criteria for DVT

Answer 14

2 or more == DVT

Question 15

DVT and PE

Answer 15

• Medical Emergency!!!
• Hallmark S/S: Sudden DOE, Rapid shallow-breaths (Tachypnea)
• Others: Swelling in LE, anxiety, fever, excess sweating (diaphoresis), cough, blood in sputum (hemoptysis)

Question 16

Rhabdo!

Answer 16

• Breakdown of Sk. MM tissue–> releases myoglobin, creatine kinase (CK), K+ INTO bloodstream
• S/S: mm pain, weak, swelling, dark colored urine (tea colored), decd urine output, fatigue, jt pain
• IMMEDIATE MEDICAL attn–> kidney damage, electrolyte imbals, metabolic acidosis, death
• Statins INCs risk of rhabdo

Question 17

Rhabdo!
_ is considered a med that INCs risk of Rhabdo

Answer 17

Statins!!!!
for CHO

Question 18

Cond’s requiring IMMEDIATE medical assist:
Call 911
All first

Answer 18

see chart

Question 19

Cond’s requiring IMMEDIATE medical assist:

Call 911

Abdominal Aortic Aneurysm
AAA

Answer 19

pulsating feeling in abdomen, abd bulge

Question 20

Cond’s requiring IMMEDIATE medical assist:

Call 911

Appendicitis
(RLQ)

Answer 20

Tender McBurneys, RLQ pain, mild fever***

Question 21

Cond’s requiring IMMEDIATE medical assist:

Call 911

Acute Compartment Syndrome
think Pressure

Answer 21

6 P’s:
- Pain, Palpable tenderness, Parasthesias, Pallor, Paresis, Pulselessness

Question 22

Cond’s requiring IMMEDIATE medical assist:

Call 911

MI/Cardiac Arrest

Answer 22

LEFT neck and jaw pain along w/ chest pain

Question 23

Cond’s requiring IMMEDIATE medical assist:

Call 911

Cauda Equina
SCI

Answer 23

Saddle (think sitting on horse) anasthesias, loss of B&B function, urine retention (most Sn), LE weak

Question 24

Anaphylaxis

Answer 24

Hives, itch, SOB, rapid/weak pulse

Question 25

Cond’s requiring IMMEDIATE medical assist:

Call 911

Diabetic Ketoacidosis (remember more common in T1DM)
DM FBG >126, random >200, metabolic syndrome FBG >100
safe to Ex 100-250 blood sugar

Answer 25

Excess thirst, confusion/diff concentrating, Fruity acetoney breath=ketones

Question 26

Talk about Angina mgmt and when Emergency

Answer 26

• Controlled= No 911
• Other: Give nitroglycerin 3x @ 5min intervals– If NO sx relief== Call 911!!!!!!