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Rehabilitation of Functional Movement > Elective Orthopaedic > Flashcards

Elective Orthopaedic Flashcards

1
Q

list 11 reasons for elective surgical intervention

A 
Severe unmanageable arthritic joint pain
  Night pain severely affecting ability to sleep   Major functional limitations
  Quality of life
  Progressive deformity
  Trauma or injury
 Fractures i.e.NOF
  Avascular necrosis- (NOF)
  Birth defects and growth disorders
  Severe joint infection
  Cancer in or near a joint
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2
Q

What is included in pre op management

A 
Pre-admission clinic or pre-op joint class   MDT approach
  Education on joint replacement surgery
  Discuss expectations post surgery

Discuss possible limitations post surgery

  • Hip precautions
  • Driving

Roles of AH intervention

Discuss D/C date`

Deep breathing and circulation exercises

Discuss TEDs and; SCUDs

Trial walking aids + stairs

Educate and practice WB status

Strengthening exercises – start pre op

Falls prevention

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3
Q

THJR/HA post op day 1

A

Check WB status - PWB or WBAT - aim to get out of bed (frame or crutches) and mobilise

  • Review hip precautions
  • Chest Physio, circulation exercises
  • ROM exercises hip/knee/ankle unaffected leg
  • Bed exercises operated leg AAROM • Static quads
  • IRQ
  • Hip and Knee flexion
  • Hip abduction, extension
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4
Q

THJR/HA day 2,3 - discharge

A

Continue chest physio, circulation exercises as indicated, bed exercises

Mobilise: progress mobility distance

Standing exercises (hip flexion, abduction, adduction not past midline, extension) and supported mini squat/STS

Stairs +/- car transfers

D/C: independent bed mobility, mobility, stairs

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5
Q

post surgical hip precautions

posterior or lateral approach

A
  • no flexion past 90 degrees
  • no crossing legs/adduction past midline
    no twisting or IR
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6
Q

post surgical hip precautions

anterior approach

A

no extension
no ER
no adduction past midline

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7
Q

Hip dislocations

A

uncommon - 6-7%

More common with posterior/lateral approach, females, prev. surgery

Greatest risk in first few months

Popping sound, severe pain

Change in leg length, internal rotation of hip

Inability to weight bear 58-70%riskofreoccurrence

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8
Q

Mgmt of hip dislocations include

A

closed reductin

  • hip abduction brace
  • hip spica

further surgery

  • revision - head and lineat exchange
  • insertion of constrained component
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9
Q

TKJR post op day 1 parameters

A 
Check WB status PWB or WBAT Aim to get out
    of bed (frame or crutches) and mobilize

Chest Physio, circulation exercises

ROM exercises hip/knee/ankle good leg

Bed exercises operated leg PROM/AAROM   
Static quads
IRQ
SLR
Knee flexion and extension (+overpressure)   
Knee flexion while SOEOB

May use CPM for knee ROM - to 60 degrees
Day 1 – PROM/AAROM flex/ext knee ex

Sit out in chair

Ice packs or cryocuff/iceman

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10
Q

TKJR post op day 2

A

Continue with bed exercises, chest physio, circulation exercises

Progress knee ROM exercises, aim 90* and SLR by day 4 or pre-D/C

Mobilize with crutches or walker PWB/FWB

If doing well, start IRQ in sitting, flexion in
sitting

Promote extension in bed, flexion in sitting

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11
Q

TKJR post op day 3-4

A

Continue as per previous days

Aim 90* flexion and SLR pre D/C

Progress mobility

Stairs

D/C usually around day 4

HEP

F/U with knee class or OPD if available

Independent with mobility and; stairs

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12
Q

indications for TSJR

A

hard to control pain, particularly if affecting sleep/ADLS

∗ Glenoid cartilage degeneration
∗ Preferred over hemi for OA/inflammatory arthritis

∗ Posterior humeral head subluxation

∗ Contraindicated if:
insufficient glenoid bone stock
deltoid dysfunction
active infection

rotator cuff arthroplasty
irreparable rotator cuff
brachial plexus palsy

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13
Q

reverse TSJR indications

A

∗ CTA (cuff tear arthropathy)

∗ Rotator cuff insufficiency

∗ Pseudoparalysis

∗ Antero-superior escape

∗ 3/4pt fractures

∗ Failed arthroplasty

∗ RA

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14
Q

reverse TSJR are appropriate for

A

∗ Low functional demand

∗ >70yr of age

∗ Must have sufficient glenoid bone stock

∗ Must have a working deltoid muscle

∗ Must have an intact axillary nerve

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15
Q

TSJR post op

A

Chest Physio, circulation exercises

Mobilize out of bed day 1

Ice

Shoulder Immobiliser sling until Week 6

No WB through shoulder, no lifting

Exercises: elbow, wrist, hand + grip, c-spine

PROM: flexion to 90, external rotation to 0

∗ Passive or active-assisted motion only during early rehab

∗ limiting factor in early rehab is risk of injury to the subscapularis tendon repair

∗ pendulum exercises, scapula setting/positioning

∗ Progress to ER isometrics

∗ Limit passive external rotation

∗ risk of tear and pull-off of subscapularis tendon from
anterior humerus

∗ tear leads to anterior shoulder instability (most common form of instability after TSA)

∗ IR eccentric and isometric

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16
Q

9 safe D/C guidelines for all patients

A

Adequate support and assistance in place

Equipment required at home

Walking aid issued

Mobilizing independently

Safe on stairs

Joint range aim achieved

Obs stable, wound healing, no infection

Catheter out

Pain managed appropriately

17
Q

Compare elective vs trauma orthopaedic surgery, elective surgery is for what

A 
planned joint replacements 
TKJR
THJR
TSJR
ligamentous reconstruction 
elective spinal surgery 
paediatric corrective surgeries

these can have pre - operative management prior to surgery

18
Q

compare elective vs trauma orthopaedic surgery, orthopaedic trauma includes what

A 
#NOFs
spinal fractures 
fracture and dislocation management: such as OR Ex-fix, cast/splint 
wound, tendon/ligament management
19
Q

what patient details are needed

A

demographics - age, where they live

a diagnosis - including cause, complaint, surgery/treatment, dates
eg. Elective R) THR 02/05/15

Consultant/surgeon
check OP notes

20
Q

What to include in a S/E

A 
Patient's feelings
present Hx
past orthopaedic Hx
medical history 
social hx
meds
21
Q

When looking at treatment, list all the fundamentals

A 
accurate and concise treatment and document 
joint mobilisation 
swelling management 
pain management 
WB status 
walking aids 
exercises 
fitting of orthoses
22
Q

when looking at your plan/further managment, list all the fundamentals that need to be accounted for

A 
short term goals (in patient) 
ongoing reassessment 
progression of treatment 
frequency/progression of treatment s
discharge criteria 
equipment 
home programs 
referrals - outpatient services

Rehabilitation of Functional Movement (12 decks)

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