EWH Surgeries Flashcards
UCL reconstruction
- Tommy John
- palmaris longus or gracilis graft
- hinged brace for first 6 weeks with ROM progressed during this time
what does early rehab look like with a UCL reconstruction
- 0-3wks focus on PROM
- protect the graft
- address issues proximal and distal
what do you avoid in early rehab with UCL reconstruction and why
- avoid active/passive shouler ER because it puts a valgus stress on reconstruction
intermediate phase of rehab for UCL reconstruction
- 4-12wks
- gradual increase to full ROM per protocol
- promote healing of graft
- regain and improve muscle strength-slow integration of exercises
advanced strengthening phase for UCL reconstruction
- 12+wks
- progress power/endurance
- introduce UE plyometrics
- interval throwing program typically beginning at 16 wks
cubital tunnel release indications
- failed conservative therapy
- severe compression
- muscle weakness or wasting
cubital tunnel release procedure
- ligament “roof” of cubital tunnel cut and divided
- may need to perform ulnar n. anterior transposition if compression severe enough
post-op recovery for cubital tunnel release
- ROM exercises, scar massage, edema control and use of elbow pad starting at 3-5 days post-op
- progressive strengthening exercises are initiated at 6wks post-op
when is return to normal permitted for cubital tunnel release
- 6-8 weeks following surgery
if a pt gets cubital tunnel release and is a manual laborer, strengthening may take up to how many weeks
12 weeks
distal bicep repair initial immobilization
posterior splint immobilizes elbow at 90 degrees flexion for 5-7 days with forearm in neutral
what kind of brace is typically used for a distal bicep repair
- hinged elbow brace
- 45 degrees to full flexion
how do you know if a pt follows an accelerated protocol or traditional protocol for distal bicep repair
- call doctor
- follow traditional until you know
during first 6-8wks for distal bicep repair,
- ROM focus
strengthening typically takes how long for a distal bicep repair
8 wks
carpal tunnel release
transection of transverse ligament
when is a carpal tunnel release typically done
- failed conservative therapy
- muscle wasting in the hand
- very compressed nerve
post-op for carpal tunnel release
- no precautions
- splinting in neutral-15 degrees of extension
- scar management
- edema control
- ergonomic education
- mobilization
- tendon gliding
- strengthening initiated around 3-4wks
how long are you immobilized with a flexor tendon repair and in what position
- 3-4wks with wrist and digit flexed
what precautions do flexor tendon repair follow
- resisted ext and passive flexion within limits of splint
- AROM to tolerance initiated at 4wks
how long are you immobilized with extensor tendon distal repairs and in what position
- 6-8wks with DIP joints in neutral
what precautions do extensor tendon distal repairs follow
- AROM at 6wks with PIP in neutral
- active ext initiated first, followed by flexion
how long are you immobilized with extensor tendon proximal repairs and in what position
- 4 wks with wrist and digital joints in ext
what precautions do extensor tendon proximal repairs follow
- early AROM/PROM in flexion with MCP joint in extension
- full AROM initiated into flexion/extension at 6wks
open reduction internal fixation
- closed reduction is either not possible or fracture healing would be protracted
- restrictions depend on location and severity of fx and extent of soft-tissue injury
