Intro to surgery Flashcards
Involves incision of adequte length and depth through superficial and deep layers of skin, fascia and joint capsule
Open procedure
used to descrive an open procedure to expose joit stracture
Arthotomy
uses arthroscope. Small incisions on the skin
Arthroscopic procedure
dx tool where there is line c camera to visualize the loob ng joint
arthroscope
Small incisions on the skin
portals
Common in shoulder knee and hip, ligament repairs
Arthroscopic procedure
Malaki incision in Open
bigger Soft tissue disruption
longer recovery time
Uses arthroscopy for a portion of the procedure but also requires and open surgical field
Arthroscopically assisted procedure
Autograft
self
harvest from donors side
Allograft
same specie
uses cadaveric donor
Synthetic graft
gore tex and dacron
disadvantages Autograft
needs 2 surgical procedure because it needs to harvest the skin then replace it
damage to weakening of otherwise healthy tissue at the donor site
disadvantages allografts
potential disease transmission from the donor
dec graft streth
risk of graft failure to immuno rejection
usually tendon lng, d pwede cartillage
disadvantages allografts
potential disease transmission from the donor
dec graft streth
risk of graft failure to immuno rejection
usually tendon lng, d pwede cartillage
done after complete muscle tear
muscle repair
Full contracting mm is stretched or receive a complere bkie
moi of full muscle tear
Repair after ___ hrs when inflammaroty signs are minimal in mm repair
48-72 hrs
Mx guidliens for muscle repair
Mm sets may be done immediately after rugery
WB for muscle repair
partially restrcited until pt achieves fxnal level of strenght and flexibility in the repaired mm
Post immob in muscle repair
AROM’S IN TOLERATED RANGE gradual progression of low load high reps resistance para makit tolerance ng mm
AROM’S will tell us how
willing the patient is to
move. Ano lang ka
nyang ROM.
Precautions for muscle repair
no strethching and vigorous mm contraction until soft tissue healing is completed (6-8 wks)
Tendon repair result of macrotrauma
Young person
Tendon repair
Deteration
repetitive macrotrauma
Elderly
Full tear
low strenght
little to no pain
bat may pain sa partial tear
napupull ang injured area
partial tear
Strenght 3-2+
Tendon repair should be done ___ and why
immediately
umuurong agad tendon
stretched beyond normal units
Dilation:
fibrous band or structure that abnormally attached body parts
Adhesion:
removal of a structure
Excision
cut or wound produced by a sharp object
Incision:
subjective evidence of a pt’s dse
Symptom
prediction of a probable outcome of a dse
Prognosis
closing an opening by stitches
Suture
artificially produced opening in a body structure
Stoma
sudden, involuntary contraction of a mm
Spasm
drooping or sagging of a body structure
Prolapse
INDICATION FOR SX INTERVENTION
- Incapacitating pain at rest or c fuc. Act.
- Marked limitation of arom or prom
- Gross instability of a joint alignment
- Significant structural degeneration
- Chronic jt swelling
- Failed conservative (non-sx) pr prior sx mx
- Significant loss of func. Leading to disability as the result of any of the preceding factors.
MX GUIDELINES
Rehab begins c pt education & pre-rehab exercises or func. Skill dev’t before sx and continues c direct intervention from a therapist and long-term self-mx by the pt after sx
. PRE-OP EXAMINATION AND EVALUATION
● Pain ● ROM and Jt. Integrity ● Skin integrity ● MM Performance ● Posture ● Gait Analysis ● Functional Status
PRE-OP PT EDUC: METHODS AND RATIONALE
● Pt educ begins pre-operatively
● Pre-op instruction gives a pt an idea
regarding the factors assoc. c sx such as
wound care, precautions following sx, use
of asst. devices or immobilizer
COMPONENTS OF PRE-OP PT EDUCATION
● Overview of plan of care ● Post-op precautions ● Bed mobility and transfers ● Initial post-op exercises ➔ Deep breathing and coughing exercises ➔ Active ankle exercises ➔ Gentle mm-setting exercises of immobilized jts ● Gait training ● Wound care ● Pain mx NOTE: PRE-OP EXERCISE PROG MAY BE PARTICULARLY BENEFICIAL IF A PROLONGED PERIOD OF IMMOBILIZATION OR REDUCED WEIGHT BEARING IS NECESSARY AFTER SX.
POST-OP EXAMINATION AND
EVALUATION
● Pain ● Swelling ● Potential Circulatory and Pulmonary complications ● MM weakness and/or atrophy ● WB ● Weakness and LOM of other non-affected jts
FACTORS THAT INFLUENCES THE
COMPONENTS, PROGRESSION, AND
OUTCOMES OF A POST-OP REHAB
PROG.
● Extent of tissue pathology or damage ❖ Size of severity of the lesion ● Type and unique characteristics of the sx procedure ● Pt-related factors ❖ Age, extent of pre-op impairments, and functional limitations ❖ Health Hx, particularly use of meds and for DM pts ❖ Lifestyle Hx, inc. tobacco use ❖ Needs goals, expectations, and social support Level of motivation and ability to adhere to an exercise prog ● Stage of healing of involved tissues ● Characteristics of types of tissues involved ❖ Response to immobilization and remobilization ● Integrity of structures adjacent to involved tissues ● Philosophy of the surgeon
how long MAXIMUM PROTECTION PHASE lasts
(FEW DAYS - 6 WEEKS)
how long MODERATE PROTECTION PHASE
( 4 to 6 weeks- 12 weeks)
how long MINIMUM PROTECTION PHASE
(6 TO 12 WEEKS- 6 MONS OR BEYOND)
POTENTIAL POST-OP COMPLICATIONS & RISK REDUCTION
A. PULMONARY COMPLICATIONS B. DVT AND PULMONARY EMBOLISM C, JOINT SUBLUXATION OR DISLOCATION D. RESTRICTED MOTION FROM ADHESIONS AND SCAR FORMATION E. FAILURE, DISPLACEMENT OR LOOSENING OF INTERNAL FIXATION DEVICE F. DEEP VEIN THROMBOSIS AND PULMONARY EMBOLISM: A CLOSER LOOK
Necessary for surgeries such as joint replacement, arthrodesis, or
internal fixation of fractures & reconstruction procedure
ARTHROTOMY/open procedure
Requires a lengthy period of
rehabilitation for soft tissue
healing.
ARTHROTOMY/open procedure
Increase soft tissue
disruption
OPEN PROCEDURE
decrease soft tissue
disruption
ARTHROSCOPICALLY
ASSISTED PROCEDURE
how long before mm tear is repaired
48-72hrs where inflammatory signs
are minimal
Muscle is reopposed sutured and immobilization in a ____position
because we don’t want
to stretch the muscle or
tendon
MM sets for Muscle tear
low level contraction: to increase the circulation
of the muscle and lessen
the atrophy
MC site for tendon repair
bicipital tendon and
achilles tendon
Post-op Management for tendon tear
Muscle setting is begun immediately after sx ● Remove immobilization for brief periods of exercise ● PROMS or active cxn of antagonistic muscle group written a protected range ● Controlled antigravity motions are initiated after tendon had several weeks to heal (subacute) ● WB: may be restricted and heavy weight lifting are contraindicated (6 - 8 weeks) ● Vigorous stretching and high intensity resistance exercise can be initiated at 8 weeks
Vigorous stretching and high
intensity resistance exercise can
be initiated at ___ for tendon repair
8 weeks
CAPSULE STABILIZATION AND RECONSTRUCTION
is indicated for
● Traumatic dislocation with associated capsular, labral avulsion or fracture ● Recurrent dislocation ● Subluxation despite conservative management ● Irreducible dislocation
A specific portion of capsule is incised and
tightened by overlapping and then suturing
the redundant tissue
Capsulorrhaphy (Capsular shift)
Repair of capsule and labral lesion by
reattaching the labrum to the rim of the
glenoid combined with stabilization of the
capsule
Capsulolabral Reconstruction
Arthroscopic approach that uses laser to
shrink selective portions
Electrothermally Assisted Capsulorrhaphy
