Ortho Surgical Procedures

Question 1

Laminectomy

Why?
What/How?
Rehab expectations?

Answer 1

1. disc protrusion or spinal stenosis
2. posterior approach;
   complete - removal of lamina, spinous process, ligamentum flavum; partial - removal of one lamina
3. s/p weight and EXT ROM limitations

Question 2

Spinal Fusion

Why?
What/How?
Rehab expectations?

Answer 2

1. axial pain w/ unstable spine segments, advanced arthritis, uncontrolled peripheral pain
2. Cervical = anterior approach; Lumbar = posterior approach
3. weight lifting and AROM (twist, bend) restrictions, OPPT 6 wks s/p

Question 3

Total Arthroplasty - Shoulder

Why?
What/How?
Rehab expectations?

Answer 3

1. Arthritis, fracture, or RTC tear
2. Anterior approach - subscapularis detached;
   TSA = replace glenoid and humeral components
   Hemiarthroplasty = replace one of those
   Reverse TSA = dysfunctional RTC, reverse concave-convex
3. sling for 6-8 wks (depends on protocol; weightbearing, lifting, IR MMT restrictions

Question 4

Subacromial Decompression

Why?
What/How?
Rehab expectations?

Answer 4

1. Impingement
2. Open approach (deltoid detached), Mini-Open Approach (Deltoid split), or arthroscopic
3. Rapid recovery, sling 1-2 wks,
   Early rehab = pain control, gentle ROM; Later = strength

avoid shoulder EXT early on if deltoid repair

Question 5

Rotator Cuff Repair

Why?
What/How?
Rehab expectations?

Answer 5

1. Depth (partial vs full); Width (small < 1cm, medium 1-3 cm, large > 5 cm)
2. Small partial-thickness = debridement; others repair
3. Depends on protocol, sling, progress PROM/AAROM/AROM, isometrics/concentric/dynamic/plyometric; lifting/WB precautions

Question 6

Shoulder Stabilization Surgery

Why?
What/How?
Rehab expectations?

Answer 6

1. Chronic instability (Anterior)
2. Anterior instability = anterior capsule tightened, labral tear repair, Bankart = repair of anterior labrum, SLAP = repair of superior labrum; arthroscopic
3. Anterior approach = avoid ER, EXT, HABD, resisted IR if subscap detached
   Posterior approach = avoid IR, flex, HADD
   progress arom and strength, do not have to wait for full ROM to begin strengthening

Question 7

Hip ORIF

Why?
What/How?
Rehab expectations?

Answer 7

1. hip fx
2. Open procedure (TFL, glute med, vastus lateralis can be affected); Older adults (consider THA)
3. WB restrictions depends on age, location of fx, bone quality; progress ambulation first

Question 8

Anterior Cruciate Ligament Reconstruction

Why?
What/How?
Rehab expectations?

Answer 8

1. tearing causing pain and instability
2. Gold Standard: bone-patellar tendon graft (bone to bone healing); gracilis/semitendinosus graft (tendon to bone healing)
3. Depends on protocol: ROM (ext), CKC exercises
   Bone-patella graft = anterior knee pain, caution with quad strengthening
   Hamstring graft = caution with flexion exercises

Question 9

Criteria for return to sport (ex. ACL)

Answer 9

1. No pain/effusion
2. Full ROM
3. No instability
4. Quad strength
5. Hamstring strength
6. Functional Testing (hop, run, balance tests)

Question 10

Posterior Cruciate Ligament Reconstructions

Why?
What/How?
Rehab expectations?

Answer 10

1. PCL tear, pain and instability
2. Grafts similar to ACL
3. Avoid repeated knee flex, limit posterior shear forces

Question 11

Meniscus

Why?
What/How?
Rehab expectations?

Answer 11

1+2. Partial meniscectomy = inner 2/3 meniscus torn (older adults); Repair by suture = outer 1/3 meniscus torn (younger)
3. WB restriction and bracing (repair); full WB w/o brace (partial)

Question 12

Achilles Tendon Repair

Why?
What/How?
Rehab expectations?

Answer 12

1. complete tear of achilles tendon
2. arthroscopic, sutured if able or graft
3. Casting in slight PF (NWB), boot (PWB); caution with PF and calf stretching until tendon heals