Ortho Surgical Procedures Flashcards
Laminectomy
Surgical considerations:
- performed in the presence of disk protrusion and spinal stenosis
- complete vs incomplete (lamina, spinous process, and ligamentum flavum)
Rehab considerations:
- lifting restrictions
- extension restrictions
Spinal Fusion
Surgical considerations:
- indicated in axial pain with unstable segments, advanced arthritis, or uncontrolled peripheral pain
- bone harvested from iliac crest
Rehab considerations:
- spinal precautions (BLT)
- bracing if surgeon does not stabilize segments
- OPPT 6 weeks post op
Total Shoulder Arthroplasty
Surgical considerations:
- Total: both glenoid and humeral head replaced
- Hemi: only one is replaced
- Reverse: reverses the concave/convex relationship, most commonly used with dysfunctional RTC
Rehab considerations:
- sling
- ROM restrictions (ext, ER, IR)
- NWB and no lifting
Subacromial Decompression
Surgical considerations:
- when shoulder impingement does not respond to conservative treatment
Rehab considerations:
- rapid recovery, only 1-2 weeks in sling
- if deltoid repair was done = no extension
Rotator Cuff Repair
Surgical considerations:
- partial vs full thickness
- small, medium, or large (>5cm)
- small partial only requires debridement
Rehab considerations:
- sling with abduction pillow for several weeks
- no AROM, lifting or WBing
Shoulder Stabilization Surgeries
Surgical considerations:
- capsular shift (tightening of the joint capsule by cutting or shrinking)
- anterior instability is most common
- Bankart repair = anterior labrum
- SLAP = superior labrum
Rehab considerations:
- anterior repair = sling and avoid ER/ext/horz abd
- posterior repair = immobilize in handshake position and avoid IR/flex/horz add
Hip ORIF
Surgical considerations:
- femoral neck fx = intracapsular, nonunion and necrosis (blood supply)
- intertrochanteric fx = extracapsular, implant failure
Rehab considerations:
- early WBing
- be aware of fixation failure (thigh/groin pain, leg length discrepancy, leg positioned in ER)
Surgeries to fix articular cartilage defects
Rehab considerations:
- WBing precautions
- extension brace
ACL Reconstruction
Surgical considerations:
- autograft over allograft
- bone patellar bone is gold standard
- use of gracilis or semitendinosis
Rehab considerations:
- hinged brace locked in extension (until good quad control)
- WBing precautions
- want to achieve full extension early
- no open chain exercises with flexion of 0-45 degrees
- graft will get weaker before it gets stronger
- return to sport at 6 months
PCL Reconstruction
Surgical considerations:
- if in isolation, surgery might not be needed
Rehab considerations:
- same as ACL but progression is more gradual
Meniscus Injuries
Surgical considerations:
- partial meniscectomy = older adults, inner two thirds (poor healing)
- meniscus repair = younger patients, outer third
Rehab considerations:
- repair = WBing precautions, limit flexion
- meniscetomy = full WBing, quicker recovery
Lateral ankle reconstruction
Surgical considerations:
- repair of damaged ligaments
- harvest autograft (fibularis brevis)
Rehab considerations:
- casted for 1 week followed by walking boot then brace
- Non-Wbing and therapy does not begin immediately after surgery
- careful of taking pt into inversion
Achilles tendon repair
Surgical considerations:
- closed repair if close to injury time, open repair if delayed
- usually a repair but can also use graft
Rehab considerations:
- initially casted
- Non-WBing for several weeks
- push for more aggressive therapy/progression of WBing
