What are the basic principles of post op rehab?
- Post op procedures are guidelines - don’t follow them blindly!
- Criterion based - not time based
- Tissues protected initially - then stressed to allow for collagen formation in the right direction
- Rehab is a balance between stressing the tissues enough to prevent deconditioning/contracture and not stimulating too much so as to injure them
- COMMUNICATION!
Briefly describe the TSA procedure
key steps:
1. disinfection (since physios see the pt very frequently, the signs of infection are important to recognize - fever, redness, swelling, sweating, tenderness, lack of wound healing, discharge from wound
- longitudinal line and cross lines (this is to line up the skin problem)
- incision and access to subscap - cut subscap and retracted - dislocated humeral head and cut off humeral head; intramedullary tunnel cut into humeral head)
- glenoid shaved off; plastic component affixed to glenoid with cement; excess cement removed
- Humeral prosthesis put into intramedullary canal and humeral head prosthesis affixed
- shoulder joint relocated; ROM checked (esp IR); subscap sowed back up which is an important part of the procedure
What is involved in the preop phase for a TSA?
Education of the patient:
- measuring for the sling
- donning and doffing of the sling
- instructions for ADLs
- precautions for movements using specific examples
- self care instructions like cryotherapy
- exercise instructions for ROM/strength
What are the basic phases of post op rehab?
Phase 1 = Max protection
Phase 2 = Moderate protection
Phase 3 = Minimal protection
Phase 4 = Return to activity/RTS
What are the goals of the 4 phases in TSA?
Phase 1 goals (0-4 weeks):
- pain+edema control
- shoulder elevation 120º
- ER 30º
- light ADLs
Phase 2 goals (4-10 weeks):
- 0/10 pain
- PROM - 150º elevation; ER 45º
Phase 3 (10-16 weeks)
- 0/10 pain
- PROM 160º elevation; ER 60º; IR to T12
- independent in HEP
- advanced ADLs
- normal scapulohumeral rhythm
- MMT 4/5
Phase 4 goals (16-22 weeks):
- maximize ROM
- independent in HEP
- enough strength to meet all ADLs
*Precaution for all stages = avoid painful ADLs or ROMs and adhere to any MD directions in early stages
Example exercises for each phase of TSA?
Phase 1:
- sling immob (to protect)
- pendulum ex
- passive ROM progressing to active assisted ROM
- scapulothoracic mobs too!
Phase 2:
- pool ex (flexion/horizontal add+abd)
- isometrics
- humeral head control ex (ball stabilization)
Phase 3:
- progressive resistance ex for scap/elbow mm’s/rows/chest press
- flexibility ex (wand stretch/towel stretch)
- stabilzation for scap/humeral head
- isometrics - with deltoid not in neutral
Phase 4:
- flexibility as above
- resistance exercise
- sports specific training if needed
What are the steps for spinal fusion surgery?
Stage 1: exposure and decompression
Stage 2: Hardware (screws/rods) placed on pedicles
Stage 3: distraction to restore height
Stage 4: insertion of permanent hardware and closure
What are the goals of pre op spinal fusion phase?
- teach logrolling + hip hinging
- teach importance of avoiding lumbar movement post op
- maximize strength/function/general conditioning
- avoid any movements that aggravate pain; avoid movements that strain neural tissues if there is neural sensitivity
Describe the post op phases after spinal fusion surgery?
Phase 1 (0-2 weeks):
- logrolling for transfers; progress from walker-cane-independent
- NO lumbar movement; avoid sitting >20-30 mins/lifting >2.5kg/lying prone/quadraped
- teach how to transfter/isometric ex/walking as tolerable/pain control
Phase 2 (2-6weeks):
- try to get independent ADLs by week 6
- still avoid all lx movements
- sitting 30-45 mins/still no lifting >2.5kgs (so no PRE whatsoever); no ankle weights even
- pain control/gentle ab work (heel slides)/isometric extension/stationary bike
Phase 3 (6-14 weeks):
- might be able to RTW
- progress sitting to level needed for work
- loaded resistance exercises with neutral spine with pt is able; progressive lumbar stabilization ex; stationary bike/treadmill
- should be able to tolerate multiple positions: prone/quadraped/supine/upright
Phase 4 (>14 weeks):
- maximise function
- return to gym activites if educated on spine safe activities
- progress lumbar stabilization with extremities to increase load on core
- should be able to perform upright resisted actrivities with good trunk control
Describe a basic kyphoplasty procedure
- Hollow tube called canula and pointed instrument called trocar within the canula is inserted through holes over the fractured vertebra
- guided by fluroscopy to guide placement of canula and trocar
- bone cement injected (vertebroplasty) to harden the VB
- balloon blown up in the VB to restore height -then cement is injected (kyphoplasty)
- canula removed
