Post-Surgical Management - Week 7

Question 1

Indications for surgical management of MSK conditions

Answer 1

• Severe trauma
• Severe degeneration
• Guidelines/standards are constantly shifting
• Techniques come into and then out of fashion

Question 2

Most common MSK surgeries

Answer 2

• Knee replacement
• ACL surgery
• Hip replacement
• Shoulder replacement
• Arthroscopy
• Joint fusion

Question 3

Open procedures

Answer 3

Involve large incision

Question 4

Arthroscopic

Answer 4

• Smaller incisions = lower risk of infection
• Less blood loss and scarring
• Preserve surrounding tissues

Question 5

Common Post Op complications

Answer 5

• Infections
• Venous thromboembolism - deep vein thrombosis
• Pulmonary embolus (PE)
• Poor wound healing
• Scarring and adhesions
• Prolonged immobilization

Question 6

Infection risk factors

Answer 6

• Coincident infection/colonization
• Steroid use
• Obesity
• Smoking
• Extremes of age
• Poor nutritional status
• Transfusion

Question 7

Signs and symptoms of infection

Answer 7

• Redness
• Swelling
• Heat
• Pain
• Cloudy or discolored drainage

Question 8

PT Role in infection

Answer 8

• Monitoring of surgical site until healing of wound complete
• Educate patient and practice sound infection control procedures
• Report signs of infection to patient, care-giver and surgeon

Question 9

Deep vein thrombosis - venous thromboembolism

Answer 9

Blood clot formed in deep veins - common in lower leg - if breaks free, can lead to pulmonary embolism

Question 10

Risk factors of DVT

Answer 10

• Age
• Best rest/immobility/ distance travel
• CHF
• Estrogen, family history, blood cancers, solid cancers
• Major trauma
• Past VTEs and stroke, obesity, pregnancy/post partum, smoking, non infectious inflammatory conditions

Question 11

PT role in DVT

Answer 11

• Recognize signs and symptoms and refer out fast for medical testing and intervention
• Prevention of immobility, mobilization, exercise to promote circulation
• Monitoring anti-coagulant status, patient compliance with medications and monitoring lab values

Question 12

Poor wound healing risk factors

Answer 12

• Smoking
• Infection
• Diabetes
• Age
• Nutrition
• Immune function

Question 13

PT role in poor wound healing

Answer 13

• Encourage proper nutrition
• Behavior modification
• Infection control

Question 14

Scars and adhesions

Answer 14

• Infiltration of fatty and fibrous tissue, fibrosis
• Perspective: surgery is controlled trauma:

Question 15

Risk factors of scars and adhesions

Answer 15

Prolonged immobilization

Question 16

PT role with scars and adhesions

Answer 16

• Early mobilization as safe
• Passive mobility techniques and scar mobilization

Question 17

Detrimental effects of immobilization

Answer 17

• MSK tissues require loading to maintain optimal condition
• Prolonged immobilization will degrade tissues and make it more susceptible to injury (cartilage, ligament degeneration, decreased in bone density, weakness and atrophy of muscle and changes in resting length)

Question 18

PT role in detrimental effects of immobilization

Answer 18

• Sage early mobilization
• Proper positioning when immobilized
• Progressive strengthening program

Question 19

Post op intervention

Answer 19

• Address impairments in typical step-wise progression
• Work within healing time-frames
• Know post-operative precautions and contraindications
• Monitor for complications and incorporate preventative interventions
• Follow protocol

Question 20

Post op protocols

Answer 20

• Surgery-specific/ surgeon specific guideline
• Time based and criterion based
• Establish expectations for patient improvement and progression of treatment
• Detail what is permitted and when/how
• Not a cook-book —> not a replacement for reasoning