Red Flags/Contraindications

Question 1

What are the post op precautions for THA (posterior/posterolateral approach)?

Answer 1

No hip flexion past 90
No adduction past midline
No IR beyond neutral

Question 2

What are the post op precautions for THA (anterior/anterolateral and direct lateral approaches)?

Answer 2

No hip extension
No ER beyond neutral
No hip adduction past midline
No combined motion of hip into FABER
If glut med cut then no resisted or anti-gravity abduction for 6-8 weeks

Question 3

What are precautions post spinal surgery?

Answer 3

10lb lifting precaution
Mobilize as tolerated and avoid excessively painful motions
Minimize bending and twisting activities
Avoid excessive extension (for laminectomy)
May have braces, collars, etc.

Question 4

What are sternal precautions? How long are they in place?

Answer 4

6-8 weeks

• No pushing
• No pulling
• No lifting one arm above 90
• No hand behind back
• No driving for 4 weeks
• No lifting more than 10lbs

Question 5

What are contraindications associated with fractures?

Answer 5

• Contracting muscles attached to injured bone
• AROM of affected joint immediately post op or post # (above and below is good)
• WBing through affected joints
• Movements that elicit pain

Question 6

What lines cause mobility to be contraindicated when present?

Answer 6

• Femoral arterial line
• Swan Ganz catheter
• IABP (?)

Question 7

What are contraindications when mobilizing someone with a chest tube?

Answer 7

• Raising evac system or chest tube above level of insertion
• Pulling on the tube
• Lying on the tube and preventing drainage (can side lie on that side but have to make sure it isn’t kinked or preventing drainage)
• Tip over reservoir

Question 8

What are contraindications and precautions to stretching?

Answer 8

Acute inflammation, bony block, recent #, sharp or acute joint pain, hematoma, tissue trauma, contracture of soft tissue providing stability to an area, hypermobile segment, certain post op surgery procedures, prolonged corticosteroid injections

Question 9

What are the precautions to mobilization?

Answer 9

Neuro signs, dizziness, severe movement loss, hyper mobility, osteoporosis, pregnancy, spondylolithesis, hx of malignancy, diabetes, haemophilia, children

Question 10

What are the contraindications to mobilization?

Answer 10

Malignancy, cauda equine lesions, spinal cord lesions, multiple nerve root involvement, rheumatoid collagen necrosis, #/dislocation, active bone disease, acute inflammation, sign of the buttock, VA disease, CV ligament instability, non mechanical cause

Question 11

What are the contraindications to postural drainage?

Answer 11

Intracranial pressure > 20
Hemoptysis
Esophageal anastomosis
Aneurysm
Laminectomy
Unstable CV status
Pt upset/agitated, pleural effusion, pneumothorax, pulmonary edema/CHF, PE
\+ rib #, unstabilized head or neck injury, acute spinal injury or surgery

Question 12

What are the precautions/contraindications to percussions?

Answer 12

Flail chest/rib #
Prone to hemorrhage
Metastatic bone cancer, brittle bone (OP)
Burns
SubQ of neck/thorax
Poor/unstable CV condition
Recent skin graft
Resectable tumor
Pneumothorax
Asthma