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Therapeutic Interventions > Surgical Management > Flashcards

Surgical Management Flashcards

1
Q

What are the potential indications for surgery?

A

failed conservative management, gross instability of a joint or boney segments, profound neurological compromise, marked limitation of active or passive motion, joint deformity or abnormal joint alignment, significant structural degeneration, chronic joint swelling, significant loss of function leading to disability as a result of any of the above

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2
Q

What are some ideal pre-operative management approaches to surgery?

A

exam and eval of status, patient education and opportunity for questions, and some movement intervention

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3
Q

What are the benefits of preoperative PT?

A

exam and eval of preOP impairments and functional status to est. a baseline for postOP; opportunity to identify and prioritize needs and goals and functional limitations after surgery; basis for est. rapport for enhanced continuity of care; mechanism for patient education about the surgery and components of postOP rehab; method for improving overall fitness which could improve postOP recovery activities

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4
Q

A well-planned rehab program with what is fundamental to pt’s postOP care?

A

carefully progressed sequence of therapeutic exercise interventions, functional training, and ongoing patient education

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5
Q

True/false: Most surgeries have similar timeframes for each stage.

A

False - timeframes for each phase vary from one procedure to the other

ex: arthroscopy - max protection phase ~ 1 day vs complex hand tendon repair - max protection phase ~ several weeks

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6
Q

The following characteristics describe which protection phase?:

initial postOP period when protection of operated tissues is paramount in the presence of inflammation and pain

immobilization is necessary in some, others it is advisable to place low level stresses soon after surgery

muscle setting exercises to prevent muscle atrophy also indicated

A

maximum

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7
Q

The following characteristics describe which protection phase?:

inflammation has subsided, pain and tenderness are minimal, tissues are able to withstand gradually increasing levels of stress

criteria for progression to this phase often include absence of pain at rest and the availability of at least limited pain free movement

emphasis on restoring ROM and normal arthrokinematics while tissues continue to heal and remodel

A

moderate

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8
Q

The following characteristics describe which protection phase?:

little to no protection of operated tissues is required

to progress to this stage, full/alomst full, pain-free AROM should be available and joint capsule should be stable

rehab focuses on restoring functional strength and participating in gradually progressed functional activities

A

minimum

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9
Q

What is the approximate timeframe for the maximum protection phase?

A

few days/week - month/6 weeks depending on type of surgery and tissues involved

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10
Q

What is the approximate timeframe for the moderate protection phase?

A

typically begins at 4-6 weeks postop and continues to 4-6 additional weeks

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11
Q

What is the approximate timeframe for the minimum protection phase?

A

begins anywhere from 6-12 weeks postop and may continue until 6 mos or beyond

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12
Q

What are the potential PostOp complications? (12)

A

pulmonary complications (pneumonia, atelectasis); local or systemic infection; DVT or Pulmonary embolism; delayed wound healing; muscle function deficits second to tourinquet compression and resulting ischemia or nerve compression; failure, loosening, or displacement of internal fixation devices; delayed union of bone; rupture of incompletely healed soft tissue repair or reconstruction; subluxation or dislocation of joint surfaces/implants; nerve entrapment from scar tissue formation; adhesions and scarring -> contractures and joint hypomobilty; loosening of joint omplants secondary to periprosthetic osteolysis/infection

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13
Q

What are the broad categories of orthopedic surgery procedures?

A

repair, reconstruction, stabilization, replacement, realignment, transfer, release, resection, fixation, fusion

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14
Q

What is an open surgical approach?

A

incision of adequate length and depth thru skin, fascia, muscles, and joint capsule so OP field can be fully visualized during procedure

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15
Q

Name some examples of open procedures.

A

joint replacement, arthrodesis, internal fixation of fracture, some soft tissue repairs and reconstruction(tendon/ligament)

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16
Q

True/False: With an open procedure, there is extensive disturbance of soft tissues that requires a length period of rehab while healing.

A

true

17
Q

What is an arthroscopic procedure?

A

several small incisions for insertion of endoscope to visualize the interior of joint via camera; mini motorized tools are inserted and used to repair tissues in or around the joint, remove loose bodies or debris from joint surfaces

18
Q

What are some examples of arthroscopy?

A

ligament, tendon, capsule repairs/reconstruction; debridement of joints; meniscectomy; articular cartilage repair; synovectomy

19
Q

True/False: There is moderate disturbance of soft tissues during arthroscopic procedures.

A

false - minimal due to the small incisions

20
Q

What procedure uses arthroscopy for a portion but also requires open surgical field for selected aspects?

A

arthroscopically assisted procedure/ mini open

21
Q

Name some reasons for tissue graft.

A

reconstruct ligaments of knee or ankle, articular cartilage repair, many boney procedures

22
Q

Match the type of tissue graft to the description.

a. allograft
b. synthetic graft
c. autograft

  1. uses pt’s own tissue harvested from a donor site in the body
  2. uses fresh or cryopreserved tissue from a source other than the pt, typically a cadaveric donor
  3. alternative to human tissue
A

a = 2, b = 3, c = 1

23
Q

True/False: Synthetic grafts have a high rate of failure and often don’t hold up.

A

true

24
Q

When is a surgical reconstruction and stabilization indicated?

A

reduce excessive capsular laxity contributing to instability of a joint

25
Q

When may surgical repair, reconstruction, or reattachment be necessary?

A

after severe injury to ligament, tendon, or muscle

26
Q

What is a muscle transfer?

A

tendon unit required to improve stability of an unstable joint or to enhance NMS control and function

27
Q

When is release of soft tissue indicated?

A

young pt w/ severe arthritis and resulting contractures in whom joint replacement isn’t an option; myopathic and neuropathic diseases (muscular dystrophy, cerebral palsy) to improve functional mobility

28
Q

Release of soft tissues to achieve decompression and relieve pain may be indicated for what?

A

impingement or compartment syndrome

29
Q

What is a joint procedure?

A

orthopedic surgery involving the joints in management of pain and dysfunction associated with arthritis or acute injury

30
Q

What procedure involves arthroscopic removal of fibrillated cartilage, unstable chondral flaps, loose bodies in a joint, and sometimes osteophyte excision?

A

arthroscopic debridement and lavage

indicated to relieve joint pain and biomechanical “catching” during joint movement

31
Q

What is a synovectomy?

A

removal of the synovium in the presence of chronic joint inflammation

typically in pt’s with RA with chronic proliferative synovitis

32
Q

What is an arthroplasty?

A

any reconstructive joint procedure with or without joint implant - common procedure to relieve pain and improve function in pt’s with joint degeneration assoc. w/ late stage arthritis

involves resection of articulating surfaces and replacement with artificial compartments

33
Q

What is arthrodesis?

A

surgical fusion of the surfaces of a joint for severe joint pain w. late stage arthritis and joint instability

34
Q

Which if the following is not true for arthrodesis?

a. may be the only option for failed TJA
b. most frequently in TSpine and SI joint
c. potential for developing excessive stresses exists due to transfer of loads above and below the fused joint
d. excessive stresses over time results in pain and hypermobility

A

b is false - most frequently in C Spine, L Spine, wrist, thumb, and ankle

35
Q

What is an open reduction and internal fixation of fractures?

A

fixation is used to stabilize and maintain the alignment of the fx site as it heals

36
Q

What is an osteotomy?

A

surgical cutting and realignment of a bone most often in knee or hip to reduce pain and correct deformity, necessary for surgically shortening or lengthening a bone

Therapeutic Interventions (12 decks)

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