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624: Acute Care Therapeutic Exercises > Surgical Procedures > Flashcards

Surgical Procedures Flashcards

1
Q

8 Indications for Surgery for Musculoskeletal Disorders

A
  • Incapacitating pain at rest or with functional activities
  • Marked limitation of active or passive motion
  • Gross instability of a joint or bony segment
  • Joint deformity or abnormal joint alignment
  • Significant structural degeneration
  • Chronic joint swelling
  • Failed conservative or previous surgical management
  • Significant loss of function leading to disability as the result of any of the preceding factors
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2
Q

Preoperative education improves what 4 things postoperatively?

A
  • increased the health related quality of life
  • decreased the # of hours of therapy needed during inpatient stay
  • decreased patient anxiety during recovery/acute care stay
  • decreased pain levels and decreased requests for pain medication
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3
Q

The inflammatory phase for bone is from day _ to day _

A

1 - 7 days

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4
Q

When is the soft callus forming during bone healing?

A

weeks 2 - 3

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5
Q

When is the hard callus forming during bone healing?

A

3 - 4 months

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6
Q

How long does the entire remodeling of bone process take?

A

Up to one year

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7
Q

When does near normal tensile strength (NNTS) in muscle return?

A

7 days

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8
Q

Ligaments and tendons take _ months for an 85-95% return of NNTS.

A

4

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9
Q

The inflammatory phase for ligament/tendon is from day _ to day _

A

1 to days 3 or 5

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10
Q

When is the proliferative (repair) phase of ligament/tendons?

A

Day 3-Day 21

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11
Q

When does the remodeling phase for ligaments begin?

A

day 21

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12
Q

When does the remodeling phase for tendons begin?

A

day 42

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13
Q

Why is muscle setting important during the repair and remodeling phases of healing?

A

It is important to avoid adhesions

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14
Q

Why does articular cartilage have limited healing potential?

A

Due to its lack of a clotting cascade

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15
Q

What are the 3 phases of healing?

A

1) Acute/Inflammatory
2) Subacute/Proliferative
3) Chronic Remodeling

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16
Q

What is the time frame for the maximum protection phase of tissue healing?

A

From a few days to 6 weeks (tissue dependent)

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17
Q

What is the time frame for the moderate protection phase of tissue healing?

A

Usually begins 4-6 weeks post-op

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18
Q

What is the time frame for the minimum protection phase of tissue healing?

A

6-12 weeks post-op; may continue to 6 months post-op and beyond

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19
Q

How long does skin healing take?

A

7 - 14 days

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20
Q

When do staples/sutures come out?

A

Day 14

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21
Q

When should staples/sutures come out of a revised, total, or infected knee?

A

Day 21 secondary to compromised wound

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22
Q

Which heals better, staples or sutures?

A

sutures

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23
Q

When is bone at its weakest?

A

During weeks 3 and 4

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24
Q

Healing time ____ in smokers

A

doubles

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25
Q

3 types of pulmonary complications post-op

A
  • Pneumonia
  • Atelectasis
  • Pulmonary embolism
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26
Q

Elevated HR is indicative of what type of pulmonary complication

A

a pulmonary embolism

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27
Q

What is DVT?

A

Deep Vein Thrombosis

which is the formation of a blood clot (thrombus) in a deep vein

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28
Q

What are the risk factors for DVT?

A
  • postop or post fracture immobilization
  • prolonged bed rest
  • sedentary lifestyle
  • trauma to venous vessels
  • limb paralysis
  • malignancy
  • advanced age
  • obesity
  • congestive heart failure
  • use of oral contraceptives
  • pregnancy
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29
Q

How can 20-25% of DVTs and PEs be identified?

A

by dull aching, severe pain, swelling, heat and redness of skin

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30
Q

What is the only way to confirm the presence of a DVT?

A

Diagnostic imaging

31
Q

4 Ways to avoid venous stasis (DVTs)

A
  • Initiating ambulation after surgery ASAP
  • Foot AROM
  • Compression stockings
  • SCDs
32
Q

What is a pulmonary embolism?

A

When a clot breaks away from the wall of a vein and travels proximally to the lungs

33
Q

5 Signs/Symptoms of Pulmonary Embolism

A
  • Sudden onset of SOB (Dyspnea)
  • Rapid, shallow breathing (Tachypnea)
  • Chest Pain
  • Fever, sweating, cough, hemoptysis
  • Elevated heart rate (Tachycardia)
34
Q

How long should DVT and PE patients be on blood thinners after hospital D/C?

A

6 months

35
Q

Example of a repair surgery

A

ACL

36
Q

Example of a release or decompression surgery

A

arthroscopic subacromial decompression

37
Q

Example of a realignment or stabilization surgery

A

Osteotomy

38
Q

Example of a reconstruction or replacement surgery

A

arthroplasty

39
Q

Example of a fusion or fixation for bony union surgery

A

ORIF such as Lumbar spine fusion

40
Q

3 types of tissue grafts

A
  • Autograft
  • Allograft
  • Synthetic graft
41
Q

Describe an autograft and give an example

A

This type of graft uses the patient’s own tissue harvested from a donor site in the body.
Example: Patellar tendon grafts are used for ACL/PCL repair surgery.

42
Q

Describe an allograft and when it is used

A

Usually cadaveric. Used if autograft is unavailable or has failed.

43
Q

Vigorous stretching and full level activity are contraindicated for _ - _ weeks postoperatively a repair, reattachment, reconstruction, stabilization, or transfer of soft tissues

A

6-8 weeks

44
Q

Why do tendon repairs have a longer immobilization period than muscle?

A

Because they have decreased blood supply therefore healing is slower

45
Q

Why is remobilization with limited tensile force initiated as early as possible after tendon repair?

A

to prevent adhesions because tendons need to glide within their sheath

46
Q

After tendon repair restricted weight bearing and lifting occurs for _ - _ weeks

A

6-8 weeks

47
Q

After tendon repair vigorous stretching and high intensity resistance exercise should not be initiated until _ weeks

A

8

48
Q

Ligament Repair vs. Reconstruction

A

Repair involves approximating and suturing

Reconstruction involves the use of a tissue graft

49
Q

How long does it take for full rehab after a ligament repair or reconstruction?

A

6 months to 1 year

50
Q

Which joint is the most commonly stabilized and reconstructed joint?

A

The GH joint

51
Q

How does transfer or realignment of a muscle-tendon unit affect the unit?

A

It alters the line of pull of a muscle, but it does not change the action

Example: realignment of the quadriceps changes the line of pull, but not the mechanism

52
Q

How does transfer or realignment of a tendon from one bony surface to another affect the unit?

A

It alters the line of pull of a muscle as well as the action of the muscle

Example: moving the flexor carpi ulnaris to the dorsal surface of the hand changes the action from a flexor to an extensor.

53
Q

What are the indications for release, lengthening, or decompression of soft tissue (myotomy, tenotomy, or fasciotomy)?

A

Contracture prevention or minimizing progressive deformity; such as in muscular dystrophy and cerebral palsy.

54
Q

Postop soft tissue release or lengthening what position should the affected limb be immobilized?

A

in a LENGTHENED position, except during exercise

55
Q

What is a synovectomy?

A

Removal of synovium (joint lining) in the presence of chronic joint inflammation

56
Q

When is a synovectomy indicated?

A

When medical management has failed for 4-6 months

57
Q

What type of patients typically undergo synocevtomies?

A

Patients with Rheumatoid Arthritis

58
Q

Following a synovectomy what should you avoid?

A

excessive exercise or activity that increases joint pain or swelling

59
Q

What is an example of an arthroscopic debridement or repair surgery?

A

Meniscal tears

60
Q

Are articular cartilage procedures and postop management easy?

A

NO, they are typically slow and grueling

61
Q

Protected weight bearing should continue until week _ or _ after articular cartilage procedures

A

8 or 9

62
Q

What are the disadvantages of excision arthoplasty?

A
  • Joint instability
  • In the hip, leg length discrepancy
  • Muscular imbalance and weakness
63
Q

What is excision arthroplasty and in what body part is it typically performed in?

A

A flexible silicone implant is placed where the articular surface was removed where is becomes encapsulated with fibrous tissue as the jont reforms

Performed primarily in the fingers

64
Q

What is interposition arthroplasty and in what body part is it typically performed in?

A

It is the biological resurfacing of a joint to provide a new articular surface

Performed in elbows usually after failure of total elbow replacement or in extremely young patient

65
Q

What is the absolute contraindication to total joint arthroplasty?

A

Active infection in the joint

66
Q

What is Arthrodesis?

A

Surgical fusion of the surfaces of a joint

67
Q

What is the optimal position for hip arthrodesis?

A

10-15 degrees of flexion

68
Q

What is the optimal position for ankle arthrodesis?

A

90 degrees

69
Q

Restricted weight bearing until _ - _ weeks post-arthrodesis

A

8-12

70
Q

What is an osteotomy?

A

A surgical operation whereby a bone is cut to shorten, lengthen, or change its alignment

71
Q

How long does a bony union take after an osteotomy?

A

8-12 weeks

72
Q

Increased tourniquet time increases the risk of what?

A

DVTs and nerve impairment

73
Q

After a total hip surgery the hip is put into what 3 positions to determine intraoperative stability?

A
  • Extreme hip flexion
  • Extension and external rotation
  • Flexion and internal rotation

624: Acute Care Therapeutic Exercises (20 decks)

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