THEREX FINAL REVIEW Flashcards
tendonitis healing timeline
3-4 weeks to 5-7 weeks
lacerations of tendons healing time
5-7 weeks to 3-6 months
exercise induced muscle strain takes ___ days to recover
0-3 days
grade 1 mm strain takes
0-14 days to recover
grade 2 mm strain takes ___time to recover
4-14 days to 2-3 months
grade 3 mm strain takes up to ___time to recover
6 months to recover
ligament grade 1 sprain takes ___ to recover
0-3 days
ligament grade 2 sprain recover time
3-4 weeks-3-6 months
ligament grade 3 sprain recover time
5 weeks-6 mo/1 year
ligament graft takes how long?
2-3 mo-up to 2 years
bone takes how long to recover?
5-7 weeks to 2-3 months
cartilage repair takes how long to recover?
2-3 months up to 2 years
pre-op management should include
focus on restoring full ROM (pre-op ROM affects post-op ROM)
*education
*expectations
*precautions post-op education
*pain management
post-op primary care should include what?
- clean dressing
- distal pulses
- look for compartment syndrome
5 post op complications that can occur early or late in healing
- infection (red, hot, pain, LOF, swelling)
- DVT/PE
- delayed wound or bone healing
- nerve entrapment/compression
- adhesion/scarring
BENCH 3 PTS
- bed rest 3+ days
- edema
- non-varicose superficial veins
- cancer (active)
- history of DVT
3 CM LARGER ON AFFECTED LEG
Paralysis
Tenderness
Swollen
PEACE is for when?
immediately after post-op
LOVE is for when?
subsequent care after post op
grade 1 mm strain
mild damage, minimal loss of strength/motion
grade 2 mm strain
no rupture but significant LOSS OF STRENGTH/MOTION
*weak/painful
grade 3 mm strain
defect that you can feel
need sx probably
weak, PAINLESS SOMETIMES
grade 1 ligament sprain
stretched but keeps joint stable
*does NOT LIMIT MOTION
grade 2 ligament sprain
joint LOOSE (partial tear)
grade 3 ligament sprain
SPLIT INTO 2 PIECES, joint unstable (complete tear)
What is the max protection phase post op?
days –6 weeks
*inflammation/pain phase
*precautions!
*PROM or AAROM depending
what is the post op mod protection phase?
less inflammation, more mobility
4-12 weeks long
FULL, PAIN FREE AROM
*want to restore joint motion, gradually strengthen, improve neuro-msk control/stability
post op min protection phase
6 weeks-12 months
*very little protection
*restore strength, patient education!
case! A 17 year old patient has non op PCL/MCL tear! according to guidelines, he can jog at 8 weeks. But he didn’t get PT until 5-6 weeks and lacks full ROM, strong quad activation.
Can he safely run?
NO
*consider the individual and not just the timeline
*ROM has a window of time
*can’t regain motion after few months of healing
if you have a stress fx, will it show on imaging?
imaging may appear negative!
*may not be seen for 1 wk to several months
ottawa knee rules
- age over 55
- can’t take 4 steps
- tenderness patella
- tender at fib head
- can’t flex to 90 degrees
Ottawa anke/foot rules
- pain at ankle OR midfoot AND
tender at lateral or medial mal
tender at base of 5th met or navicular
OR CAN’T WEIGHT BEAR 4 STEPS
primary bone healing requires
absolute stability
*STRESS SHIELDING
secondary bone healing is known as
fracture repaired without surgery
*cast or sling (indirect healing)
what is stress shielding?
PATIENT IS NON WB
PLATES*
fragments held by compression, takes slower for bone to heal
*absolute stability/no motion at fracture site
what is stress sharing?
lets secondary callus formation
-partial load transmission across fx site
-casts, pins, screws, external fixators, ETC…
*forces of WB distributed btwn bone and device
*EARLY WB IS GOOD
early WB with what types of devices
cast, rod and external fixator (secondary healing)
late WB with what devices
PLATE (unless bridged)
*delayed WB with pin, screw, wire
exercise post-ORIF MAX PROTECTION PHASE
first 6-8 weeks
ankle pumps, deep breathing
resistive ex to everything except sx leg
submax mm setting:
-glutes
-abd
-add
-quads
-hams
supine vs standing ex:
-flex, abd, ext, SLR
posterolateral THA
cut the glutes
*no flex 90
*no add
*no IR
abduction pillow, transfer to non op side
direct anterior approach THA
cut the TFL/sartorius (abductors are weak!)
*no ext
*no ER, NO ABD
avoid frog leg! turn towards bad leg, use abduction pillow
what kinds of exercises are for day 1-3 post op?
ankle pumps,
gait training, transfers
functional training with movement and WB restrictions
*ISOMETRICS
what kinds of exercises for phase 2 post op?
week 1-6 MOTION IS LOTION
endurance, CARDIO, proprioception, nmes, ROM*
full ROM and full WB should happen for patellar post op when
6-12 weeks
12 weeks on no more ext brace
tibial plateau post op guidelines for ROM week 1-2
AAROM: 90 degrees of flexion
NO WB
isotonic ankle/glutes
tibial plateau post op guidelines for ROM week 2-8
FULL ROM, quad sets isometric
NO WEIGHT BEARING AT 2 MONTHS
when do you weight bear for tib plateau post op?
PROGRESS TO full ROM, BEGIN AT END OF 3 MONTHS
*gentle resistive
WEEK 12-16 for tib plateau post op
full AROM progressive resistance WBAT
when is ACL ligament reconstruction weakest?
at 6-12 weeks!
most likely torn at 12 weeks
criteria for full ambulation
need 0 degrees ext, 90 deg knee flex
30 SLR without lag
min pain, swelling
symmetric gait with no limp
MD/PT approval
ACL STRENGTH AND JOGGING PHASE
6-12 weeks
criteria: 2 degrees of normal knee ext, 120 flex
quad/hams 60% normal
*can do 1 min of single leg squats
pain below 3
ACL REHAB
agility and power phase
12-20 weeks post op
strength, weight training
plyometrics and light agility
ACL RETURN TO PLAY POST OP
20+ weeks
need pain less than 2/10
need quad/hams 90%, 60% HQ ratio for women
90% SLH test
PCL management
Closed chain immediately!
NOT HAMS UNTIL 6-12 WEEKS
MCL AND LCL POST OP
for 6 weeks avoid valg/varus, rotation
QUAD STRENGTH, NORMAL ROM
WB OR ROM RESTRICTION TO MCL/LCL?
no
MCL and LCL grade 1 tear should heal
few days to two weeks
(2: 2-4 weeks)
(3: 4-8 wks)
quad/patellar tendon rupture protocol for first 12 weeks
NO RESISTED OPEN CHAIN STRENGTH
*WBAT locked in ext
quad/patellar tendon gets full ROM when
8 weeks
what mm are activated during quiet stance
gastroc/soleus
tib ant
glute med
TFL
iliopsoas
erector spinae
what happens when post displacement of COG but weak quads
fall-no ankle
