Advanced Musculoskeletal > LE Post-Op > Flashcards

LE Post-Op Flashcards

(64 cards)

Study These Flashcards
1
Q

Rehab and response to surgery largely depends

A
  • extent of tissue damage
  • surgical technique/expectations
  • patient factors
  • current stage of healing
  • tissue/structure characteristics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

immediate post op red/yellow flags

A
  • incision
  • fever
  • pain or symptom characteristics outside of surgical expectations
  • DVT signs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

DVT signs

A

 Tenderness along venous system
 Global LE swelling
 Severe pain
 Homan’s Sign (questionable metrics, but useful)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Maximal protective phase

A

 0-6 weeks typically
 Patient education
 Ensure restrictions (WBing, lifting, etc)
 Manage pain/swelling
 Protect surgical structures  Address non-direct tissues/structures
 Maintain mobility/strength of non-op side
 Minimize atrophy of surrounding tissues
 Prevent infection/ pulmonary complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Moderate protective phase

A

 4-6 weeks
 Less pain
 Restore ROM
 Scar mobility
 Increase neuromuscular control
 Strengthening? depends on surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

minimal protective phases

A

 6-12+ weeks
 Minimal/no external protection likely
 Strength
 Function
 Sports Specific

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what position is muscle sutured and immobilized in?

A

shortened

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

muscle repair considerations

A

ROM within protected ranges can begin AFTER immobilization is removed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

tendon repair considerations

A

ROM often initiated in max phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what does muscle and tendon repair strengthening being with

A

low load and high reps
- concentric/isometric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is contraindicated for 6-8 weeks following muscle and tendon repair

A

vigorous stretching and full contraction against resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

general ligament repair procedure considerations

A

*Immobilization in safe position to reduce excessive tension of graft
*Early protective ROM is allowed typically *Progression highly dependent on specific ligament function
*May take 9-12 months for full healing of repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Eval of post-op patient

A
  • Obtain/review protocol *Subjective history – include post-op history and restrictions
    *Full screen of joints above and below
    *ROM assessed for involved joint within restrictions and tolerance
    *Strength assessment of involved joints usually deferred
    *Function/gait assessed within restrictions
    *Incision assessment *Edema Assessment
    *Soft tissue assessment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what does lumbar fusion use

A

hardware/implants and bone graft

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

why is lumbar fusion done

A

to prevent progression of degeneration stenosis, spondy, or dysfunctional mobility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

bone growth stimulator for lumbar fusion

A
  • surgeon dependent
  • patient dependent (comorbidities, smoker, multi-level fusion)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

lumbar fusion rehab- educate in positioning of comfort and decreased stress to structures

A

 Side w/ pillows for alignments
 Supine with pillow support to decrease lumbar stress
 Avoid prone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

lumbar fusion - restricted movements depending on stage of healing or overall task stress

A

 Sitting/driving due to flexion stress - prolonged
 Flexion exercises until healing occurs (especially segmental flexion stressors)**
 Extension to neutral is typically appropriate
 Ambulation within tolerance and goal to progress off AD and into walking routine
 Lifting > 5 lbs for during first 1-2 phases**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

phase 1 rehab lumbar fusion

A
  • safe mobility
  • core engagement
  • muscle activation
  • LE strengthening
  • upright posture exercise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Phase 2 rehab lumbar fusion

A
  • progress core to include UE/LE
  • introduce CKC
  • progress LE strengthening
  • balance
  • cardio
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

when is lumbar discectomy/laminectomy recommended

A

 Ineffective conservative treatment
 Rapid onset of myopathy, muscle wasting, weakness, or loss of bowel/bladder function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

discectomy and laminectomy rehab

A
  • overall comparable to fusion with more rapid progression
  • phase 1 can be more advanced compared to fusion (pt and surgeon dependent)
  • supine and SL positions appropriate
  • cardio
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what position is limited s/p supine and side lying positions appropriate

A

 Prone (extension) limited with laminectomy during max protective (and possibly during moderate) phases and progressed slowly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

rehab considerations post labral tear

A
  • hip brace
  • rehab can being POD #1-3 or some wait up to 2 weeks
  • continuous ROM
  • TD/Flat foot WB vs NWB
  • pt ed
  • do not ignore core, pelvic floor, ankle strengthening
  • prone lying daily (use positioning to advantage)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
hip brace post labral tear
limits ROM based on procedure ex: 0 degrees ext, 25 ABD, 90 flex, 0 IR, 20-30 ER typically wear 24 hrs, 2-6 weeks
26
what does phase transition in labral tear depend on
dc of brace or AD and as appropriate muscle activation/ strength
27
hip arthroscopic surgery - femoroplasty and acetabuloplasty
shaving bone very painful
28
hip arthroscopic surgery - micro fracture
may increase WB restrictions and time
29
hip arthroscopic surgery - capsular plication/capsulorraphy
- avoid ext/ER in early phase - avoid prone in early phase - avoid aggressive/end range stretches
30
hip arthroscopic surgery - iliopsoas release
- limit hip flexion contraction - consider positional stretching
31
hip arthroscopic surgery - glute med repair
- depends on thickness of tear - very restricted ROM/ strengthening to avoid stress to healing contractile tissue - can be up to 6-8 weeks of brace use/WB
32
femoral fracture rehab considerations
- early considerations on protecting fracture and promoting mobility - WB dependent on characteristics (most fixation allow immediate WBAT**) - progression based on protective phases (90 hip flex within 2-4 weeks)
33
femoral fracture complications
 Non-union healing  Failure of hardware  Secondary complications from initial injury if traumatic  Greater trochanter: Gluteus medius  Lesser trochanter: iliopsoas  Subtrochanteric region: gluteus max  Persistent/high intensity pain in groin  Excessive Trendelenburg sign  Progressive leg length discrepancy*
34
micro fracture (knee)
Stimulate “marrow based repair response” and development of fibrocartilage
35
Osteochondral autograft/allograft transfer (OATs) (knee)
 Bone to bone transfer, donor site from non-WB location  For focal lesions, non-TKA appropriate  Mosaicplasty – similar, using small osteochondral plugs from donor site vs. single piece of tissue (OAT)
36
Autologous chondrocyte implantation (ACI)
 Harvested chondrocyte from patient, developed in lab, surgically implanted  Early positioning (ensuring proper contact of chondrocytes to surface and use of gravity)  Very long healing process (6-9 months)  Reserved for young populations typically following traumatic articular deficit
37
Early rehab OATs/ACI
- PROM only for up to 6 weeks (CPM) - full knee ext PROM needed immediately - locking brace full ext - d/c after proper healing and quad control (6 wks)
38
which type of meniscus repair is gold standard
inside-out
39
meniscus repair
- ext lock knee brace ROM restriction: restricted to 90 deg flexion for first 2 weeks (at least) with typical 10 deg increase each week until full.***  peripheral/red zone repair sometimes allows PWB immediately; FWB by 4 weeks  NWB/TTWB for central/root repairs common for 4-6 weeks. (possibly longer for meniscus transplants)***
40
meniscus repair squating progression
 0-45 deg knee flex for first 4 weeks  0-60/70 deg knee flex for up to 8 weeks  Deep squatting, twisting and pivoting at 4-6 months
41
how long are hamstring curls avoided for meniscus repair
8 weeks
42
early rehab focus of meniscus repair
 restoring full knee extension ROM  managing pain  promoting quad activation/resolving extension lag
43
meniscus repair possible complications
- saphenous nerve injury (medial) - peroneal nerve injury (lateral) - failed repair - failed rehab (extensor lag, flexion contracture)
44
meniscectomy
- no immobilization - WBAT - ROM progress as tolerated
45
gold standard ACL reconstruction
- patella tendon graft
46
ACL immobilization
 Only for early protection (versus meniscus repair)  Can be present from 1-6 weeks pending surgeon/procedure  Use with particularly unstable knee
47
ACL knee ROM
 Progression based on surgeon preference and patient signs/symptom  Regardless – early full knee extension is a must! Literature suggests by 4 weeks (I say earlier)  90-110 deg knee flexion by weeks 4-6
48
ACL WB
 Varies: WBAT immediately to some form of PWB  FWB without AD or brace can be achieved as early as 4 weeks if: good quad control, full knee extension, and no pain with WB.****
49
ACL Exercise precautions in max protective phase
- avoid ant translation of tib:  Open chain TKE (especially between 45 deg to full knee extension)  Closed chain quad strengthening between 60-90 deg flex
50
criteria for ACL rehab phase 2
 Minimal pain/swelling  Full knee ext***  Proper quad activation (no extensor lag)***  At least 110 deg knee flex  Quad strength = 50-60% of uninvolved side  No evidence of excessive joint laxity
51
criteria for ACL rehab phase 3
 Typically at weeks 10-12  No joint pain/effusion  75% quad function compared to uninvolved side  Functional Hop Test > 70%  Hamstring:Quad ratio > 65%
52
TAA - immobilization
 Neutral ankle position with short cast/posterior orthosis immediately post-op for 10-21 days  Then replaced with walking cast/controlled ankle motion (CAM) boot
53
TAA WB
 Varies  Ranges from NWB 3-6 wks to mild PWB to WBAT within 2 weeks.  Regardless, typically achieve FWB in 6 weeks in immobilizer
54
TAA rehab considerations in max protective
 Gait/AD training  Transfer/mobility training  WB restriction education and training  Low isometrics of ankle musculature  AROM of toes  Ankle ROM – initiated within 2-6 weeks.  Initiate appropriate LE strengthening
55
ankle arthodesis
“gold standard” for surgical management of this condition  Indicated for younger, post-traumatic arthritis of TC joint that has high functional demands and can compensate through surrounding joints well. - ankle fused on 0 DF, 5-10 ER
56
arthrodesis WB
non-WB for up to 6 weeks, begin PWB training when evidence of bony union  FWB in normal footwear common by weeks 12-16.  Custom shoe/orthotic typical
57
Lat ankle lig surgery WB
 2-6 weeks NWB in cast followed by WBAT 2-4 weeks in CAM boot or orthosis  Recent evidence may suggest immediate PWB is helpful for recovery, but not currently most common  FWB without immobilization at about 6-12 week
58
lat ankle lig surgery Max protective stage
 Similar to most ortho surgeries (pain/edema, education, etc)  Ankle PF and DF ROM as tolerated  Inversion/Eversion typically restricted to 10-15 deg arc***
59
lat ankle lig surgery mod/min
 Full ankle ROM by 8 weeks  Restore normal gait without AD or boot  Restore LE strength, balance, and proprioception
60
Traditional achilles tendon repair
 Immobilized in 20 deg PF for 6 weeks NWB during this time Progress to CAM boot and 0 deg DF in moderate phase Some suggestions this may increase DF ROM restrictions and weak PF
61
early mob and WB achilles tendon repair
Typically less than 2 weeks immobilization into 20 deg PF Use of hinged CAM boot during this time to allow WBAT, locked at appropriate ROM Progress to 0 deg DF in orthosis or CAM boot for additional 6 weeks
62
Achilles tendon repair DF ROM progression
 Not > 10 deg DF by 8 weeks  Symmetrical DF by 12 weeks
63
achilles tendon repair progression to plyometric activity
◦ No earlier than 12 weeks and pending: ◦ Full DF ROM ◦ No pain with ambulation/WB ◦ 5 unilateral heel raises >/= to 90% of contralateral height
64
Advanced Musculoskeletal
flashcards
Decks in class (21)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions