Many injuries, diseases, and disorders of the musculoskeletal system can be associated with levels of impairment so significant that surgical intervention is required. These impairments can affect all musculoskeletal tissues—muscles, tendons, ligaments, cartilage, fascia, joint capsules, or bones—of the upper or lower extremities or spine. Ideally, surgery is preceded by a comprehensive examination and evaluation of the patient's impairments and functional status, coupled with preoperative patient education. Following surgery, a planned course of postoperative rehabilitation is usually warranted.
This chapter provides an overview of the indications for surgical intervention for musculoskeletal pathology, describes considerations for preoperative management, notes factors that influence the outcomes of surgery, provides general rehabilitation guidelines following surgery, and identifies potential complications that may interfere with the achievement of optimal functional outcomes. The chapter concludes with an overview of several orthopedic surgical procedures that may be undertaken for the management of musculoskeletal conditions
Descriptions of selected surgical procedures for common injuries or disorders of each region of the extremities are provided in Chapters 17, 18, 19, 20, 21, 22. In these chapters, guidelines and progressions for postoperative management of specific surgeries are presented that are based on the principles of tissue healing and exercise prescription addressed in Chapter 10, rather than adherence to specific protocols. These principles can be applied by the therapist when designing exercise interventions for patients undergoing current surgical procedures and can also be applied as a foundation for future rehabilitation strategies as surgical interventions change and evolve.
Indications for Surgical Intervention
Many acute, recurring, and chronic musculoskeletal conditions are managed successfully with conservative measures, such as rest, protection with splinting or use of assistive devices, medication, therapeutic exercise, manual therapy, functional training, and the use of physical agents or electrotherapy. However, surgical intervention is the best treatment option when a conservative program has not been successful in adequately modifying impairments or restoring function, or if the severity of a patient's condition is beyond the level that is appropriate for conservative management. Indications for a variety of musculoskeletal surgeries are identified in Box 12.1.11,13,16,62
BOX 12.1 Indications for Surgery for Musculoskeletal Disorders of the Extremities and Spine
Incapacitating pain at rest or with functional activities
Marked limitation of active or passive motion
Gross instability of a joint or bony segments
Joint deformity or abnormal joint alignment
Significant structural degeneration
Chronic joint swelling
Failed conservative (nonsurgical) or prior surgical management
Significant loss of function leading to disability as the result of any of the preceding factors
Guidelines for Preoperative and Postoperative Management
Although surgical intervention can correct or reduce the adverse conditions and impairments associated with musculoskeletal pathology, a carefully planned and progressed rehabilitation program is essential for the patient to achieve optimal functional outcomes after surgery. Ideally, rehabilitation ...