Many injuries, diseases, and disorders of the musculoskeletal system are associated with levels of impairment that require surgical intervention. These impairments can affect all musculoskeletal tissues 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, 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 used in the management of musculoskeletal conditions.
Descriptions of 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 are applied by the therapist when designing exercise interventions for patients who have undergone 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. However, 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, surgical intervention is the best treatment option. Indications for a variety of musculoskeletal surgeries are identified in Box 12.1.11,12,60
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
Trauma resulting in significant tissue damage
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 implemented rehabilitation program is essential for the patient to achieve optimal functional outcomes after surgery. Ideally, rehabilitation begins with patient education and “prehabilitation” exercises or functional skill development before surgery and continues with direct intervention from a therapist and long-term self-management by the patient after surgery.
Considerations for Preoperative Management