An array of injuries, diseases, and disorders of the musculoskeletal system that affect muscles, tendons, ligaments, cartilage, fascia, joint capsules, or bones can cause structural and functional impairment of the upper or lower extremities or the spine, resulting in activity limitations and participation restriction (functional limitation and disability) to such an extent that surgical intervention is required. Ideally, surgery is preceded by a comprehensive examination and evaluation of a patient's impairments and functional status coupled with preoperative patient education and followed by a planned course of postoperative rehabilitation.
This chapter provides an overview of indications for surgical intervention for musculoskeletal pathology, considerations for preoperative management, factors that influence the outcomes of surgery, general guidelines for management during progressive phases of postoperative rehabilitation, and potential complications that can interfere with the achievement of optimal functional outcomes after surgery. The chapter concludes with an overview of the many types of orthopedic surgery procedures that may be undertaken for the management of musculoskeletal conditions of the upper and lower extremities.
Descriptions of selected surgical procedures for common injuries or disorders of each region of the extremities are described in Chapters 17 through 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 basis of rehabilitation in the future as surgical interventions change and evolve.
Indications for Surgical Intervention
Many acute, recurring, or chronic musculoskeletal conditions are managed successfully with conservative (nonoperative) measures, including rest, protection with splinting or use of assistive devices, medication, therapeutic exercise, manual therapy, and functional training, as well as the use of physical agents or electrotherapy. However, if a conservative program has not been successful and one or more impairments continue to significantly compromise a patient's ability to function or if the severity of a patient's condition is such that nonoperative management is not an appropriate option, surgical intervention becomes the treatment of choice. Indications for a variety of musculoskeletal surgeries are identified in Box 12.1.11,13,15,56
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 boney segments
Joint deformity or abnormal joint alignment
Significant structural degeneration
Chronic joint swelling
Failed conservative (nonsurgical) or previous 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 adverse effects and impairments (e.g., pain, ...