OCS Surgical & Post-Operative Care 3 — Questions and Answers
Question 1: A patient 6 weeks post-SLAP repair is cleared to begin active-assisted ROM. Which motion should be introduced LAST due to greatest risk of re-injury?
- External rotation at 90° abduction (Correct answer)
- Forward flexion in the scapular plane
- Internal rotation behind the back
- Pendulum exercises
Correct answer: External rotation at 90° abduction
External rotation at 90° abduction places maximum stress on the repaired superior labrum and biceps anchor and is typically the final motion introduced.
Question 2: Following a Bankart repair for anterior shoulder instability, which position must be strictly avoided in the early post-operative period?
- Shoulder abduction combined with external rotation (Correct answer)
- Shoulder internal rotation across the body
- Shoulder forward flexion to 90°
- Shoulder extension to neutral
Correct answer: Shoulder abduction combined with external rotation
Abduction with external rotation is the apprehension position that stresses the anterior capsule and labrum repair and must be avoided early post-operatively.
Question 3: What is the primary purpose of wound drainage systems (e.g., Jackson-Pratt drains) in post-operative orthopedic patients?
- Prevent hematoma formation and reduce infection risk by removing accumulated fluid (Correct answer)
- Provide a route for antibiotic instillation
- Monitor blood loss to guide transfusion decisions only
- Maintain negative pressure to promote tissue approximation
Correct answer: Prevent hematoma formation and reduce infection risk by removing accumulated fluid
Drainage systems remove accumulated blood and fluid from the surgical site, preventing hematoma formation which can increase infection risk and impair healing.
Question 4: A patient 4 months post-total shoulder arthroplasty (TSA) asks when they can return to golf. Which factor MOST influences this timeline?
- Type of implant used (anatomic vs. reverse TSA) and surgeon protocol (Correct answer)
- Patient's pre-operative strength levels
- Age of the patient
- Number of physical therapy sessions completed
Correct answer: Type of implant used (anatomic vs. reverse TSA) and surgeon protocol
Anatomic TSA may allow earlier return to golf than reverse TSA due to different muscle mechanics and implant constraints specific to each design.
Question 5: Which sign indicates compartment syndrome following lower extremity orthopedic surgery and requires emergency intervention?
- Pain out of proportion to injury with pain on passive stretch of the muscles in the compartment (Correct answer)
- Mild swelling with intact pulses and capillary refill
- Bruising and ecchymosis at the surgical site
- Decreased knee ROM with soft end-feel
Correct answer: Pain out of proportion to injury with pain on passive stretch of the muscles in the compartment
Pain disproportionate to the clinical picture combined with pain on passive muscle stretch is the earliest and most reliable clinical indicator of compartment syndrome.
Question 6: After cervical spine fusion (ACDF), which activity should the physical therapist avoid during the early post-operative phase?
- Cervical rotation and extension exercises (Correct answer)
- Diaphragmatic breathing exercises
- Scapular retraction exercises with neutral spine
- Postural education in seated position
Correct answer: Cervical rotation and extension exercises
Cervical rotation and extension stress the fusion site during the bony healing phase (typically first 6-12 weeks) and risk hardware failure or pseudarthrosis.
Question 7: A patient undergoes a medial opening wedge high tibial osteotomy (HTO). What is the PRIMARY biomechanical goal of this procedure?
- Shift mechanical axis load away from the diseased medial compartment to the healthier lateral compartment (Correct answer)
- Increase the Q-angle to improve patellar tracking
- Restore normal tibial plateau slope to improve PCL function
- Decompress the proximal tibiofibular joint
Correct answer: Shift mechanical axis load away from the diseased medial compartment to the healthier lateral compartment
HTO corrects varus malalignment by shifting the mechanical axis laterally, unloading the arthritic medial compartment and redistributing forces to the intact lateral compartment.
OCS Surgical & Post-Operative Care 3
A patient 6 weeks post-SLAP repair is cleared to begin active-assisted ROM.
Which motion should be introduced LAST due to greatest risk of re-injury?