Post-Operative Instructions Proximal Hamstring Repair

Transcription

1 Laith M Jazrawi, MD Prfessr f Orthpedic Surgery T Pst-Operative Instructins Prximal Hamstring Repair Day f surgery A. Diet as tlerated B. Pain medicatin as needed every 4-6 hurs (refer t pain medicatin sheet). C. Make sure yu have a physical therapy pst-p appintment scheduled during the first week after surgery. D. If yu were given a brace this shuld be wrn at all times except during sleep. First Pst-Operative Day A. Pain medicatin as needed. Secnd Pst-Operative Day Until Return Visit A. Unless therwise nted, weight-bearing is te-tuching nly fr the first 6 weeks after surgery. After 6 weeks, yu can bear as much weight n the affected leg as yu can tlerate. Mst patients use crutches fr the first 2-3 weeks. B. Call ur ptin 4, ptin 2 t cnfirm yur first pstperative visit, which is usually abut 1-2 weeks after surgery if yu have nt been given a time. If yu are experiencing any prblems, please call ur ffice r cntact us via the internet at C. The initial Aquacel dressing shuld be kept n fr the first 2 weeks after surgery. After 2 weeks, yu may remve the Aquacel dressing and shwer. Apply 4x4 (r similar size) Telfa r Tegaderm t these wunds prir t shwering and when shwering is cmplete apply fresh dry Telfa r Tegaderm. D. If shwering is begun befre 2 weeks (earliest allwed is third pstperative day), the Aquacel dressing MUST be kept dry. *Telfa Adhesive Island Dressings r Tegaderm+Pads may be purchased nline and at select pharmacies. NYU Langne Orthpedic Center 333 E 38th St, New Yrk, NY T F

2 Dr. Laith M. Jazrawi Assciate Prfessr Department f Orthpaedic Surgery Rehabilitatin Prtcl Fllwing Prximal Hamstring Primary Repair The hamstring muscle grup cnsists f three muscles: the biceps femris, semitendinsus and semimembransus. All three f these muscles riginate frm the ischial tubersity f the pelvis and then insert belw the knee with the biceps femris a=aching n the fibula and the semimembransus and semitendinsus a=aching n the?bia (Figure 1). These muscles crss the hip and the knee, and therefre can affect bth hip and knee m?n. Acute hamstring strains are cmmn in sprts that invlve sprin?ng, kicking and high-speed skilled mvements. A Na?nal Ftball League team published injury data fr their team during pre-seasn training camp frm Hamstring strains were the secnd mst cmmn injury, nly surpassed by knee sprains.1 Numerus studies have shwn that hamstring strains are ne f the mst cmmn injuries in sprin?ng sprts, sccer, rugby and Australian rules ftball.1-12 Hamstring strains primarily ccur at the prximal muscultendn junc?n.13 Prximal muscultendn strain injuries have been shwn t be treated effec?vely with rehabilita?n.1, 8 Much less cmmn, but mst Uen much mre severe, are the hamstring injuries invlving cmplete avulsin f the hamstring cmplex ff the ischial tubersity. When this ccurs a large amunt f bleeding (hematma) will frm in the back f the thigh and the tendn will mve dwn the thigh, retrac?ng away frm the ischial tubersity (Figures 2 and 3). Almst all injuries ccur frm a slip r a fall that creates frceful hip flexin with simultaneus knee extensin, many f these during spr?ng ac?vi?es th St. New Yrk, NY (646) newyrkrth.cm!

3 Rehabilitatin Prtcl Fllwing Prximal Hamstring Primary Repair In addi?n t falls this injury can ccur with waterskiing starts and bull riding These cmplete avulsins result in significant r cmplete lss f hamstring func?n depending n hw many f the tendns are avulsed. This can lead t pr leg cntrl and difficulty even walking. Because f the significant structural damage and resultant disability, these injuries are Uen treated with pen surgical repair. The clinical indica?ns fr surgical repair are cmplete hamstring avulsin f all 3 tendns r significant retrac?n with less than 3 tendns avulsed. Outcme studies indicate that if surgery is perfrmed shrtly auer injury, the utcme is superir t thse whse surgery was delayed several mnths. Acute surgical repair is perfrmed by suturing the trn tendns t suture anchrs placed in the bne at the anatmical rigin. This usually requires 2-4 suture anchrs and Panacryl r Ethibnd sutures (Figures 4 and 5) In addi?n t falls this injury can ccur with waterskiing starts and bull riding These cmplete avulsins result in significant r cmplete lss f hamstring func?n depending n hw many f the tendns are avulsed. This can lead t pr leg cntrl and difficulty even walking. Because f the significant structural damage and resultant disability, these injuries are Uen treated with pen surgical repair. The clinical indica?ns fr surgical repair are cmplete hamstring avulsin f all 3 tendns r significant retrac?n with less than 3 tendns avulsed. Outcme studies indicate that if surgery is perfrmed shrtly auer injury, the utcme is superir t thse whse surgery was delayed several mnths. Acute surgical repair is perfrmed by suturing the trn tendns t suture anchrs placed in the bne at the anatmical rigin. This usually requires 2-4 suture anchrs and Panacryl r Ethibnd sutures (Figures 4 and 5) Pst-pera?vely crutches are used t assist in walking fr the first few weeks. A brace r prtec?ve device als may be used t prtect the hamstring. One factr in this decisin is the?me f year (snw / ice), as mst reprted episdes f early failure are related t slipping and falling. Anther factr, which is assessed during surgery, is the ease with which the trn tendn can reach its riginal inser?n n the pelvis. If the tendn was significantly retracted there is a greater likelihd f lnger pst-pera?ve prtec?n th St. New Yrk, NY (646) newyrkrth.cm!

4 Rehabilitatin Prtcl Fllwing Prximal Hamstring Primary Repair Phase I (Surgery t 6 weeks after surgery) Gals Prtectin f surgical repair Prgress ROM by 30 degrees per week t full ROM by 8 weeks Crytherapy unit t be used 4-6 times per day fr 20 minutes Crutches/nn-weight bearing fr 4 weeks with prgressin t full-weight bearing Precautins Nn-weight bearing with crutches fr 6 weeks N active hamstring cntractin N hip flexin greater than 45 degrees Knee extensin limited pending intra-perative tensin n the repair Suggestins Crytherapy fr pain and swelling cntrl 3-5x a day Light desensitizatin massage t the incisin and psterir hip Scar massage Silicn patch ver incisin (if pen repair) Phase II (6 weeks t 8 weeks fllwing surgery) Gals Restre nrmal gait Pain free and nrmal functinal ADLs Precautins Mnitr tenderness f surgery site N hamstring flexibility r stretching exercises are t be perfrmed during this phase. Lengthening f the repair and return f nrmal hamstring flexibility will be allwed t ccur n its wn Range f Mtin Exercises Therapeutic Exercises Increase Frward Flexin, Internal/External Rtatin t full mtin as tlerated Restre nrmal gait pattern (emphasize gd leg cntrl with extensin f knee during swing phase and heel strike) Imprve ADL functin i.e sit->stand, stairs, etc. Begin light hamstring strengthening with lw lads, high reps and high frequency by perfrming hamstring leg curls in standing with the hip extended. Start with zer resistance then prgress as tlerated 1lb at a time 2 sets/20, 4-5x a day Begin ttal leg strengthening: heel raises, quad sets, shrt arc squads, general hip strengthening in side lying, single leg balance fr prpriceptin Other Suggestins Light desensitizatin massage t the incisin and psterir hip Scar massage th St. New Yrk, NY (646) newyrkrth.cm!

5 Rehabilitatin Prtcl After Arthrscpic SLAP Repair Phase III (8 weeks t 12 weeks fllwing surgery) Gals Pain-free perfrmance f nn-impact aerbic activities Unrestricted ADLs at hme r wrk Precautins Mnitr hamstring flexibility and tenderness f surgery site Therapeutic Exercises Begin nn-impact aerbic cnditining as tlerated with any f the fllwing: statinary bike, stairmaster, elliptical trainer, nrdic track, aquatic therapy with swimming r functinal activities in the water (avid frceful, explsive, r repetitively strainful activities) Cntinue t prgress TLS as tlerated: ¼ squats, stepdwns, leg press, knee extensins, heel raises, hip abductr in standing with tubing r machine, balance and prpriceptive training Prgress hamstring strengthening in standing by increasing weight r initiating TheraBand Patient may prgress t prne psitining n a machine and then t seated leg curls (with hip flexed at 90 degrees) n a machine r with tubing References th St. New Yrk, NY (646) newyrkrth.cm!

6 Laith M Jazrawi, MD Prfessr f Orthpedic Surgery T Pst-Operative Rehabilitatin Prtcl: Prximal Hamstring Tendn Repair Patient Name: Date: Weeks 0-6: Gal: Prtectin f surgical repair Precautins: Nn-weight bearing with crutches fr 6 weeks N active hamstring cntractin N hip flexin greater than 45 degrees Knee extensin limited pending intra-perative tensin n the repair Durable Medical Equipment: Prgress ROM by 30 degrees per week t full ROM by 8 weeks Crytherapy unit t be used 4-6 times per day fr 20 minutes per sessin Crutches/Nn-weight bearing fr 4 weeks with prgressin t full-weight bearing weeks 5-7 Exercises: Crytherapy fr pain and swelling cntrl 3-5x/day Teach patient hw t transfer frm supine t sit, stand t sit, as well as perfrm ADLs safely. (Avid greater than 45 degrees f hip flexin when the knee is extended during any and all activities, ie. sitting) Heel prps with quad sets, supine psitin nly, t avid knee stiffness and quad shut dwn Other: 1. Light desensitizatin massage t the incisin and psterir hip 2. Scar massage 3. Silicn patch ver incisin (if pen repair) Clinical fllw-up: Fllw-up with physician at apprximately 2 weeks pstperative Weeks 6-8: Gal: Restre nrmal gait Pain free and nrmal functinal ADLs Precautins: Mnitr tenderness f surgery site N hamstring flexibility r stretching exercises are t be perfrmed during this phase. Lengthening NYU Langne Orthpedic Center 333 E 38th St, New Yrk, NY T F

7 Laith M Jazrawi, MD Prfessr f Orthpedic Surgery T f the repair and return f nrmal hamstring flexibility will be allwed t ccur n its wn. (This is traditinally nt an issue fllwing this prcedure) Exercises: 1. Restre nrmal gait pattern (emphasize gd leg cntrl with extensin f knee during swing phase and heel strike) 2. Imprve ADL functin, ie. Sit -> stand, stairs, etc. 3. Begin light hamstring strengthening with lw lads, high reps and high frequency by perfrming hamsring leg curls in standing with the hip extended. Start with zer resistance then prgress as tlerated 1 lb at a time-2sets/20, 4-5x/day 4. Begin ttal leg strengthening (TLS): a. Heel raises b. Quad sets (active heel lift) c. Shrt arc quads d. General hip strengthening in side lying (gluteus maximus and medius) e. Single leg balance fr prpriceptin Other: Light desensitizatin massage t the incisin and psterir hip Scar massage Clinical fllw-up: Fllw-up with physician at apprximately 8 weeks pstperative t advance rehab and mnitr prgress Weeks 8-12: Gal: Pain-free perfrmance f nn-impact aerbic activities Unrestricted ADLs at hme r wrk Precautins: Mnitr hamstring flexibility and tenderness f surgery site Exercises: 1. Begin nn-impact aerbic cnditining as tlerated with any f the fllwing: a. Statinary bike b. Stairmaster c. Elliptical trainer d. Nrdic track e. Aquatic therapy with swimming r functinal activities in the water (Avid frceful, explsive r repetitively strainful activities) 2. Cntinue t prgress TLS as tlerated: a. ¼ squats b. Stepdwns c. Leg press d. Knee extensins NYU Langne Orthpedic Center 333 E 38th St, New Yrk, NY T F

8 Laith M Jazrawi, MD Prfessr f Orthpedic Surgery T e. Heel raises f. Hip abductr in standing with tubing r machine g. Balance and prpriceptive training 3. Prgress hamstring strengthening in standing by increasing weight r initiating TheraBand 4. Patient may prgress t prne psitining n a machine and then t seated leg curls (with hip flexed at 90 degrees) n a machine r with tubing Clinical fllw-up: Fllw-up with physician at apprximately 14 weeks pstperative t release t all activities as tlerated. The patient s frequency f fllw-up with the therapist will be determined n an individual basis and depend largely n the patient s adherence, as well as the patient s and therapist s cmfrt level. Signature: Date: NYU Langne Orthpedic Center 333 E 38th St, New Yrk, NY T F