Physiotherapy - Theses

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Sternal management following cardiac surgery

BALACHANDRAN, SULAKSHANA ( 2015)

Patients who have undergone cardiac surgery involving a median sternotomy are routinely asked to follow sternal precautions post-operatively that are not standardised, with significant variation in the type and duration for which they are recommended. These precautions usually include the restricted use of the upper limbs and trunk, with the broad aim of preventing the development of sternal complications such as sternal instability. However, there is limited research investigating the basis of these precautions and as such it is not known how tasks involving the upper limbs and trunk affect the healing sternum. If sternal precautions are overly restrictive, they may delay functional recovery, which is significant in a patient population that is presenting with a greater number of co-morbidities pre-operatively. This poses the question of whether sternal precautions are warranted in all patients following cardiac surgery involving a median sternotomy. This thesis aims to: (1) explore the physiotherapy management of patients following cardiac surgery involving a median sternotomy, (2) investigate the risk factors for sternal complications in this patient population, (3) determine the clinical utility of ultrasound as a tool to assess sternal healing and (4) examine how tasks involving the upper limbs and trunk affect the sternum in this patient population.