The working principles of our hands, shoulders and knees are similar to that of a perfectly designed machine. However, any problems in these designs necessitate equally perfect solutions.

The working principles of our hands, shoulders and knees are similar to that of a perfectly designed machine. However, any problems in these designs necessitate equally perfect solutions. Therefore, hand, shoulder and knee surgery is a highly specialized surgical branch requiring the application of highly sensitive techniques. Furthermore, no matter how successful the surgery, it is not possible to achieve full recovery in the absence of a well-planned physical therapy and rehabilitation program. .. Treatment and Rehabilitation in the Aftermath of Hand, Shoulder and Knee Surgery is as important as the surgery itself...

Thanks to important improvements in the field of hand, shoulder and knee surgery, the operations are becoming simpler for the patients. A well-planned physical therapy program in the post-surgical period will have a significant impact on the successful outcome of the surgery.

Acting like an extension of our brain into the environment, our hands perform a variety of functions ranging from very fine motor skills such as holding a needle to lifting heavy weights which requires force, our knees are strong enough to lift a load of 45 kilograms all the way up to 1 meter levels, and our shoulders are able to perform four different kinds of movements? When we examine the way in which these parts of our body operate, once more we understand this perfectly designed machinery that is our body. However, any problems in these designs necessitate equally perfect solutions. Perhaps it is because of this reason that articular surgery has only recently started to claim its share of medical improvements. It is a fact that the advanced surgical techniques we apply in these joints such as arthroscopy (intra-articular, closed surgery) and artificial prosthesis do not date back very far. For instance, arthroscopic surgery has been around for approximately 20 years. It is a good idea to talk about the importance of physical therapy in the aftermath of these surgeries because no matter how successful the surgery may be, it is impossible to achieve full recovery in the absence of a well-planned physical therapy and rehabilitation program .

Yes, our topic is those frequently-encountered hand, shoulder and knee joint problems, the surgical methods applied in this field and the post-surgical healing processes.... Our specialists are Hand Surgery Specialist Dr. Ufuk Nalbantoğlu, Physical Therapy and Rehabilitation Specialist Prof. Sabri Narman, Orthopedics and Traumatology Specialist Prof. Osman Güven and Orthopedic Traumatology and Sports Injuries Specialist Prof. Ömer Taşer. They explained in detail the most frequently asked questions in this regard, the surgical procedure and the post-surgical therapy process.

HAND SURGERY

It would not be wrong to say that hands are the extension of the brain into the environment. The hands are equally competent to perform activities that require very fine motor skills and activities which require considerable force. Furthermore, hands are used as a sensory organ as well. We can tell whether an object is cold or hot by touching it with our hands. For hands to fulfill their functions in the best possible manner, the hand muscles need to be working well and the joint movements should be in perfect working order. Because of this, hand surgery is a highly specialized surgical branch requiring the application of highly sensitive techniques. Dr.Ufuk Nalbantoğlu, Hand Surgery Specialist at Acıbadem Kadıköy and Kozyatağı Hospitals says that the reason for hand and upper extremity surgery to be accepted as a separate branch is the presence of an excessive interlinkage of tissues in a very small area.

Hand traumas are one of the major reasons for resorting to surgical methods. Apart from traumas such as fractures, neural and vascular injuries, severed tendons and muscles, the field of hand surgery also takes care of tumors, nerve impingements, rheumatism problems and congenital anomalies.

Post-surgically, Dr. Ufuk Nalbantoğlu draws attention to the need to start physical therapy as soon as possible in order for the patient not to experience any loss in his/her movement functions. Provided that the patient's wound is in good condition, Dr.Ufuk Nalbantoğlu says physical therapy should start within the first week following the surgery. Dr. Ufuk Nalbantoğlu says that failure to start physiotherapy will result in the formation of movement-restricting rigidities within a period of three to six weeks, which will go on to become irreversible after the sixth week. In a well-planned physical therapy program, the joints are moved within a safe angular spectrum in order not to inflict any damage on the fixation performed by the surgeon, and at the same time other parts of the body (for instance shoulders and the elbow) are also exercised. Thus, the objective is to make it possible for the patient to return to his/her work and daily activities as soon as possible.

SHOULDER JOINT SURGERY

Professor Osman Güven, an Orthopedics and Traumatology Specialist at Acıbadem Kadiköy Hospital states that when it comes to the shoulders, the most frequently encountered problems are arthrosis (popularly known as calcification) in and around the joints in the shoulder. The wear and tear in the joints and the cartilages of the shoulder initially manifests itself as loss of function and pain, and later as restriction of range of motion. The wear and tear sustained by the muscles that allow for motion in the shoulder ranks second among problems encountered in the shoulder. Professor Osman Güven states that these problems first make themselves felt through pain, later progressing into partial or total rupture, and, over time may be even culminate in total inability on the part of the patient to lift his/her arm. The third significant group of disease in the shoulders is "shoulder instability". Observed in patients of a younger age compared with the first two kinds of problems, this disease manifests itself in repetitive shoulder dislocations. Explaining that some people are born with shoulder joints that typically allow for dislocation at the slightest sudden reflex, Professor Güven adds that surgery is considered to be an applicable method in repeating dislocations. These problems are followed by traumas such as shoulder fractures.

Reporting that there have been significant improvements in surgical treatment in recent years, Professor Güven continues as follows: "The improvements in the arthroscopy method have made it possible to perform most of the non-traumatic surgeries as closed surgery. This is particularly advantageous for the patients who may heal fast and painlessly. Furthermore, it allows us to start the patient on exercise and therapy as soon as possible. Provided that it is not a case of full or wide rupture repair, we may generally start physical therapy on the second day following surgery. Some of our patients demonstrate great progress within a period of 2-3 weeks, whereas previously in the absence of such surgical treatment they would have to wait for months with their arms in a hanger. They would start physical therapy later on and it could very well take months before they would derive any benefits."

In the aftermath of the surgery: Professor Sabri Narman, a specialist in Physical Therapy and Rehabilitation at Acıbadem Kadıköy Hospital, starts by saying that their first objective after shoulder surgery is to eliminate the oedema (swelling) and the pain at the surgical site. Explaining that their top priority is the elimination of the pain and ensuring the comfort of the patient, Professor Sabri Narman underscores the importance of cold pack application in the treatment of the oedema.

Depending on the scale of the surgery, Professor Narman says they may start physical therapy even on the first day following surgery. Professor Narman explains as follows, "First, we apply passive exercises which the patient performs with the help of support devices without using his/her own physical strength. Over time, exercises progress into what is called active-assistive (meaning they are performed either with the help of the physical therapists themselves or with the help of the devices) movements. Once the wounds heal and there is no longer any pain, we move on to resistance exercises." Professor Narman emphasizes that they do not neglect the general condition of the patient throughout the

therapy and that they supplement their regimen with other activities such as cycling, stair-climbing and other exercises.

KNEE SURGERY

When it comes to knee surgery, the first thing tat comes to mind is meniscus surgery. Cartilage structures located inside the knee, just like cartilages, the menisci are not able to repair themselves. As such, when they sustain any kind of injury or rupture, they may need to be removed or sutured. It is possible to perform arthroscopic methods in meniscus surgery.

Professor Ömer Taşer, a specialist in Orthopedic Traumatology and Sports Injuries at Acıbadem Bakırköy Hospital says that cartilage problems in the knee are commonly observed and that some cases may now be treated with cartilage transplant. According to the information Professor Taşer provides, this method allows for the removal of a bone block from another non-weight bearing site of the joint area and the cartilage of this bone block may be transplanted to the damaged site. In our day, knee prosthesis procedures are frequently applied in advanced knee joint problems. Professor Ömer Taşer says that they perform very successful operations where the damaged and worn and torn parts of the joint are removed and replaced by a customized artificial joint, which is the prosthesis.

Explaining that it is possible to repair anterior cruciate ligament ruptures, a phenomenon particularly observed in sports performers, with tissues obtained from the person himself or from cadavers, Prof. Dr. Taşer goes on to add that as such, post-surgically, it is possible for the newly added tissue to be rehabilitated in a manner that will make it function like the cruciate ligament.

The aftermath of the surgery: Professor Sabri Narman says that use of pain killing modalities after knee surgery make it possible to start rehabilitation the first day following surgery. He explains that they have special equipment that allows the joints to perform the necessary movements. The most important rule of treatment is to keep those muscles surrounding the knee strong.

Stating that failure to start early mobilization following surgery will result in rigidity in the knees which may prove difficult to overcome in the future, Professor Narman continues as follows "If you do not bend the knee at a minimum of 70 degrees range of motion within two weeks following the surgery, you may no longer be able to fully open that knee. However, if you provide this range of motion within the first two weeks, there will be no potential regression."

Stating that they may ensure 120 degrees of range of motion for the knees following successful surgery, Professor Sabri Narman explains that pre-surgical period is important in knee prostheses. Pre-surgical weight loss in obese patients reduces the load born by the prostheses, thereby improving the life expectancy of the prostheses.

Professor Sabri Narman states that post-surgical rehabilitation is a teamwork consisting of surgeons, physiatrists and physical therapists. According to Professor Narman, this team has to work in coordination and in consensus in order to fully reap the benefits of the surgery.

Dr. Ufuk Nalbantoğlu states that in order to retain the functions of the hand, it is necessary to start physical therapy and rehabilitation as soon after the surgery as possible. Professor Ömer Taşer emphasizes that there have been significant improvements in knee surgery thanks to arthroscopic, intra-articular surgical methods. Another important characteristic of arthroscopic surgery is that it allows for earlier onset of physical therapy.