Reconsidering Sternal Precautions

After any surgical procedure that involves a sternotomy, it is common for the patient to be placed on Sternal Precautions. The precautions are placed on the patient as a result of the recent opening and decreased stability of the sternum. The precautions typically include:

- No flexion/abduction past 90 degrees
- No weight-bearing through the upper extremities
- No scapular adduction (this is seen with horizontal abduction)
- No lifting > 5-10 lb.
- No unilateral reaching posteriorly

However, there are variations throughout the nation. This study displays the lack of evidence for Sternal Precautions along with descriptions of surgical procedures that often utilize the precautions. One of the issues noted is the activity restriction placed on the patient that can contribute to other co-morbidities linked to sedentary activity. Additionally, the forces created with the restricted activities are crucial to stimulating tissue healing. Without these stresses, the healing rate of the sternum is slowed. It may be time to reconsider whether or not the restricted activities truly stress the surgical closure enough to cause instability.