9/30 - Shoulder Instability Post-Op Flashcards
what is a bankart lesion
labral tear
- stretching anterior-inferior capsule & IGHL
- periosteal stripping of subscap from neck of glenoid fossa
what is the gold standard for surgical intervention for anterior instability
bankart repair
what happens anatomically during a bankart repai
reattachment of avulsed anterior capsule to glenoid rim
what are indications for a bankart repair (3)
- symptomatic recurrent anterior shoulder dislocations
- failed conservative therapy
- unidirectional anterior instability
what are contraindications for a bankart repair (3)
- voluntary instability w emotional/psycho problems (ie popping it out to show you)
- seizure disorder
- multidirectional instability
why is multi-directional instability a contraindication to a bankart repair
only stabilizing anterior
- still other instability
what ms are impacted by a bankart repair
subscap
why is there a difference in immediate management after an open vs arthroscopic bankart repair
open - more collateral damage
- cutting thru more stuff
- creates bleeding environment
- inc potential for scar tissue but helps w healing
- can move sooner
arthroscopic - less collateral damage
- less bleeding»_space; dec healing environment
- immobilized longer
what is a difference in rehab motions after open vs arthroscopic bankart d/t involved structures
arthroscopic - subscap intact
- ER / IR @30° ABD
cut thru anterior capsule in both, want to avoid loading anterior capsule for both
what is a good way to do scap retractions in phase 1 after arthroscopic bankart repair and why
plantar grade (or side lying)
- minimizes shoulder ext
what are milestones to progress from phase 1 to phase 2 of rehab after an arthroscopic bankart repair (3)
- appropriate healing
- compliant w immobilization guidelines - staged ROM goals achieved
- not exceeded - minimal to no pain w ROM (0-2/10)
why is elevation in the scapular plane a good exercise in phase 2 of rehab after an arthroscopic bankart repair
minimal capsular tightness
subacromial clearance
optimal length-tension RC/scap
what are the milestones to progress from phase 2 to phase 3 of rehab after an arthroscopic bankart repair (3)
full ROM without substitution
good dynamic scap control
strengthening w 0-2/10 pain
what are 3 goals of phase 3 of rehab after an arthroscopic bankart repair
- normal strength, endurance, NM control and power
- gradual stress to anterior capsulolabral structures
- gradual return to full ADLs, work duties, rec activities
who is someone who would progress to phase 4 of rehab after an arthroscopic bankart repair
someone who needs to get back to sport or has an intense job
- not everyone needs to get to this phase
what are milestones to return to full activity after an arthroscopic bankart repair (4)
MD clearance
no pain / full ROM
no sensation of instability
adequate RC/scap strength w/o pain
what is a better way of asking/testing if someone has any remaining sensation of instability
NM control
- do they have proprio reposition sense
when would you see a surgical intervention for a SLAP type 1
if some other RC involvement
what are precautions for type 2 SLAP lesion repairs (4)
- control forces 8 weeks
- no overhead motions 4 weeks
3. no isolated biceps 8wks
4. no resisted biceps 12wks
when you begin AROM of biceps after a type 2 SLAP lesion repair, what is an important consideration for how you do this
should be co-contraction w other ms
- dec load on biceps
shouldn’t be isolated biceps contraction/activity
what is milestone criteria to reach the minimal protection phase of rehab after a type 2 SLAP lesion repair (4)
full and painless AROM
good stability
4/5 or greater strength
no pain/tenderness
what are milestones to get to the advanced strengthening phase of rehab after a type 2 SLAP lesion repair (3)
full pain-free AROM
strength 75-80% of uninvolved
no pain / tenderness
what are milestones to get to the return to activity phase of rehab after a type 2 SLAP lesion repair (3)
full functional ROM
satisfactory shoulder stability
no pain / tenderness
why is a biceps tenodesis often done
if biceps were to be reattached to glenoid, might retear
- so reattach it lower
why does a biceps tenodesis work
other ms can do what biceps do
what is a good pt population for biceps tenodesis
lower level pts
- other ms are now going to be doing what the biceps does
what is a takeaway if you know that the tendon/ms was repaired and restored to original place
more tenuous bc quality of tissue might not be great
tenodesis vs tenotomy
tenodesis - need to wait for healing
- but good stability
tenotomy - not waiting for anything to heal
- just cut
- can get popeye’s sign as bicep’s tendon retracts
why can’t you fix bone loss w a soft tissue procedure
bone loss will get worse over time
- see wasting away
what ms are your biggest considerations post-op
biceps
subscap
