Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHTY2101 EOS > B3 L38 Orthopaedics Inpatients- Common Surgeries of the Upper Limb > Flashcards

B3 L38 Orthopaedics Inpatients- Common Surgeries of the Upper Limb Flashcards

1
Q

Inpatient Physiotherapy management of four shoulder surgeries commonly seen on the Orthopaedic Ward. What are they?

A
  1. Subacromial Decompression (SAD)
  2. Rotator Cuff repair
  3. Shoulder Reconstruction
  4. Shoulder Arthroplasty
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a subacromial decompression?

A

Indicated for Impingement of Rotator Cuff non responsive to conservative Mx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does a subacromial impingement look like?

A

Image

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are 2 ways that the subacromial decompression (SAD) can be perfomed?

A
  1. arthroscopically
  2. open (predominantly A/S)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are 4 things that the subacromial decompression surgery involve?

A

Clearing of subacromial arch:

  1. removal of bursa
  2. coracoacromial ligament,
  3. reshaping undersurface of the acromion (Acromioplasty)
  4. Possible- Excision of the lateral 1/3 of the clavicle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are 3 things that the subacromial decompression surgery does not involve? What does that mean for the patient?

A
  1. Disruption or repair of muscle
  2. Disruption or repair of tendon
  3. Disruption to the joint

Therefore the patient can commence immediate active movement of the affected shoulder within limits of pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the Post Operative Presentation of a subacromial decompression?

A

Arm supported in sling for comfort only (removed as soon as able)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why can the sling be removed as soon as possible post a subacromial decompression?

A

not protecting any structures (no physiological reason) can impact other surrounding structures eg. sling causes kyphotic spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the 4 procedures to follow the Post Operative management of a subacromial decompression?

A
  1. Post operative Respiratory check if required (Circulatory care not a priority as patient will be mobile)
  2. Day 0-1 may commence - Neck, Scapular (LTs), Elbow, Wrist and Hand movements
  3. IF there is no muscle, tendon or joint disruption (only a SAD) – may commence active assisted shoulder ROM exercises on Day 1 and progress as tolerated. Exercises are then progressed as pain allows
  4. Education ++ re sling use, ice for pain relief (+/- No abduction 3-6 weeks depending on Drs orders)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the position of the arm that the patient cannot be in for 3-6 weeks post subacromial decompression?

A

+/- No abduction 3-6 weeks depending on Drs orders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the types of slings?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are 4 characteristics of rotator cuff tears?

A
  1. Usually the Supraspinatus Tendon
  2. Single substantial trauma or micro-trauma over time
  3. The Supraspinatus tendon can rupture traumatically with associated symptoms or spontaneously without causing acute symptoms.
  4. With increasing age more people will have torn cuff muscles with or without pain.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

A rotator cuff repair Can be performed ______ or ______.

A

arthroscopically; open

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is rotator cuff repair done? (procedure) How does this affect the patient post op?

A
  • Surgeon will initially perform an arthroscopy of the shoulder to examine the structures involved – can then be converted to open procedure if required
  • Disruption or repair of muscle with deltoid split
  • Disruption or repair of tendon of rotator cuff
  • Therefore the patient cannot commence immediate active movement of the affected shoulder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the goal of the rotator cuff repair?

A

reattach good quality tendon to the bone from which it is torn (good re-attachment point)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

If RC is repairable, a ______ or ______ is fashioned in the normal attachment site.________ draw the edge of the tendon securely into the groove to which it is to heal

A

groove; trough; Sutures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the Post Operative Presentation of a rotator cuff repair?

A
  • Arm supported in sling and binder
  • Some surgeons use an abduction wedge or abduction brace to maintain abduction whilst the repaired tendon heals (less common over last three to four years) to take the tendon off stretch
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the 5 procedures to follow the Post Operative management of a rotator cuff repair?

A
  1. Post operative Respiratory check if required (Circulatory care not a priority as patient will be mobile)
  2. Sling on at all times except for exercises usually for 6 weeks (protect structures- remain in abduction)
  3. Day 1 may commence - Neck, Scapular (LTs), Elbow, Wrist and Hand movements, as well as gentle pendular exercises (gentle pendular exercises are usually classified as passive exercises)
  4. NO active movements or increasing of shoulder ROM (structures are at risk with contraction) for 6 weeks post op. Patient is usually reviewed by the surgeon at that stage and referred for outpatient physiotherapy to progress the rehabilitation
  5. Pain relief including ice important in post op management
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When are 2 cases where anterior stabilisation (shoulder reconstruction) is needed?

A

acute dislocation recurrent instability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Over 95% of shoulder dislocations are _______ Dislocation but may also have_______, _______ or ______ dislocations

A

Anterior; Posterior; Inferior; Multidirectional

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the mechanism of injury with an acute shoulder dislocation?

A

a fall on the outstretched hand.

  • Ninety to ninety-five per cent of dislocations are anterior with the head of the humerus being driven forward and externally rotated. The capsule of the joint is usually torn and the glenoid labrum may be avulsed
22
Q

What is the mechanism of injury with recurrent shoulder instability?

A

Recurrent instability may result from recurrent dislocations or from repeated activities that stress and subsequently stretch the capsule

23
Q

What are 4 characteristics of Anteroinferior Glenohumeral Ligament in an anterior stabilisation procedure?

A
  1. Originates as a portion of fibrous glenoid labrum anteroinferiorly
  2. primary restraint to anterior and anteroinferior instability
  3. avulsion of this complex from the antero inferior glenoid labrum results in a bankart lesion (85% of anterior dislocations)
  4. IGHL must fail for anterior dislocation to occur as primary restraint to anterior and anteroinferior instability
24
Q

What is the natural history for Young patients to have re-dislocations?

A

When the patient’s proximal humeral growth plate is open, there is up to 100% rate of re-dislocation

In young adults, the rate of re-dislocation ranges from 55 to 95%

25
Q

What is the natural history for older patients to have re-dislocations?

A

Rate of re-dislocation decreases as age increases.

  • If traumatic dislocation also resulted in a tear of the rotator cuff repair can result in pain relief and return of strength.
26
Q

What are the Surgical Techniques for Acute Dislocation for an anterior stabilisation procedure?

A

Repair of individual Glenohumeral ligaments &/or Bankart lesion repair.

27
Q

What are the 3 Surgical Techniques for Recurrent Instability for an anterior stabilisation procedure?

A
  1. Bankart Lesion Repair
  2. Subscapularis Procedures
  3. Putti Platt
  4. Magnuson Stack
  5. Coracoid transfers
  6. Bristows
28
Q

What is a Bankart Lesion Repair?

A

Bankart lesion is an avulsion of the anteroinferior glenoid labrum at its attachment to IGHL complex

Procedure involves the resuture of the capsule and glenoid labrum through drill holes of the anterior glenoid rim. Expect a little loss of ER post operatively

29
Q

What is a Bankart lesion?

A

Bankart lesion is an avulsion of the anteroinferior glenoid labrum at its attachment to IGHL complex

30
Q

What is the procedure for a Bankart repair?

A

Procedure involves the resuture of the capsule and glenoid labrum through drill holes of the anterior glenoid rim.

Expect a little loss of ER post operatively

31
Q

What are 3 subscapularis procedures?

A
  1. Putti Platt
  2. Magnuson Stack
  3. Bristows
32
Q

Wat is a putti platt?

A
  • Procedure tightens and reinforces the anterior capsule by dividing and shortening the Subscapularis.
  • Limited ER post operatively.
  • Full ER is only obtained if surgical repair is torn
33
Q

What is a Magnuson Stack?

A
  • Transfers subscapular tendon and capsule laterally and inferiorly (from lesser tuberosity across bicipital groove to greater tuberosity) to tighten anterior capsule.
  • May expect up to 50% loss of ER post operatively.
34
Q

What is a Bristows?

A

Involves the relocation of the corocoid process along with attached corocobrachialis and short head of biceps, through a division in the subscapularis tendon and attached by screw fixation to the anterior aspect of the scapula neck. The conjoined tendons act as a dynamic sling.

Expect limited ER post operatively.

35
Q

What is the Post Operative Management of an anterior stabilisation?

A
  • Aim of initial post op management is to avoid stressing the repaired structures until fibrous healing occurs at approx 6 weeks.
  • Exercises commenced Day 1 and patients usually discharged from hospital Day 1-2
  • Neck, wrist, hand and scapular retraction exercises commenced immediately
  • Active elbow ROM exercises in IR and upper arm supported (except with Bristows)
  • Passive shoulder flexion <90 and ER <0 (protecting subscap)
36
Q

What is the Post Operative Presentation of an anterior stabilisation?

A

Arm resting in Sling and Binder

37
Q

What is the Planning for discharge after an anterior stabilisation

A

A physiotherapy review at 6 weeks may be indicated to commence active ROM and strengthening progression

38
Q

What are the 2 types of shoulder replacements?

A
  1. Hemiarthroplasty
  2. Total shoulder replacement-
39
Q

What is a Hemiarthroplasty (shoulder replacement)?

A
  • Single prosthesis replacing humeral head and retaining patients own glenoid fossa.
  • Suitable for managing conditions that only affect the humerus such as proximal humeral fracture
40
Q

What is a total shoulder replacement?

A

prosthesis replaces both the humeral and glenoid surfaces- suitable for conditions that affect both sides of the joint such as arthritis

41
Q

What does a total shoulder replacement look like on an x-ray?

A
42
Q

What does TSR surgery involve? How does that affect the patient post-op?

A

Disruption and repair of subscapularis tendon

Therefore the patient cannot commence immediate active movement of the affected shoulder

43
Q

What are the 3 objectives of physiotherapy post operatively?

A
  1. Increasing range of movement, initially PASSIVELY (due to the disruption of the rotator cuff muscles), then progressing through active-assisted movements, and finally active exercises
  2. Progressively gain strength of the soft tissues after healing has occurred
  3. Regain an optimal upper quadrant environment to maximise glenohumeral function
44
Q

What is the post operative presentation of a total shoulder replacement?

A
  • Arm resting in Sling and Binder
  • Often requiring PCA pain relief (eg IV Morphine)
45
Q

What are the 8 objectives for Day 1 Post Op treatment for a total shoulder replacement?

A
  1. Chest check and exercises if indicated
  2. Exercises for neck, wrist, fingers, and elbow
  3. Ice
  4. Ambulate and SOOB as tolerated
  5. Shoulder girdle exercises – i.e. lower traps exercises
  6. Thoracic spine exercises to improve thoracic extension
  7. Pendular shoulder exercises
  8. Passive shoulder exercises: Flexion 0-60 degrees Abduction 0-60 degrees ER to neutral
46
Q

What are the 5 Criteria for Discharge for a TSR?

A
  1. Safe and independent mobility
  2. Independent with HEP
  3. Full ROM neck, wrist, hand and elbow
  4. Comfortable sling support
  5. Outpatient appointment arranged at 3-6 weeks (depending on Drs time frame) to commence assisted active program
47
Q

What is the expected timeline for active and passive movements post TSR op?

A
  1. 0-3 weeks passive only
  2. 3-6 weeks assisted active
  3. 6 weeks active resisted
48
Q

What are the 3 complications with TSR?

A
  1. Sepsis (infection), loosening of the glenoid or humeral component, material failure, dislocation and intraoperative fractures
  2. Most common is glenoid component loosening
  3. Rotator cuff lesions correlate to poor results
49
Q

What is a reverse total shoulder replacement? 3 characteristics.

A
  1. Ball and socket are reverse
  2. Center of rotation is moved medially
  3. Improved action of the deltoid
50
Q

When is a reverse TSR the preferred choice?

A

patients with deficient RC

51
Q

What is the rehab for a reverse TSR?

A

Similar rehab to TSR

PHTY2101 EOS (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions