Common Shoulder surgeries Flashcards
Bankert lesion
- caused typically in the labrum from an anterior dislocation that tears part of the labrum
Bankart repair (open)
- indications
- expectations
- usually an open procedure
- indications: anterior instability bankart lesion “torn loose”
- expectations: eliminate instability, full or near full external rotation
How does an open bankart repair occur
- deltopetoral interval
- reflect the deltoid and pec not cut
- subscapularis is cut and reflected to expose joint capsule
- vertical incision to access the joint
- anterior labrum will be reanchored
- jt capsule is pulled/tighened
- subscapularis is repaired
what motions should be under caution with a bankart repair
- careful with ER (the subscapularis is healing)
- first 1-3 weeks = 30º ER
- 3-6 weeks = 45º
- after 6 weeks get back to normal
- also limit forcefully contraction IR
bankart repair: week 0-2 goal
- protect the surgical procedure
- minimize the effects of immobilization
- diminish pain and inflammation
Open bankar repair: week 0-2 cautions/interventions
- sling 1-2 weeks
- submaximal isometrics: no resisted IR until 2-3 weeks
- PROM/AAROM: flexion to tolerance; ER/IR in scapular plane but not to end range
How long is an arthroscopic bankart repair in a sling for
- 4 weeks
- they feel better sooner so they are in the sling longer to stop them from disrupting the healing
Weeks 3-4 open bankart repair post op
- gradually progress ROM
- flexion to 120-140 degrees
- ER 35-45º (scapular plane)
- IR 45-60ºscapular plane
- light isotonics: tubing ER, dumbells
- gentle self capsular stretching
weeks 5-6 open bankart lesion repair post op typical rehab
- progress ROM
- IR/ER at 90ºof abduction
- ER 70-75º
- iR 75º
- progress all strengthening exercises
Week 8-10 open bankart lesion repair post op
- re-establish full ROM
- normalize arthrokinematics
- improve muscular strength
- enhance neuromuscular control
return to sport for bankart repair post op - time frame
- 6-9 months especially for high demand or throwing athletes
Arthroscopic bankart procedure
- capsule is tightened/sewed together
- open will get more tightness/stability
- if glenoid needs to be repairs
- this may loosen up more rapidly
precautions after After Anterior Glenohumeral Stabilization and/or Bankart Repair
- 1st 6 weeks limit ER, horizontal abduction and extension (stretch anterior capsule)
- arthorscopic procedures should limit flexion more than open
Bristow-latarjet procedure
- anterior instability with glenoid defect
- bony block with additional dynamic stability
- coracoid transfer with biceps short head
- resection of coracoacromial ligament
- biceps short head provides a sling to support anteriorly
outcome of Bristow-latarjet procedure
- average 5 year follow up no significant instability
- improved subjective reports with arthroscopic tendency toward increase recurrence compared to open
- high demand UE activities less RTS in both groups
Multidirectional Instability Arthroscopic capsular plication
- indications and expectations
- indications: multidirectional instability with significant symptoms complaints “born loose”
- AMBRI
- expectations: provide a stable shoulder for functional activities, rarely return to athletics, high failure rate (more lax collagen = more failure rate)
Multidirectional Instability Arthroscopic capsular plication post op protocols
- post operative protocols vary based on surgeons perception of attained stability
- often immobilized for extended period to promote scarring up
Multidirectional Instability Arthroscopic capsular plication outcomes generally
- generally ROM recovered slowly (they are easily over stretched)
- often patients lax with collagen deficiency –> do not need to facilitate them stretching
- surgery alone fails to provide stability
