EXAM 3 - OA and clavicle Flashcards
what allows for stability in the GH joint
shape of the joint, the articular cartilage, the labrum, capsule and the intra-articular pressure
degenerative change sis seen in what percentage of adult over 65%
17% to 20%
what is the presentation of shoulder OA
- 17% of patients with shoulder pain.9
- Women
- Previous history of shoulder injury
- Overhead sports and occupational endeavors
- ROM: External rotation appears to be significantly affected
- Sleep issues
- Night pain
- Anxiety / Depression
- Pain perception
is MRI helpful for the differential diagnosis for OA
yes
helpful to confirm the diagnosis and less helpful to rule out the diagnosis
what is indicated in post op management - total shoulder arthorscopy
sling and progressive exercise for ROM and strengthing
what position should the shoulder be when placed in a sling
neutral position
for those who have undergone a TSA
when should shoulder ROM exercises be implemented in therapy
delayed up to 4 weeks
what is the evidence behind pre-op PT before TSA
based on clinical expertise
what is the evidence for no surgery but PT
absence of evidence
clinical expertise say that PT may help pt who have not undergone TSA
fro conservative management is there any particular intervention that is recommend
no
evidence of post op PT outcomes and edema
absence of evidence
clinical expertise say that PT may help
what are examples of non-surgical repair of shoulder OA
PT
activity modification
Intra-articular Injections
meds
what are Lifestyle modifications for OA
ROM restriction – going to need to find different ways to perfrom ADLs
Physical Therapy intervention
Modalities
Joint Mobilization
Range of Motion
Strengthening
Intra-articular Injections typically are what
Corticosteroids
Medication used for shoulder OA
NSAIDS, aspirin, acetaminophen
3 types of shoulder replacement
hemi-arthroplasty
total arthroplasty
reverse arthroplasty
Indications for shoulder arthroscopy
Rotator cuff tear arthropathy
Degenerative Joint Disease
AVN failed pasts replacement
Degenerative Joint Disease
OA
RA
Post Traumatic RA
Proximal Humeral fractures
Rotator cuff tear arthropathy
There is RC issue because of the change in the osteokinematics
total shoulder arthroplasty provided better functional outcome than hemiarthroplasty for pt with OA
yes is a two year follow up
what happens if the center mech of the shoulder is distrupted
subacromial structures can be impinged
During upper extremity elevation, the rotator cuff is responsible for what
keeping the humeral head centered in the glenoid
In the presence of a rotator cuff failure what happens to the biomechnics of the shoulder and what does this cause
biomechanical alterations and abnormal motions predispose the joint to abnormal wear.
where do we see abnormal wear in the shoulder with RC failure
superior portion of the glenoid and the underside of the acromion
followed by degeneration of the articular cartilage in the area.
why have total shoulder replacments become the norm
the continued degeneration of the glenoid or humeral head.
when is the total shoudler artho indicated
degenerative conditions where the RC is still intact.
Revision after hemiarthroplasty
goals of a Shoulder Arthroplasty
Restore Function, decrease pain, sleep
what is occuring when we do a Hemi Arthroplasty
Only half the articular surfaces are replaced
Rehabilitation for a hemi-arthroplasty may be slightly accelerated with what intervention
immediate motion allowed if the rotator cuff is still relatively intact and there was no need for repair
which surface is replaced in a Hemi Arthroplasty
glenoid or the humeral head
Phase I - goals
Reduce pain and inflammation and
Reduce muscular inhibition
Phase II
Full PROM
Increase AROM
Do not overstress healing tissue
Initiate dynamic shoulder stability
Scapular rhythm Active elevation against gravity Normal swing in gait
Phase III
AROM/Strengthening phase
Phase IV
functional return
general rehab guidelines - sling day and night
day 1-2 weeks
nigh 4-6 weeks
general rehab guidelines - gerneal ROM
for first 4 -6 weeks
general rehab guidelines - when do we add strength in
4 weeks
isometrics
phase 1- what do we do
Increase PROM, initiate AAROM late in phase
pahse 2 - goals
Control pain and inflammation and continued healing of soft tissue
phase 2 sling
sling is gradually removed
Phase III - part2
Gradual restoration of shoulder strength, power, and endurance
Optimize neuromuscular control
Gradual return to functional activities with involved upper extremity
Phase IV - rom
Nonpainful AROM
phase 4 - goals
Functional use of upper extremity
Maximize strength, and endurance
Gradual return to more advanced functional activities
what are the indication for Reverse Total Shoulder Arthroplasty
GH Joint Arthritis
Irreparable RC tear
Complex fractures
Failed TSA with the rotator cuff tendons deficient/absent
what is an arthropathy
a joint disease, of which arthritis is a type
what is a Cuff tear arthropathy
characterized by a severe humeral head collapse following massive tearing of the RC.
what are proposed about inactivity following a massive tear of the RC
results in instability of the humeral head and leakage of the GH joint synovial fluid.
what does the loss of synovial fluid do to art cart
predisposes the articular cartilage to degeneration due to poor nutritional status.
articular cartilage is worn away and the surfaces are exposed, this lead to painful shoulder motion and learned non-use.
what does rTSA do to the biomechanics of the shoulder
Reversal of biomechanics
Increased moment arm of the deltoid
Increased overhead elevation
Decreased pain
intervention for AC joint dysfunction
activity modification
pain modulation
restroation of function - ROM and strength
return to sport or occupation
phase 1- what do we do
Increase PROM, initiate AAROM late in phase
Full distal extremity (elbow, wrist, hand) AROM
Independence with modified ADL’s
pahse 2 - goals
Control pain and inflammation and continued healing of soft tissue
Reverse Total Shoulder Arthroplasty indications
GH Joint Arthritis
Irreparable RC tear
Complex fractures
Failed TSA with the rotator cuff tendons deficient/absent
what is a arthropathy
joint disease, of which arthritis is a type
Cuff tear arthropathy
characterized by a severe humeral head collapse following massive tearing of the RC.
it was proposed that inactivity following a massive tear of the RC results in what
instability of the humeral head and leakage of the GH joint synovial fluid.
what does leakage of the synovial fluid lead to
The loss of synovial fluid predisposes the articular cartilage to degeneration due to poor nutritional status.
articular cartilage is worn away and the surfaces are exposed, this lead to painful shoulder motion and learned non-use.
outcome of Cuff tear arthropathy
destruction of the GH joint articular cartilage, osteoporosis, and ultimately collapse of the humeral head
loss of the RC lead to what change in biomechanics
the centering forces on the glenoid are lost, altering GH joint biomechanics.
leading to superior migration of the humeral head,
what happens if we have superior migration of the humeral head
which, over time, erodes the coracoacromial ligament and the acromioclavicular joint and the glenohumeral joint
what happens to the shoulder biomechanics with rTSA
Reversal of biomechanics
Increased moment arm of the deltoid - more relient on the deltoid
Increased overhead elevation
Decreased pain
