Brainscape's Knowledge GenomeTM

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


See full index

PHTH 550- Orthopaedic Management Final > Lecture 17: UE Arthroplasty > Flashcards

Lecture 17: UE Arthroplasty Flashcards

1
Q

A. For what conditions is a shoulder arthroplasty done?

B. What is the outcome of shoulder replacements?

A
  1. TSA: good outcomes for osteoarthritis and inflammatory arthritis.
  2. Hemiarthroplasty: Proximal humerus #.
  3. Reverse shoulder arthroplasty when rotator cuff tear.

B. Usually successful procedure w/ decreased pain and improved motion and function.

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

What are the types of shoulder arthroplasties?

A
  1. Hemiarthroplasty: Replacement of proximal humerus.
  2. Total Shoulder Arthroplasty: Replacement of the humarl and glenoid components of the G/H joint.
  3. Reverse Total Shoulder Arthroplasty (rTSA): when there is a massive rotator cuff tear the humeral component is concave instead of convex and g/h is convex. This moves the centre of rotation of the G/H joint medially and inferiorly which increases the moment arm of the deltoid. Deltoid can provide more G/H elevation, stability and mobility.
  4. Lat dorsi tendon transfer (LDTT): when there is a teres minor insufficiency (loss of external rotation) or rotator cuff tear the lat dorsi tendon goes from anterior to posterior to allow for external rotation. (gain about 15 degrees)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the two surgical approaches used for shoulder arthroplasty?

A
  1. Deltopectoral approach: more common. Go through anterior deltoid and pec maj. so only subscapularis gets cut.
  2. Superior approach: Release anterior deltoid from clavicular attachment, increasing post op contraindications.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the most common dislocation risk for TSA?

A

Normally shoulder instability is abduction and full ER. Not for TSA its posterior instability:
HBB: Adduction, IR and extension that poses the greatest risk following TSA (especially reverse TSA).

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

What are the Post-Op Contraindications following TSA?

  1. Activity restrictions
  2. Movement restrictions
  3. Active movement restrictions 4. Resistance Training restrictions
A 
1. 
No driving 3 wks
No WB on UE 6 wks 
No heavy pushing or pulling 6 wks 
No lifting object > 3 lbs for 12 wks

rTSA w/ LDTT: No lifting objects > 6 lbs for 16 wks.

2.  (PROM and AROM)
rTSA w/ LDTT: No ROM at all for 4-6 wks 
No ext  past neutral 6-8 wks (rTSA 12wks)
No EOR HBB 6 wks (rTSA 12)
No EOR abd/ER 6 wks 
No EOR ER 6 wks

rTSA: No EOR IR 6 wks

  1. (AROM)
    No active shoulder IR 6 wks
    Superior Approach: No active shoulder flexion 6 wks
  2. No RT 6 wks
    rTSA w/ LDTT: up to 9 wks
    Superior approach or rTSA w/ LDTT: can be up to 12 wks

No IR RT 9-12 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How are TSAs managed post-operatively?

A

Immobilize sling 3-4 wks
Sleep on pillow arm in flexion (to prevent arm for going into extension past neutral)

rTSA w/ LDTT: Custom brace for 4 wks at least. Holds arm slight elevation in scapular plane w/ 15 degrees ER.

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

TSA 1-4 days post-op (inpatient):

  1. Contraindications
  2. PT management
A 
1. 
Movement: 
-No Ext past neutral
-No EOR: HHB, Abd/ER, ER
-No AROM: IR, Flex (SA)
Resistance: 
-No RT
-No WB on UE
-No heavy pushing or pulling 
-No lifting objects> 3 lbs

2.

  • Education: Contraindications and positioning.
  • AROM: Elbow, wrist, hand, Cx spine.
  • Pendulum Ex
  • PROM: Flex, Abd, IR, ER scapular plane
  • Cryotherapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

TSA up to 6 wks:

  1. Contraindications
  2. PT management (rehab or outpatient physio)
A 
1. 
Movement: 
- No ext past neutral 
- No EOR: Abd/ER, ER, HBB
-No AROM: IR and Flex (SA)

Resistance:

  • No RT
  • WB UE
  • Push or pull heavy objects
  • Lifting objects > 3 lbs.
  1. PROM: Flex, IR, ER (Scapular plane).
    AROM: Flex (unless sup), Elevation in scapular plane.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the goals 2 wks post op?

A

140 Flex
75 Abduction w/ no rotation
40 ER in neutral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

TSA at 6-12 wks:

  1. Contraindications.
  2. PT management
A 
1. No lifting heavy objects > 3 lbs 
No IR RT (b/w 9 and 12 wks)
2. 
ROM:
-Continue PROM and AAROM 
-Add AAROM Hoz Abd
-Begin AROM: Flex, IR, ER (pain-free)
Muscle activation: 
-Sub-max isometrics (neutral/pain free) 
-Scapular Ex 
-Later: minimal resistance to flex, elevation, ER and IR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the goals for sh ROM after TSA?

Return to function?

A 
Flex: 140-160 degrees 
Abd: 90 degree w/ 40 degrees of IR/ER 
ER: 40-60 in neutral 
IR: 70 degrees at 90 abd
Full Ext
HBB thumb to level of L2

AT 3 monts HEP
Should be able to return to functional/recreational activities w/in 4-6 months.

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

What are the differences for:

  1. rTSA
  2. rTSA w/ LDTT vs rTSA
A
  1. No Ext. past neutral x 12 weeks (vs. 6-8 wks)
    No EOR HBB x 12 weeks (vs. 6 weeks)
    No EOR IR x 6 weeks
2.
No ROM at all x 4-6 weeks
No lifting objects >6 lbs x 16 weeks
No RT up to 9 weeks (vs. 6 weeks) 
up to 12weeks ͞p superior approach
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the criteria for PT discharge following TSA?

A
  • Pt able to maintain pain free AROM
  • Maximized functional use of UE
  • Maximized muscular strength, power and endurance
  • Pt has returned to advanced functional activities

-Lifelong ROM ex’s recommended.

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

What activities are not recommended ever after TSA?

A

Football, Gymnastics, Hockey, Rock Climbing

-Review table in slides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

For what conditions is a elbow arthroplasty done?

What is the prognosis of a TEA?

A
  • Inflammatory arthropathies (RA)
  • Posttraumatic OA
  • Distal humerus # or non-union
  • Reconstruction after tumor resection
  • Successful for pain relief, motion and function.
  • Higher complication rate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What types of prostheses are used for TEA?

A
  1. Semi-constrained (linked): physical link (pin) between the humeral and ulnar components.
  2. Non-constrained (unlinked): no pin, usually if ligaments are intact.
    More conservative rehab.
17
Q

What are the contraindications following TEA?

  1. Activity
  2. Movement
  3. Resistance
A 
1. 
No driving 2-3 wks 
No WB on UE 12 wks 
No pushing or pulling 12 wks 
No lifting objects > 10-15 lbs for life 
No hobbies involving repetitive throwing for life.
  1. No AROM for elbow Ex against gravity 6 wks
    AAROM/AROM in gravity free plane usually permitted.

Non-Constraint procedure:
No ext combined w/ supination for 6 wks.

  1. No elbow flex RT 6-8 wks
    No Wrist RT 6-8 wks
    No elbow ext RT 12 wks

Triceps tendon is cut during procedure.

18
Q

What is done post-operatively to manage TEA?

A

Removable extension splint for 4-8 weeks. Take off for rehab.

19
Q

How are TEA managed post-operatively in terms of rehabilitation?

  1. 1-4 days post-op (in-pt until 6 wks)
  2. 6-8 to 12 wks
  3. Week 12
A
  1. AAROM to AROM for: Elb, F/A, wrist
    -Ext only in gravity free plane if allowed.

AROM: Shoulder, Cx Spine and fingers
Cryotherapy
Education (positioning, contraindications)

  1. Begin AROM elb ext against gravity
    Begin STR for elbow flex and wrist
    (isometric to isotonic w/ elbow supported)
  2. Isotonic elbow STR ex and progress to functional use.
20
Q

What is the end goal for rehabilitation?

A

ROM 30-130 degrees.

Unlikely to regain full extension or flexion.

PHTH 550- Orthopaedic Management Final (13 decks)

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