Lecture 8, Instability & TSA

Question 1

Indications for TSA

Answer 1

Primary = persistent and incapacitating pain or proximal humeral fracture
Secondary = loss of mobility or stability. loss of strength

Question 2

Complications of TSA

Answer 2

tight subscap
fracture of humerus
damage to nerves
re-tear of RCR

Question 3

Considerations for postoperative management

Answer 3

integrity of rotator cuff
intraoperative ROM
immobilization
thoracic alignment
abduction pillow

Question 4

Strengthening depends on….

Answer 4

status of rotator cuff

Question 5

Stretching and post-op

Answer 5

absolutely NO END RANGE stretching

Question 6

Mechanism of injury, dislocation

Answer 6

humerus is rapidly and forcefully moved psoteriorly when in ER/abd

Question 7

Bankart lesion

Answer 7

tear of anterior inferior glenoid labrum

Question 8

Acute protection phase of dislocation

Answer 8

protect the healing tissue
promote tissue circulation
musce setting
posture

Question 9

What actions are not advised for dislocations?

Answer 9

Extension –> contraindicated
ER –> precaution

Question 10

Subacute traumatic shoulder dislocation

Answer 10

increase joint mobility
increase stability and strength of rotator cuff
avoid position of dislocation
neuromuscular education

Question 11

What is contraindicated during subacute dislocation?

Answer 11

all joint mobs

Question 12

Return to function, shoulder dislocation

Answer 12

return to full activity in 2.5-4 months
remember that kids under 20 have a higher rate of dislocation

Question 13

Etiology of atraumatic shoulder instability

Answer 13

connective tissue laxity
repetitive microstress

Question 14

Signs of generalized hypermobility

Answer 14

able to touch pals to floor when bending at waist
genu recurvatum
elbow hyperextension
MCP hyperextension
thumb abduction to ipsilateral forearm

Question 15

Functional impairments with shoulder instability

Answer 15

pain
weakness
paresthesias
crepitus
instability during sleep

Question 16

Phase 1 to Post op goals

Answer 16

Immediate/in patient

decrease inflammation
some PROM
AROM at distal structures
no AROM at shoulder

caution w/elbow extension and remember they are at risk for DISLOCATION and TEAR

Question 17

Phase 1 steps

Answer 17

0-6 weeks – PROM
4-6 weeks – AAROM

Question 18

Progress from phase 1 to phase 2

Answer 18

PROM is tolerated at 90°of flexion, 45° ER, 60°IR

Question 19

Phase 2 Post Op

Answer 19

Early & Late phases

Early–> no lifting, pushing, pulling. Continue with PROM/AAROM, joint mobs

Late–> scapular strengthening

Question 20

Moving to Phase 3

Answer 20

minimal pain
has achieved at least 130° PROM flexion, 60° PROM ER, 70° IR
able to actively elevate shoulder against gravity

Question 21

Early phase of Phase 3 TSA

Answer 21

no lifting objects heavier than 5lbs
resisted shoulder IR, ER
vary degrees of elevation with weights

Question 22

Late phase of Phase 3 TSA

Answer 22

resisted flexion, elevation, extension
continue progressing IR, ER strengthening
progress IR behind back

Question 23

Phase 4 TSA

Answer 23

14 weeks
maintain non-painful AROM
functional use of UE
improve strength, power, endurance