Lecture 8, Instability & TSA Flashcards
Indications for TSA
Primary = persistent and incapacitating pain or proximal humeral fracture
Secondary = loss of mobility or stability. loss of strength
Complications of TSA
tight subscap
fracture of humerus
damage to nerves
re-tear of RCR
Considerations for postoperative management
integrity of rotator cuff
intraoperative ROM
immobilization
thoracic alignment
abduction pillow
Strengthening depends on….
status of rotator cuff
Stretching and post-op
absolutely NO END RANGE stretching
Mechanism of injury, dislocation
humerus is rapidly and forcefully moved psoteriorly when in ER/abd
Bankart lesion
tear of anterior inferior glenoid labrum
Acute protection phase of dislocation
protect the healing tissue
promote tissue circulation
musce setting
posture
What actions are not advised for dislocations?
Extension –> contraindicated
ER –> precaution
Subacute traumatic shoulder dislocation
increase joint mobility
increase stability and strength of rotator cuff
avoid position of dislocation
neuromuscular education
What is contraindicated during subacute dislocation?
all joint mobs
Return to function, shoulder dislocation
return to full activity in 2.5-4 months
remember that kids under 20 have a higher rate of dislocation
Etiology of atraumatic shoulder instability
connective tissue laxity
repetitive microstress
Signs of generalized hypermobility
able to touch pals to floor when bending at waist
genu recurvatum
elbow hyperextension
MCP hyperextension
thumb abduction to ipsilateral forearm
Functional impairments with shoulder instability
pain
weakness
paresthesias
crepitus
instability during sleep
Phase 1 to Post op goals
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
Phase 1 steps
0-6 weeks – PROM
4-6 weeks – AAROM
Progress from phase 1 to phase 2
PROM is tolerated at 90°of flexion, 45° ER, 60°IR
Phase 2 Post Op
Early & Late phases
Early–> no lifting, pushing, pulling. Continue with PROM/AAROM, joint mobs
Late–> scapular strengthening
Moving to Phase 3
minimal pain
has achieved at least 130° PROM flexion, 60° PROM ER, 70° IR
able to actively elevate shoulder against gravity
Early phase of Phase 3 TSA
no lifting objects heavier than 5lbs
resisted shoulder IR, ER
vary degrees of elevation with weights
Late phase of Phase 3 TSA
resisted flexion, elevation, extension
continue progressing IR, ER strengthening
progress IR behind back
Phase 4 TSA
14 weeks
maintain non-painful AROM
functional use of UE
improve strength, power, endurance
