LECTURE 8B: POST OP SHOULDER Flashcards
CPG for subacromial decompression surgery
for pain, function, quality of life, PT/non op management was pretty much the same as surgery
we are as good
What 4 things should you know as a PT about Rotator Cuff tears when a patient is coming to see you for RX options?
- size of tear
- location of tear
- chronicity (tendons like to turn into stumps, acute tears are repaired better)
- patient expectations and goals
What are options for full-thickness RC tears?
non-Sx: massive tears
surgery: debridement (if massive, irreparable)
open/mini-open repair (small incision)
arthroscopic repair (most people)
Partial thickness RC tear rehab
immediate passive/AAROM with wand
don’t overwork RC muscles
6-8 weeks
RC strengthening for 3-6 months
full thickness RC repair rehab
- protect
- PROM
- increase strength of active stabilizers, then improve endurance for Scap rhythm
4 phases of RCT repair rehab
- PASSIVE 0-6 weeks
- AAROM—> AROM 6-12 weeks
- strengthening 12-24 weeks
- advanced retraining 24+ weeks
Phase 1 of RC repair should look like…
NO AROM ER
NO PROM IR beyond neutral
Phase 2 of RC repair should look like…
6-12 weeks
AAROM–> AROM
Phase 4 of RC repair should look like…
24-52 weeks
aggressive strengthening
-free weights
-CKC
-PRN stretching,
Phase 3 of RC repair should look like…
light strengthening
(bands)
Do we need to do PROM initially?
Can we do more than PROM initially and load RC earlier?
PROM: yes
early loading?: no, retear risk is high
GH instability: surgical repair
Bankhart repair vs. SLAP according to clock
Bankhart: 4-6 or 3-6, anterior, inferior
SLAP: 11-1, 12-2 (superior labrum, AP)
For GH instability/labral conservative rehab,
avoid end ranges of ____ for anterior
_____ for posterior
anterior: ABD, ER
posterior: ADD, IR
GH instability rehab principles
avoid end ranges
avoid long levers
controlled ranges
RC strength/endurance for humeral head centering
CKC for co-contraction
general time frame for Bankhart repair
0-4 weeks sling
4-8 weeks PROM/AROM
8-12 weeks strengthen
12 weeks-6 months: functional/higher level
Multi-Directional Instability post op rehab (for inferior capsular shift)
1: immob
2. pendulums
3. through 2-3 weeks: PROM shoulder elevation, abd in POS, ER per MD
7: begin PT BIW or TIW
21: light weights/tubing
MDI inferior capsular shift reduces capsular volume up to ___%
57%
(need to be careful about AROM!)
What 4 things should you do/remember for SLAP/GH instability rehab?
- limit motion in unstable direction
- CKC for co-contraction
- STRENGTHEN ACTIVE STABILIZERS
- SLAP: limit biceps until healed
