Lecture 8B; Shoulder Comolex Post Op Treatment Flashcards
Rotator cuff tears Rx options depend on what
Size of tear, location of tear , adhesions , patient expectation and goasl
For a partial thickness RC tear it is sx or non sx but ___ only
Debridement
What do u begin immediate for a partial thickness RC tear
Immediate passive , AAROM w wand
What are u strengthening day 1 for a partial thickness RC tear
Non RC mm w tubing
When can u progress to light tubing RC strengthening and for how long
6-8 weeks for 3-6 months
What is the key thing for partial thickness RC tear
Don’t over work the RC mm initially
What do u want to protect in a full thickness RC repair rehab
Repaired tendon initially
How long are u not aloud to do resistance with a Full Thickness RC Repair Rehab
1st 6 weeks
What should u increase strength of with a Full Thickness RC Repair Rehab
Acute stabilizers to unload passive stabilizers
What are the 4 phases for rehab after a RCT repair
• Phase I: Passive Exercises (0-6 weeks)
• Phase II: Active Assistive-Active Exercises (6-12 weeks)
• Phase III: Strengthening Exercises (12-24 weeks)
• Phase IV: Advanced Retraining (24+ weeks)
How long is phase 1-4 for RCT repair
• Phase I: 0-6 week s
• Phase II: 6-12 weeks)
• Phase III: 12-24 weeks)
• Phase IV: 24+ weeks)
For phase 1 (0-6weeks) after RC repair there is no active or passive what
No active ER,
no passive IR
beyond neutral
What warm up exercises can u do in phase 1 (0-6 weeks)
Bike or walk
Shoulder shrug
Pendulum
How is the ROM for phase 2 (6-12 weeks) after RC repair
Active assistive progressing to active
What are some active ROM exercises that u can do during phase 2 (6-12 weeks) after RC repair
Stand during shoulder elevation
Standing shoulder ER w stick
Seated forward lean stretch
What phase can u begin light strengthening after RC repair
Phase 3 (12-24 weeks)
What are some strengthening exercises for phase 3 (12-24 weeks) after RC repair
Shoulder IR w tubing
Shoulder ER w tubing
Anterior deltoid w tubing
Supraspinatus w tubing
Scapular rotators w tubing
Biceps w tubing
Triceps w tubing
What can u do in phase 4 (24 - 52 weeks) after shoulder RC repair
More aggressive strengthening
What are some free weight exercises that a patient can do in phase 4 (24-52weeks) after RC repair
Supraspinatus
Anterior deltoid
Mid trap (T’s)
Biceps
Triceps
Shoulder extension in supine
Scapular retraction in supine
When does CKC exercises begin after RC repair
Phase 4 - 24-52 weeks
What is the last motion to gain back after a RC repair
IR
When can u start PRN stretching into IR and cross body after RC repair
Phase 4 ( 24- 52 weeks )
How mch rehab is usually the standard for rehab following RCR
3x/ week
Is instability a active or passive problem
Active
What kind of GH instability is conservative treatment most likely effective
Non traumatic
If a shoulder has a labrum tear it is also ___
Unstable
What are the surgical options for GH instability
- Open vs. Arthroscopic
- Bankhart repair
- SLAP repair
- MDI Capsular Shift
If someone has a torn labrum can they do isometrics right away
Yes bc Labrym is a passive strucutre so no mm is damage
What is the most common direction of GH instability
Anterior
What do u want to avoid when doing rehab for GH instability
End ranges initially and long levle activities
What do u want to emphasize with GH instability
RC strength , firing , endurance to dynamitically control humeral centering
Whar end ranges do u want to avoid for anterior instability and posteiror instability
Abduction/ER for anterior instability
* Adduction/IR for posterior instability
What is a bankart repair
Labral repair combined with capsular shift procedure
What is the general time line for Bankart repair for a sling , P/AROM, strengthening
4 weeks for all
When can u return to higher level of functional acitvities after a bankart repair
Around 6 month s
For MDI post operative rehab (inferior capsular shift) what should u reduce
Capsular volume up tp 57% (basically bringing back to normal )
What is the post operative rehab for MDI POD #1
Immobilization + finger , wrist , elbow AROM
What is the post operative rehab for MDI POD #2
Add pendulum exercises , sent home
What is the post operative rehab for MDI POD #3 2-3 weeks
Exercise + Ice, PROM shoulder elevation ,abduction in POS, ER per MD ok
What is the post operative rehab for MDI POD #7
Being PT twice a week or 3 times a week
What is the post operative rehab for MDI POD #21
Being light weights or elastic tubing
Where does the long head of the biceps tendon attach
Superior labrum
Pateints with what kind of SLAP lesion require sx
Type 2 -4
There is a high rate of future injury to the capsule/labrum with what patients after a SLAP lesion
< 18
How long do u have to wait to lift weights and bands for GH/SLAP lesions rehab
12 weeks
What kind of activity is best to facilitate co contraction fo GH instability/ SLAP rehab
Closed chain
What do u want to strengthen For GH instability/SLAP lesions
Active stabilizers
What do u want to limit for SLAP lesion repair
Limit strong biceps contraction until stabilized (until about 12 weeks)
What sx does a pt get if they have intact RC and if they dont have intact RC
instant RC —> TSA
No intact RC—> reverse total shoulder
