Management of Shoulder Complex

Question 1

What makes up 180 degrees of shoulder flexion?

Answer 1

120 humeral elevation

60 degrees scap rotation

Question 2

What is an important function of SA?

Answer 2

posterior tipping of scap allows for less impingement

Question 3

What other role does TRAP-SA force couple play?

Answer 3

helps optimize glenoid position, deltoid length tension, stable base to recruit scap muscles

Question 4

What is common mechanism of injury for clavicular fracture?

Answer 4

FOOSH, 80% happen in medial clavicle

Question 5

What is rehab for a clavicle fracture?

Answer 5

figure 8 brace for 3-6 weeks, ROM less than90 initially

Question 6

What is most common place for a scap fracture?

Answer 6

body

Question 7

What is common MOI for proximal humerus fx?

Answer 7

FOOSH, potential for neurovascular injury (axillary nerve)

Question 8

What is rehab for proximal humerus fracture?

Answer 8

sling use, promote range at proximal and distal joints, gentle mobilizations, respect pain, mobility before strength

Question 9

What are rehab considerations for a grade 1-2 AC joint injury?

Answer 9

limit Hor. ADD and IR, sling 2-3 weeks, gradual motion and strength

Question 10

What are rehab considerations for post op AC jt repair?

Answer 10

sling 6-8 weeks, limit elevation greater than 90, avoid full IR and H Add for 3-6 weeks, progress scaption to full ROM greater than 6 weeks

Question 11

What is difference between primary and secondary OA?

Answer 11

primary- happens for no reason

secondary- prior trauma

Question 12

What is PP for OA?

Answer 12

pain, decreased motion and function

Question 13

What is tx for OA?

Answer 13

distraction, pendulums, promote capsular mobility, RC and scap strength and endurance

Question 14

What is capsular pattern for OA?

Answer 14

ER, ABD and IR

Question 15

What is important to remember about micro fracture surgery?

Answer 15

this replaces hyaline cartilage with fibrocartilage which is not as strong

Question 16

When is a total shoulder not a good idea?

Answer 16

for laborers who have high demands, large inoperable RC tears, isolated humeral OA but intact glenoid surface

Question 17

What motions should be avoided after a TSA?

Answer 17

subscapularis precautions weeks 1-6, limit ER less than 30 degrees, No resistive IR

Question 18

What can you do after a TSA?

Answer 18

scap ROM and exercises right away, Wk 4 isometrics but no IR

Question 19

What is the main adverting of reverse TSA?

Answer 19

can be done in absence of no functional RC, increased deltoid lever arm, more powerful ABD

Question 20

When is a reverse TSA indicated?

Answer 20

massive RC tear, failed TSA

Question 21

What is contraindication for reverse TSA?

Answer 21

active infection, impaired deltoid function, need for high level shoulder function

Question 22

What position should be avoided after RTSA?

Answer 22

combined IR/ ADD/EXT, same subscap precautions, PT doesn’t start till week 2-4 weeks after

Question 23

When can you start resistive exercises with RTSA?

Answer 23

around week 12 depends on subscap healing