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Surgical > medsibridge UE surgery > Flashcards

medsibridge UE surgery Flashcards

1
Q

what precautions are there post SAD

A

None, there is no repaired structures or surgical debridement of bone

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2
Q

what are the complications associated with SAD

A
  • 2-3% incident rate
  • infection
  • scalene block nerve injury or pneumothorax
  • patient positioning nerve injury
  • portal placement suprascapular nerve or vascular injury
  • resection incomplete or excessive
  • adhesive capulets
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3
Q

what is the prognosis for SAD outcome

A

Good outcome
Jaeger 2016
1. 90% satisfaction in individuals with partial thickness impact on RTC
2. 70% satisfaction in individuals with full thickness RTC
3. 65% satisfaction in idvidauls with calcific tendonitis
Magaji 2012
individual with positive response to steroid injection, consistent HK test, mid arc pain and positive radiographic impingement reviewed more benefit than individual with 2 or less of the criteria

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4
Q

why is the supraspinatus thought to be more susceptible to tear

A
  • it has a relatively avascular zone at it humeral insertion
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5
Q

how are overhead athlete RTC tears different that routine RTC tears

A
  • routine tears are most often associated with mechanical/degenerative changes or compression of the RTC
  • overhead athletes are associated with overuse of the muscles and not a mechanic impingement of the RTC
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6
Q

What is happening that the surgical site of a RTC during the reparative phase of recovery

A
  • 5-8 weeks

- tendon to bone healing - fibroblast are actively producing collagen, callus formation is occurring in the bone tunnels

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7
Q

what is the typical time frame for the remodeling phase of a RTC

A

8-13 weeks - intitial strength program

13-22 functional return expectation

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8
Q

what complicates are most common with RTc repair

A
  • persistent stiffness - most will improve with continued rehab
  • repair failure (older people)
  • infection
  • CRPS
  • DVT
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9
Q

what are the predictors to success of a RTC repair

A
  1. good for younger, earlier surgery, smaller tears and non smokers
  2. poor - over 65, manual laborers, comorbidites particularly with bone health, 5cm or greater tear, work comp injuries, incorrect diagnosis
    COLE 2007
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10
Q

Which heals faster tendon to tendon healing or tendon to bone healing

A

tendon to tendon is fast than tendon to bone

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11
Q

what factors are commonly associated with SLAP injuries

A
  • traction force on the arm
  • repetitive overhead activity
  • impingement
  • instability
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12
Q

what patients have poor prognosis for labral reparis

A
  • individuals over 40 with concomitant RTC tears

- heavy smokers and drinkers

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13
Q

type 1 SLAP lesion are commonly associated with predisposing factors

A

age, RTC disease, OA

- fraying of the superior labrum, but attachment is intact

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14
Q

type 2 SLAP lesion are commonly associated with what predisposing factors

A

overhead throwing athletes due to the forceful max ER and ABd position
- labrum and bicep have detached from the top of the glenoid

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15
Q

type 3 SLAP lesions are commonly associated with what predisposing factors

A

manual laborers

- bucket handle labral tear with intact biceps where the tear is dropping down into the GH joint

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16
Q

How long should you usually wait to start direct bicep strengthening following SLAP repair

A

12 weeks

17
Q

return to sport of work typically occurs how long after SLAP repair

A

4-6 months

18
Q

what are the common complication after SLAP repair

A

Weber 2012 4.7%

  • repair failure or re tear
  • persistent pain
  • loss of motion
  • infection
  • instability
19
Q

At what rate to individuals return to their prior level of activity after SLAP repair and what is the typical satisfaction rate of the surgery

A
  • 80% good to excellent satisfaction rate
  • 70% previous level of activity
  • 60% of throwing athletes return to previous level of performance
20
Q

what percentage of individual report persistent pain and loss of function post SLAP repair

A
  • 70% report persistant pain

- 80% report loss of function

21
Q

what type of throwing athlete injury responds best to a SLAP repair

A
  • traumatic

- insidious onset has lower potential for successful outcomes post op

22
Q

What are the different ways in which the subs cap is taken down in TSA

A
  • tenotomy or osteotomy of the lessor tubercle
23
Q

at what point would you expect an osteotomy subscapularis uncemented stem to transition to lamellar bone healing post TSA

A

12 weeks

24
Q

what are the typical ROM expectation following TSA

A
  • flexion 140 and abduction to 120 degrees

- IR 60 ER 70

25
Q

what shoulder motion remains cautionary in the final stages of rehab post TSA

A

abduction with ER

26
Q

what are the most common complication with TSA

A
  1. humeral shaft fractures during surgery
  2. nerve injury during surgery
  3. hardware loosening post op
  4. dislocation
  5. loss of ROM
  6. instability
  7. subscapularis - post op injury or poor reattachment
  8. infections
27
Q

what is the belly press test

A

subscapularis test

  • rest the hand on the stomach with both the elbow and hand in the frontal plane
  • push into the belly, if the shoulder goes into ER a tear is suspected
  • 30 degrees ER partial tear
  • greater than 60 degrees full thickness
28
Q

what has better clinical out comes for TSA, subscapularis osteotomy or tenotomy

A

osteotomy

29
Q

Who has the greatest likelihood of developing CTS

A
  • middle aged women
  • manual labor require reparative use of hands
  • greater forces through the hands
  • chronic wirst extension with computer use
30
Q

What cluster of test is recommended to diagnosis CTS

A
  • tinel
  • phalanx
  • abduction weakness
  • nighttime or morning symptoms
  • classic median nerve distribution
  • flick test - reparative flicking or shaking out of the hands resolve symptoms
31
Q

What comorbiities can contribute to CTS

A
  • pregnancy
  • diabetes
  • systemic inflammatory arthritis
  • hypothyroid
32
Q

What diagnostic criteria suggest someone is appropriate for CTS surgery

A
  • pronounced muscle atrophy or weakness
  • loss of finger dexterity
  • severe pain
  • positive electrodiagnostic tests
33
Q

what approaches are used for CTS surgery

A

open and endoscopic, with endoscopic most prevalent and with a greater risk of complication

34
Q

what motion should be avoided in the inflammatory phase of CTS rehab and why

A

simultaneous finger and wrist flexion

  • places maximum load on the transverse carpal ligament
  • greatest concern with open procedure
35
Q

Goals of inflammatory phase of CTS

A
  • KEEP wrist in neutral to prevent bow stringing of the tendons
  • promote tendon gliding
  • decreased edema
  • control symptoms
  • avoid neural tension testing, finger dexterity and carpal mobilization
36
Q

When should the reparative phase of rehab begin after CTS surgery and how does the program change

A
  • 3-6 weeks
  • hand strengthening and dexterity started
  • continue to be cautious with joint mobilization
37
Q

what are the common complications associated with CTS release

A
  • nerve injury
  • scar hypersensitivity or hypertrophy
  • CRPS
  • infection
  • flexor tendon injury
  • palmar arch/digital arter injury
  • bowstringing due
  • carpal bone instability
  • pillar pain
38
Q

What complication to CTS can result from the release of the transverse carpal ligament

A
  • bowstringing
  • carpal bone instability
  • pillar pain - hand pain through to result from the changes in the wrist mechanics
39
Q

What are the satisfaction rates of CTS

A
  • 90% with good function and symptom report

- comoribities do not appear to impact long term success (work comp, diabetes, obesity)

Surgical (3 decks)

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