MSK Advanced Interventions

Question 1

Repair of SLAP lesion

Answer 1

When bicep tendon is detached, progress cautiously
- limit passive or assisted elev of UE to 60 deg for 2 weeks
- limit ^ to 90 deg at 3-5 weeks
- only perform passive hum rot in scap plane for first 2 weeks
- progress to 30 deg ER and 60 deg IR at 3-4 weeks

avoid tension on biceps (elbow ext w/ shoulder extension) for 4-6 weeks

avoid active bicep contraction for 6 weeks

Question 2

Rotator cuff rehab key points

Answer 2

Initiate w/ isometrics

Resisted ex should not cause pain

RTC strength must be addressed before large primary moves

Flex/ABD must be done AROM w/o shoulder hiking

No CKC x 6 weeks

Dynamic strength starts at 8 weeks for small tear, 12 weeks for large tear

Light functional activities 6+ weeks

Question 3

Legg-calve-perthes

Answer 3

Age 2-13
Short stature, males

Deformity FLATTENING of femoral head due to loss of blood supply
> Femoral head necrosis, fragments, and ossifies

Pain worsens w/ activity
Limping
Stiffness
Ext, ABD, IR limited (EABIR)

Conservative tx, scottish rite brace

Question 4

Slipped capital femoral epiphysis

Answer 4

SCFE
Age 10-17
Overweight

Displacement of femoral head due to slippage from growth plate

Pain worsens w/ activity
Limping
Stiffness
Flexion, ABD, IR limited (FABIR)

Surgical tx to stabilize

Question 5

Orthosis for congenital hip dysplasia

Answer 5

Pavlik harness
Frejka pillow

Question 6

Post ACL repair precautions

Answer 6

Graft most vulnerable at 6-8 weeks

No knees over toes w/ CKC squats

Avoid CKC 60-90 deg KF
Avoid OKC 0-45 deg KF (short arc quad)

No ankle cuff weights distal to tibia initially

Question 7

Ankle repair

Answer 7

Phase 1 (4-6 weeks)
- Active ROM of non-immob joints
- Muscle setting (4-way ankle) at 2 weeks
- Weight shifting in bilat stance while wearing orthosis

6-8 weeks post op
1.0-1.5 heel lift shoe for additional 2-4 weeks
- Beyond 12 weeks wear shoe w/o heel lift
- Avoid agg PF stretch for 12 weeks