Operative Tx of Shoulder Flashcards
what makes an RTC tear a full tear?
entire thickness has been compromised, tendon may remain attached
what structure can concomittantly be implicated in a subscap tear?
the biceps long head tendon b/c its sheath is intimately related to the subscap tendon
who is likely to get articular-side partial thickness tears?
overhead throwers and instability pts
who is likely to get bursal-side partial thickness RTC tears?
older overhead repetitive pts
how are full thickness RTC tears classified?
- small (<1cm across the full thickness defect)
- med (1-3)
- large (3-5)
- massive (5+)
what does the size of a full RTC tear impact?
the amount of time the pt will likely be immobilized
what is the “take home message” following arthroscopic RTC repair of the supraspinatus tendon?
- arm elevated to 30 in coronal/scap plane
- avoid IR (ER 0-60 safe)
what are the four post op goals for surgical GH stabilization?
- protect the healing tissue
- prevent hypomobility
- reduce pain and inflammation
- RTC and scap firing pattern reeducation
what is an important philosophy for ROM progression in post op GH instability repairs?
be conservative and err on the side of caution when addressing ROM deficits
what is an important philosophy of early rehab for GH instability surgeries?
motion exercise and training must be performed in the scapular plane so that there is little stress on the anterior capsule
which four motions can be taken to tolerance in GH instability rehab?
sagittal flexion, scapular plane flexion, horizontal add, and IR
what are SLAP rehab guidelines regarding ER progression?
- increase ER about 10 deg per week after week 1
- shoulder should be in 45 deg abd or less
- ER with 90 deg abd not recommended until week 6
which motions are allowed at the elbow wrist and hand following a SLAP repair?
all… except elbow flexion and supination
what is the early-most treatment for SLAP repair?
scap isometrics in all planes in side lying
when can GH ROM be increased accross planes for a SLAP repair?
5-6 weeks
when is full ROM expected for a SLAP repair
12 weeks
what is the most likely cause of a proximal humerus fracture?
older adult (low bone mass) as a result of a direct fall
when does bone callus form? (with regards to proximal humerus fx)
3 weeks
when does radiographic bone union occur? (with regards to proximal humerus fx)
6 weeks
whats the bottom line for treating proximal humerus fractures?
ROM early with progressive resistance exercise once the bone has healed
what are the four shoulder arthroscopic procedures?
- TSA
- RTSA
- stemmed hemi
- resurfacing
what is the most common TSA approach? why? what does it compromise?
deltopectoral - exposes the humeral head nicely - subscap tendon/attachment
when is a TSA indicated?
OA with intact RTC
when is a stemmed arthroplasty indicated?
arthritis or severe fx, but the glenoid cartilage is intact
when is a resurfacing arthroplasty indicated?
glenoid cartilage intact and no humeral fracture
why would a surgeon perform a RTSA v a TSA? what are the other indications for a RTSA?
RTSA indicated for non-intact RTC or…
- arthritis
- inability to elevate arm to 90
- failed TSA revision
why does a RTSA work so well?
the AoR moves to the glenoid increasing the lever arm and causes compression
how much elevation can patients with an RTSA achieve (max)?
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