Operative Tx of Shoulder

Question 1

what makes an RTC tear a full tear?

Answer 1

entire thickness has been compromised, tendon may remain attached

Question 2

what structure can concomittantly be implicated in a subscap tear?

Answer 2

the biceps long head tendon b/c its sheath is intimately related to the subscap tendon

Question 3

who is likely to get articular-side partial thickness tears?

Answer 3

overhead throwers and instability pts

Question 4

who is likely to get bursal-side partial thickness RTC tears?

Answer 4

older overhead repetitive pts

Question 5

how are full thickness RTC tears classified?

Answer 5

• small (<1cm across the full thickness defect)
• med (1-3)
• large (3-5)
• massive (5+)

Question 6

what does the size of a full RTC tear impact?

Answer 6

the amount of time the pt will likely be immobilized

Question 7

what is the “take home message” following arthroscopic RTC repair of the supraspinatus tendon?

Answer 7

• arm elevated to 30 in coronal/scap plane
• avoid IR (ER 0-60 safe)

Question 8

what are the four post op goals for surgical GH stabilization?

Answer 8

1. protect the healing tissue
2. prevent hypomobility
3. reduce pain and inflammation
4. RTC and scap firing pattern reeducation

Question 9

what is an important philosophy for ROM progression in post op GH instability repairs?

Answer 9

be conservative and err on the side of caution when addressing ROM deficits

Question 10

what is an important philosophy of early rehab for GH instability surgeries?

Answer 10

motion exercise and training must be performed in the scapular plane so that there is little stress on the anterior capsule

Question 11

which four motions can be taken to tolerance in GH instability rehab?

Answer 11

sagittal flexion, scapular plane flexion, horizontal add, and IR

Question 12

what are SLAP rehab guidelines regarding ER progression?

Answer 12

1. increase ER about 10 deg per week after week 1
2. shoulder should be in 45 deg abd or less
3. ER with 90 deg abd not recommended until week 6

Question 13

which motions are allowed at the elbow wrist and hand following a SLAP repair?

Answer 13

all… except elbow flexion and supination

Question 14

what is the early-most treatment for SLAP repair?

Answer 14

scap isometrics in all planes in side lying

Question 15

when can GH ROM be increased accross planes for a SLAP repair?

Answer 15

5-6 weeks

Question 16

when is full ROM expected for a SLAP repair

Answer 16

12 weeks

Question 17

what is the most likely cause of a proximal humerus fracture?

Answer 17

older adult (low bone mass) as a result of a direct fall

Question 18

when does bone callus form? (with regards to proximal humerus fx)

Answer 18

3 weeks

Question 19

when does radiographic bone union occur? (with regards to proximal humerus fx)

Answer 19

6 weeks

Question 20

whats the bottom line for treating proximal humerus fractures?

Answer 20

ROM early with progressive resistance exercise once the bone has healed

Question 21

what are the four shoulder arthroscopic procedures?

Answer 21

1. TSA
2. RTSA
3. stemmed hemi
4. resurfacing

Question 22

what is the most common TSA approach? why? what does it compromise?

Answer 22

deltopectoral - exposes the humeral head nicely - subscap tendon/attachment

Question 23

when is a TSA indicated?

Answer 23

OA with intact RTC

Question 24

when is a stemmed arthroplasty indicated?

Answer 24

arthritis or severe fx, but the glenoid cartilage is intact

Question 25

when is a resurfacing arthroplasty indicated?

Answer 25

glenoid cartilage intact and no humeral fracture

Question 26

why would a surgeon perform a RTSA v a TSA? what are the other indications for a RTSA?

Answer 26

RTSA indicated for non-intact RTC or…

1. arthritis
2. inability to elevate arm to 90
3. failed TSA revision

Question 27

why does a RTSA work so well?

Answer 27

the AoR moves to the glenoid increasing the lever arm and causes compression

Question 28

how much elevation can patients with an RTSA achieve (max)?

Answer 28

105 active