Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PT645 > Post Op Shoulder > Flashcards

Post Op Shoulder Flashcards

1
Q

General goals for post-op rehab

A

Promote healing/protect repair
Restore ROM (PROM >AROM)
Restore strength
Restore function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When is subacromial decompression indicated?

A

During unresolved impingement or if imaging deems necessary -type III

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Failed conservative treatment of impingement defined by Cohen

A

No improvement with 3 months of a comprehensive rehab program

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Important thing to consider when it comes to protocol timelines

A

They are variable depending on the extent of surgery and what needed to be repaired (i.e. was there also a rotator cuff tear or labral tear)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

First phase of the protocol

A

Passive range of motion phase- typically 2-4 weeks, progressing to active assist and active ROM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Second phase of the protocol

A

Strengthening- typically starts post-operative week 5 or 6, but very important to check with surgeon to determine course (when in doubt, utilize standard protocol timelines provided)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Subacromial decompression is also known as

A

Distal clavicle excision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Rotator cuff treatment progression

A

Non-operative management- success is dependent on status of remaining rotator cuff

Decompression without repair

Repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When is open repair used?

A

Used for large, massive tears where tissue integrity may be poor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Open repair advantages

A

Greater exposure to surgical area and good post-operative outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Characteristics of open repair

A

Involves removal and reattachment of anterior deltoid and may require post-operative rehab considerations to protect the deltoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Open repair disadvantages

A

May be marked by longer recovery and increased post-operative pain and decreased anterior deltoid function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Mini open characteristics

A

Splits deltoid vs detach/reattach of open procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Outcomes of mini open repair

A

Similar outcomes to open repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When is arthroscopic surgery used?

A

For smaller tears with good tissue integrity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Benefits of arthroscopic surgery

A

Less risk of infection, stiffness, and deltoid compromise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Types of arthroscopic surgery

A

Double row vs single row

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Passive range of motion phase for small to medium tear

A

Greater than or equal to 4 weeks (could be as much as 6-8 weeks with more conservative surgeons)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Active range of motion phase for small to medium tears

A

~8 weeks(could be as much as 6-8 weeks with more conservative surgeon)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Strengthening phase for small to medium tear

A

~12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Passive range of motion phase for massive tears

A

Greater than or equal to 6 weeks (could be as much as 8 weeks with more conservative surgeons)

22
Q

Active range of motion phase for massive tears

A

~12 weeks (could be as much as 8 weeks with more conservative surgeons

23
Q

Strengthening phase for massive tears

A

~18 weeks

24
Q

When was accelerated rehab popular?

A

Early 200s when mini open and arthroscopic procedures were popular

25
Q

What was the thinking behind accelerated rehab?

A

The procedure was less invasive so accelerated protocol could be used

26
Q

When was decelerated rehab popular?

A

In the mid to late 200s when surgeons started to find cuff failures and shut everything down and aggressive PT was blamed

27
Q

General rehab guidelines for RCR

A

Protect the repair
Passive ROM early
Early muscle training
Strengthening progression

28
Q

Important info for PROM for general rehab guidelines for RCR

A

Rotational motion 1st at 30-45 degrees of abduction (in scapular plane) working up to 90 deg of abduction, also layer in arm at side

29
Q

Important info for early muscle training for general rehab guidelines for RCR

A

Initially contractile palpation: rhythmic dynamic stabilization and/or isometrics

30
Q

Important info for strengthening progression for general rehab guidelines for RCR

A

Once strengthening begins, progress no more than 1 lb per week

31
Q

Success for RCR

A

Balance of stress and compression for promoting healing but not inhibiting healing process

32
Q

Reasons for failure for RCR

A

Patient adherence
Rehab
Surgical causes

33
Q

How can rehab contribute to failure for RCR

A

Over aggressive progression- strengthening exercises should remain low load throughout, strength can always be regained in time

Early PROM/AAROM is critical to avoid contracture or motion loss

34
Q

How can surgery contribute to failure for RCR

A

Inadequate technique or implant
Didnt restore anatomical footprint
Double row vs. single row technique

35
Q

Indications for labral repairs

A

Failure of conservative management
Slap lesion with significant RCT (>50%)
Debridement of types 1 and 2
Repair of types 3 and 4

36
Q

Rehab considerations for labral repairs

A

Type of repair
Early limitation of ER to prevent “peel back” mechanism
Avoid resistive biceps activity (flexion/supination) until at least 8 weeks post-op
Avoid 90/90 position for 6 weeks post anterior labral repair
Avoid horiz add for 6 weeks (SLAP doesnt matter) for posterior labral repair

37
Q

Total shoulder arthroplasty (TSA) indications

A

Shoulder joint pain from destructive arthritis secondary to OA, RA, or traumatic arthritis
Avascular necrosis
Severe loss of upper extremity strength
Limitations of ADL function secondary to pain

38
Q

Where is the incision in TSAs?

A

Between deltopectoral crease

39
Q

Hemiarthroplasty may be done in TSAs if…

A

glenoid surface is adequate (controversial)

40
Q

TSA may also include…

A

RCR

41
Q

Detachment of the sabscapularis in TSA guidelines

A

Avoid active IR until at least 6 weeks

Limit PROM ER in early phases

42
Q

TSA outcomes

A

95% have pain relief
Near normal range, strength, function as possible
Vulnerable in 90 deg abd + ER

43
Q

What is a predictor of post-op ROM outcomes for TSA

A

Pre-op ROM

44
Q

What should be known about goal expectations following TSA?

A

They are limited with cuff deficiencies or previous trauma injuries

45
Q

RTSA indications

A

Complete RCT that cannot be repaired
Previously unsuccessful TSA
Severe shoulder functional limitations due to pain

46
Q

Contraindications for RTSA

A

Impaired deltoid function
Isolated supraspinatus tear
Full ROM and good function despite massive RCT

47
Q

RTSA outcomes

A

High rates of dislocation in anterior superior direction
Will not regain full ROM but optimally will have less pain and “functional AROM”
Need deltoid strengthening

48
Q

After RTSA, shoulder is vulnerable in…

A

Extension, adduction, and internal rotation e.g. pushing up from chair in shoulder extension

49
Q

How to avoid anterior superior direction dislocation after RTSA

A

Avoid reaching across chest for up to 6 weeks

Avoid reaching behind back for 10-12 weeks

50
Q

Active elevation ROM following RTSA

A

Likely to reach 105-140 deg

51
Q

Rotation ROM is dependent on what following RTSA?

A

Rotation ROM is dependent on pre-operative status of teres minor

PT645 (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions