Post Op UE Flashcards
shoulder post-op considerations
- structure of joint
- size and location of tear/dysfunction
- associated pathology
- pre op strength, ROM, and function
- type of surgical approach
3 types of shoulder athroplasties
- total shoulder: glenoid and humeral surfaces replaced
- hemi-arthroplasty: humeral head replaced
- reverse total shoulder: glenoid and humeral surfaces are reversed
which shoulder surgery do people with torn rotator cuff have
reverse total shoulder arthroplasty
goals of GH arthroplasty
- restore shoulder mobility and functional use while protecting healing tissues
- education on ADL restrictions (no active elevation, WB, no ext or IR past neutral)
- ultimately can expect 140-150 of elevation and 45-50 ER if RC intact
- progression is dependent on protocol
Restrictions in max protective phase in TSA and rTSA
- PROM or AAROM only initially
- elevation to 90-120
- ER to 20-30
- No GH ext or IR
when is rotator cuff repair graft the weakest
3 weeks following repair
Rotator Cuff Repair Stuff
- max protection phase 4-6 weeks
- review protocol
- PROM only for 4-6 weeks
- no progressive resistive strengthening for 8-12 weeks
- can progress to AAROM usually 4-6 weeks
Bankhart Labral Repair
- repair of detached capsulolabrual segment from anterior rim of glenoid
- can include detachment and repair of subscap
- often combined w/ ant scapular shift
SLAP labral repair
- repair of tear of superior labor,
- associated with long head of biceps tear
- associated with recurrent GH ant instability
General guidelines and restrictions during max protective phase for Bankart lesion
- limited ROM for those motion that stress the ant capsule
- ER, horizontal abd, and ext
General guidelines and restrictions during max protective phase for SLAP
- Limited ROM for first 4 weeks (elevation 60-90 degrees, ER ROM 15-30 and IR 45-60)
- Avoid stressing biceps for 4-6 weeks and no active biceps strengthening for 8-12 weeks
radial head fracture often occurs with …
posterior dislocation
what does the UCL do
its the primary valgus restraint at elbow
UCL Reconstruction - how long is immediate post op phase
- 0-4 weeks
how to protect graft site for UCL reconstruction
no values force on elbow (no shoulder abduction and ER) for 2 mo
how long does maximal medical recovery take for UCL reconstruction
9-12 months
early active motion
moderate force and potentially high excursion
- dorsal blocking splint limited wrist ext
- perform place and hold exercises with digits
laminectomy
- removal of the lamina
- partial or full
- indicated over a fusion in patients with small unilateral disc protrusion
- pt gains back segmental mobility
fusion
- one or more segments fused together
- indicated when pt presents with axial pain w/ instability, severe arthritic degenerative changes, or peripheral pain
advantages of fusion
reduces or eliminates segmental motion, reduces stress at degenerated disc area and reduces incidence of additional herniations at the affected disc site
disadvantages of fusion
- may expedite the degenerative process, create a hyper mobility at adjacent segments and alter overall spinal mechanics
anterior cervical disc fusion
- horizontal incision
- interups platysma and longus coli mm
- complications: sore throat, hoarseness, and difficulty swallow
max protective phase for ACDF
- no heavy lifting (>10 lbs) for up to 3 months
mod protective phase
- progressive stretching with joint mobs
- initiate segmental muscle performance and progress to global stabilization exercises to patient tolerance
criteria for ACDF progression to minimally protective/functional phase
- pt has working knowledge of body and lifting mechanics
- able to hold chin tuck for 10 sec (raise 10 mmHg)
- CV tolerance to 30 mins/day
- dynamic sitting and standing tolerance of 45-60 mins
thoracic spine surgery- max protective phase precautions
- prevent excessive initial mobility or stress on tissues
- avoid lifting, twisting, and bending of the spine
thoracic spine surgery - mod protective phase precautions
avoid loading
avoid twisting and bending of spine
