Post Op UE

Question 1

shoulder post-op considerations

Answer 1

• structure of joint
• size and location of tear/dysfunction
• associated pathology
• pre op strength, ROM, and function
• type of surgical approach

Question 1

3 types of shoulder athroplasties

Answer 1

• total shoulder: glenoid and humeral surfaces replaced
• hemi-arthroplasty: humeral head replaced
• reverse total shoulder: glenoid and humeral surfaces are reversed

Question 2

which shoulder surgery do people with torn rotator cuff have

Answer 2

reverse total shoulder arthroplasty

Question 3

goals of GH arthroplasty

Answer 3

• 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

Question 4

Restrictions in max protective phase in TSA and rTSA

Answer 4

• PROM or AAROM only initially
• elevation to 90-120
• ER to 20-30
• No GH ext or IR

Question 5

when is rotator cuff repair graft the weakest

Answer 5

3 weeks following repair

Question 6

Rotator Cuff Repair Stuff

Answer 6

• 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

Question 7

Bankhart Labral Repair

Answer 7

• repair of detached capsulolabrual segment from anterior rim of glenoid
• can include detachment and repair of subscap
• often combined w/ ant scapular shift

Question 8

SLAP labral repair

Answer 8

• repair of tear of superior labor,
• associated with long head of biceps tear
• associated with recurrent GH ant instability

Question 9

General guidelines and restrictions during max protective phase for Bankart lesion

Answer 9

• limited ROM for those motion that stress the ant capsule
• ER, horizontal abd, and ext

Question 10

General guidelines and restrictions during max protective phase for SLAP

Answer 10

• 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

Question 11

radial head fracture often occurs with …

Answer 11

posterior dislocation

Question 12

what does the UCL do

Answer 12

its the primary valgus restraint at elbow

Question 13

UCL Reconstruction - how long is immediate post op phase

Answer 13

• 0-4 weeks

Question 14

how to protect graft site for UCL reconstruction

Answer 14

no values force on elbow (no shoulder abduction and ER) for 2 mo

Question 15

how long does maximal medical recovery take for UCL reconstruction

Answer 15

9-12 months

Question 16

early active motion

Answer 16

moderate force and potentially high excursion
- dorsal blocking splint limited wrist ext
- perform place and hold exercises with digits

Question 17

laminectomy

Answer 17

• removal of the lamina
• partial or full
• indicated over a fusion in patients with small unilateral disc protrusion
• pt gains back segmental mobility

Question 18

fusion

Answer 18

• one or more segments fused together
• indicated when pt presents with axial pain w/ instability, severe arthritic degenerative changes, or peripheral pain

Question 19

advantages of fusion

Answer 19

reduces or eliminates segmental motion, reduces stress at degenerated disc area and reduces incidence of additional herniations at the affected disc site

Question 20

disadvantages of fusion

Answer 20

• may expedite the degenerative process, create a hyper mobility at adjacent segments and alter overall spinal mechanics

Question 21

anterior cervical disc fusion

Answer 21

• horizontal incision
• interups platysma and longus coli mm
• complications: sore throat, hoarseness, and difficulty swallow

Question 22

max protective phase for ACDF

Answer 22

• no heavy lifting (>10 lbs) for up to 3 months

Question 23

mod protective phase

Answer 23

• progressive stretching with joint mobs
• initiate segmental muscle performance and progress to global stabilization exercises to patient tolerance

Question 24

criteria for ACDF progression to minimally protective/functional phase

Answer 24

1. pt has working knowledge of body and lifting mechanics
2. able to hold chin tuck for 10 sec (raise 10 mmHg)
3. CV tolerance to 30 mins/day
4. dynamic sitting and standing tolerance of 45-60 mins

Question 25

thoracic spine surgery- max protective phase precautions

Answer 25

1. prevent excessive initial mobility or stress on tissues
2. avoid lifting, twisting, and bending of the spine

Question 26

thoracic spine surgery - mod protective phase precautions

Answer 26

avoid loading
avoid twisting and bending of spine