Principles/Indications for Shoulder Arthroplasty

Question 1

A successful outcome for shoulder arthroplasty is dependent upon what?

Answer 1

soft tissue balance! All about balancing soft tissue and mkaing sure there is no instability

Question 2

what is rotator cuff arthropathy and what is the treatment for it?

Answer 2

massive tear, arthritis develops as a result. treatment is a reverse shoulder replacement

Question 3

T/F: most pt’s with OA do not have RTC tears, so an MRI is not needed

Answer 3

true (use MRI to evaluate cuff in those with RA)

Question 4

3 goals of shoulder arthroplasty

Answer 4

1. pain relief
2. better function
3. patient satisfaction

Question 5

contraindications to replacement (5)

Answer 5

1. severe bone destruction
2. infection
3. absence of deltoid and cuff fxn
4. neuropathic arthropathy
5. poor health or unable to comply with rehab

Question 6

Indications for shoulder arthroplasty

Answer 6

OA, RA, post-traumatic arthritis, osteonecrosis, cuff tear arthropathy, chronic dislocations, 3-4 part fractures, capsulorrhaphy arthropathy

Question 7

RA and cuff tears

Answer 7

1/3 of RA pt’s have cuff tears, 1/3 have thinned RTC

Question 8

Reverse Shoulder ARthroplasty (RTSA) indicated for who?

Answer 8

patients over age 70
those with cuff tear arthropathy
3-4 part fractures

Question 9

Reverse Shoulder ARthroplasty (RTSA) info

Answer 9

higher complication rates
powered by deltoid, no RTC muscles or ligaments needed
80-90% of pts have good results
cannot repair it if surgery fails. patients dont do as well returning to activites as with traditional replacement

Question 10

Aseptic Necrosis

Answer 10

lack of blood supply to the shoulder
risk factor = prolonged steroid use
shoulder is 2nd most common site
can also be caused due to sickle cell and alcohol

Question 11

Reverse Shoulder ARthroplasty (RTSA) can’t lift what amount for life following surgery?

Answer 11

can’t lift greater than 10-15 lbs

Question 12

Chondrolysis

Answer 12

cartilage cells died after novicane pain pump patch was put into shoulder

Question 13

HEMI vs TSA

Answer 13

hemi outcomes not as good

Question 14

what is the only muscle cut during TSA surgery?

Answer 14

subscapularis

Question 15

what is the rate limiting factor for TSA surgery?

Answer 15

repair of subscapularis. takes 3 months to heal.

Question 16

Key points to tSA surgery

Answer 16

• make incision adequate
• take time to release capsule
• balance soft tissue
• maximize subscapularis length with advancement to osteotomy margin

Question 17

goal of immediate post op care

Answer 17

pain management

Question 18

Post op PT

Answer 18

• begin 1st session before pain block has worn off

- involve spouse

Question 19

what to consider for outpt PT

Answer 19

patient motivation
cost
convenience
patient goals

Question 20

timeline of 3 phases of TSA rehab

Answer 20

0-6 wks
6-12 wks
3+ months

Question 21

0-6 weeks

Answer 21

pendulums
PROM
- flex 0-90 wihtin 2 weeks
- ext ?
Isometrics at 2 weeks
Pulleys at 3 wks
AROM of elbow, wrist hand

Question 22

6-12 weeks

Answer 22

AAROM
cane exercises
therabands
3-5 lb bicep curls
trap, SA, lat, rhomboid exercises

Question 23

12 weeks

Answer 23

light weights

gradual return to activities

Question 24

activities allowed after surgery

Answer 24

golf, bike, bowl, walk, swim, shoot, dance, low impact

Question 25

allowed with experience

Answer 25

canoe, hike, row, cc ski, doubles tennis, skating

Question 26

not allowed

Answer 26

racquetball, singles tennis, jogging, bball, football

Question 27

no consensus on the following activities following surgery

Answer 27

weight lifting, downhill skiing, rollerblading