Principles/Indications for Shoulder Arthroplasty Flashcards
A successful outcome for shoulder arthroplasty is dependent upon what?
soft tissue balance! All about balancing soft tissue and mkaing sure there is no instability
what is rotator cuff arthropathy and what is the treatment for it?
massive tear, arthritis develops as a result. treatment is a reverse shoulder replacement
T/F: most pt’s with OA do not have RTC tears, so an MRI is not needed
true (use MRI to evaluate cuff in those with RA)
3 goals of shoulder arthroplasty
- pain relief
- better function
- patient satisfaction
contraindications to replacement (5)
- severe bone destruction
- infection
- absence of deltoid and cuff fxn
- neuropathic arthropathy
- poor health or unable to comply with rehab
Indications for shoulder arthroplasty
OA, RA, post-traumatic arthritis, osteonecrosis, cuff tear arthropathy, chronic dislocations, 3-4 part fractures, capsulorrhaphy arthropathy
RA and cuff tears
1/3 of RA pt’s have cuff tears, 1/3 have thinned RTC
Reverse Shoulder ARthroplasty (RTSA) indicated for who?
patients over age 70
those with cuff tear arthropathy
3-4 part fractures
Reverse Shoulder ARthroplasty (RTSA) info
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
Aseptic Necrosis
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
Reverse Shoulder ARthroplasty (RTSA) can’t lift what amount for life following surgery?
can’t lift greater than 10-15 lbs
Chondrolysis
cartilage cells died after novicane pain pump patch was put into shoulder
HEMI vs TSA
hemi outcomes not as good
what is the only muscle cut during TSA surgery?
subscapularis
what is the rate limiting factor for TSA surgery?
repair of subscapularis. takes 3 months to heal.
Key points to tSA surgery
- make incision adequate
- take time to release capsule
- balance soft tissue
- maximize subscapularis length with advancement to osteotomy margin
goal of immediate post op care
pain management
Post op PT
- begin 1st session before pain block has worn off
- involve spouse
what to consider for outpt PT
patient motivation
cost
convenience
patient goals
timeline of 3 phases of TSA rehab
0-6 wks
6-12 wks
3+ months
0-6 weeks
pendulums PROM - flex 0-90 wihtin 2 weeks - ext ? Isometrics at 2 weeks Pulleys at 3 wks AROM of elbow, wrist hand
6-12 weeks
AAROM cane exercises therabands 3-5 lb bicep curls trap, SA, lat, rhomboid exercises
12 weeks
light weights
gradual return to activities
activities allowed after surgery
golf, bike, bowl, walk, swim, shoot, dance, low impact
