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Ortho Exam 2 > RC Tear - Tx plan > Flashcards

RC Tear - Tx plan Flashcards

(62 cards)

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1
Q

helps to prepare for post-op care –> pre-operative tx

A

calm down joint w/ modalities for inflammation/pain

PROM and AAROM

ADL hints

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1
Q

how many times will a pt visit pre-operatively

A

1-2 visits

helps to prepare for post-op care

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2
Q

PROM and AAROM –> pre-op care

A

goal is full range if possible

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3
Q

ADL hints –> pre-op care

A

dressing, bathing, sleeping

semi-reclined

recliner

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4
Q

surgery to repair a torn RC may involve

A

debridement

making more room for the RC tendon so it is not pinched or irritated (sub-acromial area)

repairing the tear

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5
Q

debridement –> surgery

A

removing loose fragments of tendon, bursa, and other debris from the space in the shoulder where the RC moves

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6
Q

making more room for the RC tendon so it is not pinched or irritated (sub-acromial area) –> surgery

A

subacromial depression

shaving bone (if necessary)

removing bone spurs from the acromion

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7
Q

repairing the tear –> surgery

A

open (almost never done anymore) –>deltoid splitting

arthroscopic

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8
Q

types of repairs

A

open repair

mini-open repair

arthroscopic

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9
Q

open repair

A

rarely done

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10
Q

mini-open repair

A

incision = 3-5 cm

uses arthroscopy to asses the damage to the structures

repair is done through a mini open incision so that the surgeon could view the shoulder structures directly

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11
Q

arthroscopic repair

A

mostly done

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12
Q

how is arthroscopic surgery done

A

3 holes for instruments

no disturbances of deltoid

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13
Q

factors that can decrease the likelihood of a satisfactory result

A

poor tendon/tissue quality

large or massive tears

poor pt compliance w/ rehab and restrictions after surgery

pt age (older than 65)

smoking and use of other nicotine products

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14
Q

post op complications

A

nerve injury

infection

stiffness

tendon re-tear

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15
Q

nerve injury –> post op complications

A

axillary N (to deltoid)

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16
Q

what is given to lessen the risk of infection –> post op complications

A

prophylactic antibiotics during the procedure

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17
Q

what happens if an infection develops –> post op complications

A

additional surgery or prolonged antibiotic tx may be needed

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18
Q

what does early rehab do –> post op complications

A

lessen likelihood of permanent stiffness or loss of motion

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19
Q

how will stiffness improve most of the time –> post op complications

A

therapy and exercise

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20
Q

what is there a chance of following all types of repairs –> post op complications

A

re-tear

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21
Q

the larger the tear –> post op complications

A

the higher risk for re-tear

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22
Q

pts who re-tear their tendons –> post op complications

A

usually do not have more pain or decrease shoulder fxn

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23
Q

when is repeat surgery needed –> post op complications

A

only if there is severe pain or loss of fxn

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24
how long of a protection period should there be following RC surgery
depends on combination of many things
25
combination of many things --> period of protection
type and size of repair surgical procedure performed method of fixation quality of tissue
26
type and size of repair --> period of protection
partial v. complete size
27
surgical procedure performed --> period of protection
arthroscopic no repair, just debridement repair w/ SAD
28
method of fixation --> period of protection
sutures w/ or w/o bony anchors
29
quality of tissue --> period of protection
good quality tissue hold sutures and implants well fair to poor quality tissue
30
RC protocols
protection phases of rehab
31
protection includes
PROM only (4-6 weeks) strengthening beings (10-14 weeks) return to sport (4-6 months)
32
phases of rehab
phase 1-4
33
phase 1 of rehab
0-6 weeks
34
phase 2 of rehab
6-12 weeks
35
phase 3 of rehab
12-20 weeks
36
phase 4 of rehab
20-26 weeks
37
phase 1 includes
pt education modalities PROM
38
goals of phase 1
maintain and protect integrity of repair gradually increase PROM diminish pain and inflammation prevent muscular inhibition become independent w/ ADLS w/ modifications
39
how should we maintain the arm --> precautions phase 1
in ABD sling/brace remove only for exercise
40
no...--> precautions phase 1
AROM of shoulder lifting objects shoulder motion behind back excessive stretching or sudden movements supporting of ay weight
41
how should we keep the incision --> precautions phase 1
clean and dry
42
PROM --> precautions phase 1
F/E < 90 ER < 30
43
goals of phase 2
allow healing of soft tissue gradually restore PROM do not overstress healing tissue decrease pain and inflammation
44
no...--> precautions phase 2
lifting sudden jerking motions excessive behind the back movements supporting of BW by hands and arms
45
what should we avoid --> precautions phase 2
UE bike
46
what should we discontinue --> phase 2
sling/brace @ end of week 6
47
what should we initiate --> phase 2
AAROM flexion in supine position AROM exercises
48
being --> phase 2
RC isometrics (low level)
49
when should we stop progressive PROM --> phase 2
until approx full ROM (pain free)
50
joint mobs --> phase 2
gentle scapular/GH as indicated to regain full PROM
51
criteria for progression to phase 3
full PROM pt should be able to elevate arm w/o shoulder or scap hiking time frame
52
phase 3 includes
strengthening
53
goals --> phase 3
full AROM (weeks 12-14) maintain full PROM dynamic shoulder stability gradual restoration of shoulder strength, power and endurance optimize NM control gradual return to fxnal activities
54
no...--> precautions phase 3
heavy lifting of objects sudden lifting or pushing activities sudden jerking motions overhead lifting
55
avoid --> precautions phase 3
UE bike, unless you can limit range
56
strengthening --> phase 3
dynamic stabilization exercises initiate strengthening program
57
criteria for progression to phase 4
able to tolerate the progression to low-level fxnal activities demonstrates return of strength/dynamic shoulder stability demonstrates adequate strength and dynamic stability for progression to higher demanding work/sport specific activities time frame
58
phase 4 includes
advanced strengthening
59
goals of phase 4
maintain full, non-painful AROM advance conditioning exercises for enhanced fxnal use of UE improve muscular strength, power and endurance gradual return to full fxnal activities
60
week 20 --> phase 4
advanced proprioceptive NM activities light sports if doing well
61
week 26 --> phase 4
may initiate interval sport program

Ortho Exam 2 (17 decks)

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