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Ortho Exam 2 > RC Tear - Tx plan > Flashcards

RC Tear - Tx plan Flashcards

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
Q

how long of a protection period should there be following RC surgery

A

depends on combination of many things

25
Q

combination of many things –> period of protection

A

type and size of repair

surgical procedure performed

method of fixation

quality of tissue

26
Q

type and size of repair –> period of protection

A

partial v. complete

size

27
Q

surgical procedure performed –> period of protection

A

arthroscopic

no repair, just debridement

repair w/ SAD

28
Q

method of fixation –> period of protection

A

sutures w/ or w/o

bony anchors

29
Q

quality of tissue –> period of protection

A

good quality tissue hold sutures and implants well

fair to poor quality tissue

30
Q

RC protocols

A

protection

phases of rehab

31
Q

protection includes

A

PROM only (4-6 weeks)

strengthening beings (10-14 weeks)

return to sport (4-6 months)

32
Q

phases of rehab

A

phase 1-4

33
Q

phase 1 of rehab

A

0-6 weeks

34
Q

phase 2 of rehab

A

6-12 weeks

35
Q

phase 3 of rehab

A

12-20 weeks

36
Q

phase 4 of rehab

A

20-26 weeks

37
Q

phase 1 includes

A

pt education

modalities

PROM

38
Q

goals of phase 1

A

maintain and protect integrity of repair

gradually increase PROM

diminish pain and inflammation

prevent muscular inhibition

become independent w/ ADLS w/ modifications

39
Q

how should we maintain the arm –> precautions phase 1

A

in ABD sling/brace

remove only for exercise

40
Q

no…–> precautions phase 1

A

AROM of shoulder

lifting objects

shoulder motion behind back

excessive stretching or sudden movements

supporting of ay weight

41
Q

how should we keep the incision –> precautions phase 1

A

clean and dry

42
Q

PROM –> precautions phase 1

A

F/E < 90

ER < 30

43
Q

goals of phase 2

A

allow healing of soft tissue

gradually restore PROM

do not overstress healing tissue

decrease pain and inflammation

44
Q

no…–> precautions phase 2

A

lifting

sudden jerking motions

excessive behind the back movements

supporting of BW by hands and arms

45
Q

what should we avoid –> precautions phase 2

A

UE bike

46
Q

what should we discontinue –> phase 2

A

sling/brace @ end of week 6

47
Q

what should we initiate –> phase 2

A

AAROM flexion in supine position

AROM exercises

48
Q

being –> phase 2

A

RC isometrics (low level)

49
Q

when should we stop progressive PROM –> phase 2

A

until approx full ROM (pain free)

50
Q

joint mobs –> phase 2

A

gentle scapular/GH

as indicated to regain full PROM

51
Q

criteria for progression to phase 3

A

full PROM

pt should be able to elevate arm w/o shoulder or scap hiking

time frame

52
Q

phase 3 includes

A

strengthening

53
Q

goals –> phase 3

A

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
Q

no…–> precautions phase 3

A

heavy lifting of objects

sudden lifting or pushing activities

sudden jerking motions

overhead lifting

55
Q

avoid –> precautions phase 3

A

UE bike, unless you can limit range

56
Q

strengthening –> phase 3

A

dynamic stabilization exercises

initiate strengthening program

57
Q

criteria for progression to phase 4

A

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
Q

phase 4 includes

A

advanced strengthening

59
Q

goals of phase 4

A

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
Q

week 20 –> phase 4

A

advanced proprioceptive NM activities

light sports if doing well

61
Q

week 26 –> phase 4

A

may initiate interval sport program

Ortho Exam 2 (17 decks)

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