RC Tear - Tx plan Flashcards
helps to prepare for post-op care –> pre-operative tx
calm down joint w/ modalities for inflammation/pain
PROM and AAROM
ADL hints
how many times will a pt visit pre-operatively
1-2 visits
helps to prepare for post-op care
PROM and AAROM –> pre-op care
goal is full range if possible
ADL hints –> pre-op care
dressing, bathing, sleeping
semi-reclined
recliner
surgery to repair a torn RC may involve
debridement
making more room for the RC tendon so it is not pinched or irritated (sub-acromial area)
repairing the tear
debridement –> surgery
removing loose fragments of tendon, bursa, and other debris from the space in the shoulder where the RC moves
making more room for the RC tendon so it is not pinched or irritated (sub-acromial area) –> surgery
subacromial depression
shaving bone (if necessary)
removing bone spurs from the acromion
repairing the tear –> surgery
open (almost never done anymore) –>deltoid splitting
arthroscopic
types of repairs
open repair
mini-open repair
arthroscopic
open repair
rarely done
mini-open repair
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
arthroscopic repair
mostly done
how is arthroscopic surgery done
3 holes for instruments
no disturbances of deltoid
factors that can decrease the likelihood of a satisfactory result
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
post op complications
nerve injury
infection
stiffness
tendon re-tear
nerve injury –> post op complications
axillary N (to deltoid)
what is given to lessen the risk of infection –> post op complications
prophylactic antibiotics during the procedure
what happens if an infection develops –> post op complications
additional surgery or prolonged antibiotic tx may be needed
what does early rehab do –> post op complications
lessen likelihood of permanent stiffness or loss of motion
how will stiffness improve most of the time –> post op complications
therapy and exercise
what is there a chance of following all types of repairs –> post op complications
re-tear
the larger the tear –> post op complications
the higher risk for re-tear
pts who re-tear their tendons –> post op complications
usually do not have more pain or decrease shoulder fxn
when is repeat surgery needed –> post op complications
only if there is severe pain or loss of fxn
how long of a protection period should there be following RC surgery
depends on combination of many things
combination of many things –> period of protection
type and size of repair
surgical procedure performed
method of fixation
quality of tissue
type and size of repair –> period of protection
partial v. complete
size
surgical procedure performed –> period of protection
arthroscopic
no repair, just debridement
repair w/ SAD
method of fixation –> period of protection
sutures w/ or w/o
bony anchors
quality of tissue –> period of protection
good quality tissue hold sutures and implants well
fair to poor quality tissue
RC protocols
protection
phases of rehab
protection includes
PROM only (4-6 weeks)
strengthening beings (10-14 weeks)
return to sport (4-6 months)
phases of rehab
phase 1-4
phase 1 of rehab
0-6 weeks
phase 2 of rehab
6-12 weeks
phase 3 of rehab
12-20 weeks
phase 4 of rehab
20-26 weeks
phase 1 includes
pt education
modalities
PROM
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
how should we maintain the arm –> precautions phase 1
in ABD sling/brace
remove only for exercise
no…–> precautions phase 1
AROM of shoulder
lifting objects
shoulder motion behind back
excessive stretching or sudden movements
supporting of ay weight
how should we keep the incision –> precautions phase 1
clean and dry
PROM –> precautions phase 1
F/E < 90
ER < 30
goals of phase 2
allow healing of soft tissue
gradually restore PROM
do not overstress healing tissue
decrease pain and inflammation
no…–> precautions phase 2
lifting
sudden jerking motions
excessive behind the back movements
supporting of BW by hands and arms
what should we avoid –> precautions phase 2
UE bike
what should we discontinue –> phase 2
sling/brace @ end of week 6
what should we initiate –> phase 2
AAROM flexion in supine position
AROM exercises
being –> phase 2
RC isometrics (low level)
when should we stop progressive PROM –> phase 2
until approx full ROM (pain free)
joint mobs –> phase 2
gentle scapular/GH
as indicated to regain full PROM
criteria for progression to phase 3
full PROM
pt should be able to elevate arm w/o shoulder or scap hiking
time frame
phase 3 includes
strengthening
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
no…–> precautions phase 3
heavy lifting of objects
sudden lifting or pushing activities
sudden jerking motions
overhead lifting
avoid –> precautions phase 3
UE bike, unless you can limit range
strengthening –> phase 3
dynamic stabilization exercises
initiate strengthening program
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
phase 4 includes
advanced strengthening
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
week 20 –> phase 4
advanced proprioceptive NM activities
light sports if doing well
week 26 –> phase 4
may initiate interval sport program
