Reverse Shoulder Replacement Flashcards
when is a RTSR used
RC is completely torn
severe arthritis
failed conventional TSR
what are switched in rTSR
glenoid and humeral head components
where is the “ball” attached
where the glenoid was
where is the glenoid attached
attached to the top of the humerus
how does the deltoid move
raises the arm overhead instead of the RC
what is there a higher risk of
dislocation
after rTSR than conventional TSR
what should we avoid
shoulder extension beyond neutral
combination of shoulder ADD and IR for 12 weeks post-op
how can the shoulder dislocation
with IR and ADD w/ extension
expectation
normal/full AROM of shoulder is not expected post rTSR
what should we expect after rTSR
105 active flexion
what is the stability and mobility of the shoulder dependent on
deltoid and peroscapula muscles
what is the main shoulder muscle for rTSA
deltoid
what does the prosthesis change
the center of rotation
by moving it medially and inferiorly
changing the center or rotation causes
increase deltoid moment arm
deltoid tension to give a better line of pull
what does the deltoid replace
RC
becomes the primary elevator of the shoulder
general guidelines of rTSR
AROM, AAROM to neck, forearm, wrist and hand
delto-pectoral approach
AROM can begin @ 6 weeks
isometrics to deltoid can begin at 4 weeks
isotonic deltoid at about 12 weeks
shoulder flexion to 105-120 in scapular plane as tolerated
delo-pectoral approach –> guidelines
defer AROM for 6 weeks to allow for adequate deltoid healing
isometrics to deltoid can begin at 4 weeks –> guidelines
beginning deltoid and periscapular isometrics will assist in restoring initial deltoud fxn
provide stability to the GH joint
phase 1
0-4 weeks
goal of phase 1
maintain the integrity of the replaced joint
while restoring passive ROM
when is the pt in ABD splint –> phase 1
all the time besides therapy, bathing, HEP
there is no –> phase 1 guidelines
shoulder AROM, AAROM or PROM into IR
no reaching behind back, esp into IR
lifting objects
supporting of BW w/ hands
what should we place under the elbow –> phase 1 guidelines
small pillow/towel
while laying on back to avoid shoulder hyperextension
interventions –> phase 1
swelling management
ROM/mobility
swelling management –> phase 1
ice
compression
PROM –> ROM/mobility –> phase 1
ER in the scapular plane of tolerance
flex/scaption </= 120
ABD </= 90
exercises –> PROM –> ROM/mobility –> phase 1
seated GH table slides
pendulums
seated horizontal table slides
AAROM –> ROM/mobility –> phase 1
none
AROM –> ROM/mobility –> phase 1
elbow
wrist
hand
when do we progress to phase 2
gradual increase in PROM (scapular plane)
PROM ER b/w 30-45 (scapular plane)
PROM IR to 0
pain < 4/10
no complications
phase 2 precautions
no reaching behind back, esp into IR
no lifting objects heavier than a coffee cup
no supporting of BW w/ hands
what do we do with a small towel/pillow –> phase 2
place under elbow while lying on back to avoid shoulder hyperextension
phase 2 is
weeks 4-6
rehab –> phase 2
ROM/mobility
strengthening
ROM/mobility –> phase 2
AAROM
AROM
inferior glide
AAROM –> phase 2
shoulder flexion w/ cane
cane ER stretch
washcloth press
seated shoulder elevation w/ cane
AROM –> phase 2
supine flexion
supine punch
strengthening of –> phase 2
periscapular
deltoid
peroscapular –> phase 2
scap retraction
standing scapular setting
supported
rowing (avoid HE)
deltoid –> phase 2
isometrics in the scapular plane
avoid HE
when to progress to phase 3
gradual increase in PROM, AAROM, AROM
0 degrees shoulder PROM into IR
palpable muscle contraction felt in scapular musculature
pain < 4/10
no complications
phase 3
weeks 7-8
moderate strengthening
phase 3 rehab
advance strengthening
precaution should be present
phase 4
weeks 9-11
continued strengthening on HEP basis
phase 4 rehab
gradual return to some sporting activity
goals of phase 3
minimize pain
initiate shoulder PROM in scapular plane
initiate motor control exercise
pt education
gradually –> goals of phase 3
progress shoulder PROM
progress shoulder AAROM
progress shoulder AROM
progress –> goals of phase 3
deltoid strengthening
periscapular strengthening
phase 3 rehab should include
ROM/mobility
strengthening
motor control
PROM –> ROM/mobility –> phase 3
full in all planes
gradual PROM IR in scapular plane </= 50
AAROM–> ROM/mobility –> phase 3
incline table slides
wall climbs
pulleys
seated shoulder elevation w/ cane w/ active lowering
AROM –> ROM/mobility –> phase 3
seated scaption
seated flexion
supine forward elevation w/ elastic resistance to 90
strengthening –> phase 3
periscapular
deltoid
periscapular –> phase 3
row on physioball
SA punches
deltoid –> phase 3
seated shoulder elevation w/ cane
seated shoulder elevation w/ cane
active lowering of ball on wall
motor control –> phase 3
IR/ER in scaption plane
flex 90-125 (rhythmic stabilization) in supine
stretching
SLing HADD
triceps and lats
phase 4 rehab includes
ROM/mobility
strengthening
motor contro
ROM/mobility –> phase 4
full ROM in all planes
strengthen –> periscapular phase 4
resistance band shoulder extension
resistance band seated rows
rowing
robbery
lawn mowers
tripod
pointer
strengthen –> deltoid phase 4
gradually add resistance w/ deltoid exercises
motor control –> phase 4
IR/ER and flex 90-125 (rhythmic stabilization)
quadruped alternation isometrics and ball stabilizations on wall
field goals
motor control –> PNF –> phase 4
D1 diagonal lifts
D2 diagonal lifts
