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Ortho Exam 2 > Reverse Shoulder Replacement > Flashcards

Reverse Shoulder Replacement Flashcards

1
Q

when is a RTSR used

A

RC is completely torn

severe arthritis

failed conventional TSR

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2
Q

what are switched in rTSR

A

glenoid and humeral head components

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3
Q

where is the “ball” attached

A

where the glenoid was

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4
Q

where is the glenoid attached

A

attached to the top of the humerus

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5
Q

how does the deltoid move

A

raises the arm overhead instead of the RC

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6
Q

what is there a higher risk of

A

dislocation

after rTSR than conventional TSR

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7
Q

what should we avoid

A

shoulder extension beyond neutral

combination of shoulder ADD and IR for 12 weeks post-op

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8
Q

how can the shoulder dislocation

A

with IR and ADD w/ extension

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9
Q

expectation

A

normal/full AROM of shoulder is not expected post rTSR

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10
Q

what should we expect after rTSR

A

105 active flexion

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11
Q

what is the stability and mobility of the shoulder dependent on

A

deltoid and peroscapula muscles

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12
Q

what is the main shoulder muscle for rTSA

A

deltoid

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13
Q

what does the prosthesis change

A

the center of rotation

by moving it medially and inferiorly

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14
Q

changing the center or rotation causes

A

increase deltoid moment arm

deltoid tension to give a better line of pull

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15
Q

what does the deltoid replace

A

RC

becomes the primary elevator of the shoulder

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16
Q

general guidelines of rTSR

A

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

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17
Q

delo-pectoral approach –> guidelines

A

defer AROM for 6 weeks to allow for adequate deltoid healing

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18
Q

isometrics to deltoid can begin at 4 weeks –> guidelines

A

beginning deltoid and periscapular isometrics will assist in restoring initial deltoud fxn

provide stability to the GH joint

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19
Q

phase 1

A

0-4 weeks

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20
Q

goal of phase 1

A

maintain the integrity of the replaced joint

while restoring passive ROM

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21
Q

when is the pt in ABD splint –> phase 1

A

all the time besides therapy, bathing, HEP

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22
Q

there is no –> phase 1 guidelines

A

shoulder AROM, AAROM or PROM into IR

no reaching behind back, esp into IR

lifting objects

supporting of BW w/ hands

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23
Q

what should we place under the elbow –> phase 1 guidelines

A

small pillow/towel

while laying on back to avoid shoulder hyperextension

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24
Q

interventions –> phase 1

A

swelling management

ROM/mobility

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25
Q

swelling management –> phase 1

A

ice

compression

26
Q

PROM –> ROM/mobility –> phase 1

A

ER in the scapular plane of tolerance

flex/scaption </= 120

ABD </= 90

27
Q

exercises –> PROM –> ROM/mobility –> phase 1

A

seated GH table slides

pendulums

seated horizontal table slides

28
Q

AAROM –> ROM/mobility –> phase 1

A

none

29
Q

AROM –> ROM/mobility –> phase 1

A

elbow

wrist

hand

30
Q

when do we progress to phase 2

A

gradual increase in PROM (scapular plane)

PROM ER b/w 30-45 (scapular plane)

PROM IR to 0

pain < 4/10

no complications

31
Q

phase 2 precautions

A

no reaching behind back, esp into IR

no lifting objects heavier than a coffee cup

no supporting of BW w/ hands

32
Q

what do we do with a small towel/pillow –> phase 2

A

place under elbow while lying on back to avoid shoulder hyperextension

33
Q

phase 2 is

A

weeks 4-6

34
Q

rehab –> phase 2

A

ROM/mobility

strengthening

35
Q

ROM/mobility –> phase 2

A

AAROM

AROM

inferior glide

36
Q

AAROM –> phase 2

A

shoulder flexion w/ cane

cane ER stretch

washcloth press

seated shoulder elevation w/ cane

37
Q

AROM –> phase 2

A

supine flexion

supine punch

38
Q

strengthening of –> phase 2

A

periscapular

deltoid

39
Q

peroscapular –> phase 2

A

scap retraction

standing scapular setting

supported

rowing (avoid HE)

40
Q

deltoid –> phase 2

A

isometrics in the scapular plane

avoid HE

41
Q

when to progress to phase 3

A

gradual increase in PROM, AAROM, AROM

0 degrees shoulder PROM into IR

palpable muscle contraction felt in scapular musculature

pain < 4/10

no complications

42
Q

phase 3

A

weeks 7-8

moderate strengthening

43
Q

phase 3 rehab

A

advance strengthening

precaution should be present

44
Q

phase 4

A

weeks 9-11

continued strengthening on HEP basis

45
Q

phase 4 rehab

A

gradual return to some sporting activity

46
Q

goals of phase 3

A

minimize pain

initiate shoulder PROM in scapular plane

initiate motor control exercise

pt education

47
Q

gradually –> goals of phase 3

A

progress shoulder PROM

progress shoulder AAROM

progress shoulder AROM

48
Q

progress –> goals of phase 3

A

deltoid strengthening

periscapular strengthening

49
Q

phase 3 rehab should include

A

ROM/mobility

strengthening

motor control

50
Q

PROM –> ROM/mobility –> phase 3

A

full in all planes

gradual PROM IR in scapular plane </= 50

51
Q

AAROM–> ROM/mobility –> phase 3

A

incline table slides

wall climbs

pulleys

seated shoulder elevation w/ cane w/ active lowering

52
Q

AROM –> ROM/mobility –> phase 3

A

seated scaption

seated flexion

supine forward elevation w/ elastic resistance to 90

53
Q

strengthening –> phase 3

A

periscapular

deltoid

54
Q

periscapular –> phase 3

A

row on physioball

SA punches

55
Q

deltoid –> phase 3

A

seated shoulder elevation w/ cane

seated shoulder elevation w/ cane

active lowering of ball on wall

56
Q

motor control –> phase 3

A

IR/ER in scaption plane

flex 90-125 (rhythmic stabilization) in supine

stretching

SLing HADD

triceps and lats

57
Q

phase 4 rehab includes

A

ROM/mobility

strengthening

motor contro

58
Q

ROM/mobility –> phase 4

A

full ROM in all planes

59
Q

strengthen –> periscapular phase 4

A

resistance band shoulder extension

resistance band seated rows

rowing

robbery

lawn mowers

tripod

pointer

60
Q

strengthen –> deltoid phase 4

A

gradually add resistance w/ deltoid exercises

61
Q

motor control –> phase 4

A

IR/ER and flex 90-125 (rhythmic stabilization)

quadruped alternation isometrics and ball stabilizations on wall

field goals

62
Q

motor control –> PNF –> phase 4

A

D1 diagonal lifts

D2 diagonal lifts

Ortho Exam 2 (17 decks)

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