Rotator cuff repair surgeries/shoulder arthroplasty

Question 1

How is a rotator cuff tear classified

Answer 1

• muscle involved (can find this through RI)
• extent (full thickness, partial thickness)
• size of tear

Question 2

what are the size categories of tears

Answer 2

• small to medium <1cm
• medium to large >1cm, <5cm
• large to massive >5 cm

Question 3

Tendinitis symptoms

Answer 3

• full AROM, PROM
• strong and painful (can progress to weak and painful)
• painful arc
• if it doesn’t get better like a tendinitis should it could be a partial tear

Question 4

RTC Clinical signs of partial or full tear

Answer 4

• partial or small tears look like impingement tendonitis
• RI weak and painful
• pain, worse with elevation = painful arc
• tender to palpation
• larger tears positive “drop arm” test as the RC is not stabilizing

Question 5

RTC surgical considerations

Answer 5

• open, arthroscopic or mini open
• acromioplasty may accompany
• success dependent on some factors

Question 6

what is a mini-open surgery

Answer 6

• vertical incision along the deltoid fibers

Question 7

What factors may the success of the surgical repair of RTC depend on

Answer 7

• size of tear (retracted?)
• quality of tissue
• quality of bone
• co-morbidities
• Tendon to tendon vs tendon to bone

Question 8

Double row RTC repiar

Answer 8

• fixed with suture anchors
• gives “footprint” for tendon to adhere
• tendon to bone = heals quicker and stronger than tendon to tendon

Question 9

surgery when the RTC tear is not acute

Answer 9

• supraspinatus/tendon may atrophy
• tendon will retract and therefore need to be stretched to attached
• muscle is deconditioned and may have fat developed in it
• if the surgeon pulls it to get it to the bone it will be under more tension

Question 10

Acromioplasty

Answer 10

• degeneration of AC joint can cause bone spurs of the acromion
• they will go on and shave/remove part of the acromion to open up the space

Question 11

mumford precedure

Answer 11

• resection of distal clavicle
• higher incidence of AC joint degeneration that causes impingement or tear of RTC
• this procedure can be done stand alone of in conjunction with others

Question 12

what is the typical post surgery position for a patient

Answer 12

• placed in abduction pillow sling

Question 13

what are the RTC post op considerations

Answer 13

• protect the healing tissues (watch adduction)
• immobilization in abduction sling
• 6-8 weeks to heal (watch ADD)
• rehab depends on: size of tear, quality of tear, quality of tissue, how well the surgeon was able to repair the tissue

Question 14

RTC outcomes: arthroscopic vs mini. open

Answer 14

• arthroscopic equals mini-open for clinical improvement and pain medication reduction
• recurrent tear rate is higher in arthroscopic than open procedure

Question 15

Total shoulder arthroplasty indications

Answer 15

• refactory pain that doesnt go away
• limited ROM
• failed conservative therapy
• ideally over 65 yrs

Question 16

Total shoulder arthroplasty considerations

Answer 16

• did they cut through the subscapulares
• if so than when moving it you should guard against end range ER and forceful IR

Question 17

Post op goals for TSA

Answer 17

• pain relief
• functional UE use

Question 18

Reverse TSA

Answer 18

• the head of the humerus becomes the socket and the glenoid becomes the ball
• indicaiton = poor rotator cuff
• allows for functional elevation without a RC
• anterior dislocation = adduction, IR, extension

Question 19

SLAP lesion repair

Answer 19

• may be associated with an accompanying tear/detachment of long head of biceps
• labrum and biceps long head tendon (if involved) debrided and reattached with tacks or sutures

Question 20

types of SLAP lesions

Answer 20

• type 1-4
• post op rehab is dependent on the type of lesion and specifics of procedure

Question 20

Ruptured biceps tendon

Answer 20

• may be convulsion from supraglenoid tubercle or in the mid tendon under acromion from impingement
• often associated with RC tear or labral tear
• anchored inferior to pec major or intertubercle groove

Question 20

Clinical signs and symptoms of biceps tendon rupture

Answer 20

• shoulder pain
• bulge in biceps region
• may not have significant strength loss
• often not repaired except athletes

Question 21

Biceps tendon rupture surgical considerations

Answer 21

• primary tenodesis
• reattach following avulsion
• fix to humerus in intertubercular groove

Question 22

Biceps tendon rupture post op cautions

Answer 22

• avoid elbow extension with shoulder extension (stretching)
• no reistive elbow flexion 4-6 weeks
• no heavy resistance 3 months