Shoulder

Question 1

Types of RC tear

Answer 1

Acute traumatic cuff tear

Atraumatic degenerative cuff tear

Question 2

When is shoulder surgery indicated?

Answer 2

full thickness cuff tear
adhesive capsulitis
traumatic dislocation
OA
Recurrent dislocation
serious pathology

Question 3

Indications for RC surgery

Answer 3

failure of 3-6 month conservative plan OR an acute full thickness tear in active patient < 50 y/o

Question 4

RC surgery types

Answer 4

arthroscopic RC repair: less invasive, smaller tears

Mini open RC repair

Open RC repair: large or complex tears

Question 5

12 factors that affect rehabilitation following surgery

Answer 5

surgical approach

size of tear: small, medium, large, massive. Worse outcomes if larger

tissue quality: good, adequate, poor - smokers/drinkers have weaker tendon health

fixation method

location of tear: posterior cuff = protect IR, anterior cuff = protect ER

type of tear:

mechanism of failure: acute traumatic or gradual

timing of surgery: immediate repair = faster progression

RC tissue quality anterior and posterior to the tear site

patient characteristics: age, smoking, diabetes, worker comp

access to care: treated by physio = better outcomes

physician philosophical approach: conservative or aggressive

Question 6

Tear > 5cm =

Answer 6

poorer outcomes

Question 7

If deltoid muscle detached…

Answer 7

no active deltoid contraction for 6-8 weeks

Question 8

Weeks 1-4 Precautions RC

Answer 8

no pushing, pulling or lifting (no heavy lifting for 4-6 months)
No shoulder extension, horizontal adduction or IR
no overhead motions
no stretching
no supporting Bw through hands
dont sleep on affected side
wound Mx
keep incisions dry/use shower sling

Question 9

Week 1-4 goals RC surgery

Answer 9

reduce inflammation
maintain integrity of repair
control pain
increase PROM as tolerated
maintain ROM of C spine, elbow, wrist

Question 10

Abduction sling for RC surg

Answer 10

abduction sling for 6 weeks
24/7 - remove 3-4x a day to straighten elbow and move wrist and hand
can remove when resting or sitting with arm by side

Question 11

Physio week 1-4 RC surg

Answer 11

Estim
PROM at shoulder
AROM at elbow
Scap depressions

Question 12

Physio week 5-8 RC surg

Answer 12

avoid overstretching
Resisted exercises from 9 weeks onwards
A/AROM for shoulder
Soft tissue mob
CV conditioning

Question 13

Physio week 8-13 RC surgery

Answer 13

AROM progressing to isotonics
begin shoulder ER with light weight

Question 14

Physio weeks 13-18 RC surgery

Answer 14

Stretches
Progressive resistance exercises

Question 15

Physio weeks 17-26 RC surgery

Answer 15

getting back to previous level of function

strengthening in sport specific activity
progress resistance exercises - ABD, ER
consider plyometrics if related to goals

Question 16

Physio weeks 26+ RC surgery

Answer 16

return to normal activity
maintain ROM, strength and endurance
athletes return to sport between 6 and 12 months

Question 17

Indications for Total Shoulder Replacement

Answer 17

high pain + night pain and disability
Advanced OA
RC arthropathy
Serious pathology - avascular necrosis
Revision surgery

Question 18

TSR post operative precautions

Answer 18

immobilised in sling up to 6 weeks
ER limited to <30 degs once out of sling