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Acute > Shoulder > Flashcards

Shoulder Flashcards

1
Q

TSA

A

total shoulder arthroplasty

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2
Q

RTSA

A

reverse total shoudler arthroplasty

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3
Q

RCR

A

rotator cuff repair

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4
Q

What is replaced in a TSA?

A

glenoid and humeral surfaces

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5
Q

RCTR

A

rotator cuff total repair

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6
Q

Unconstrained

A
  1. rotator cuff must be intact
  2. small, shallow glenoid component
  3. allows greatest freedom of motion, not inherent stability
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7
Q

Semiconstrainsted

A
  1. larger glenoid component
  2. some degree of stability provided
  3. rotator cuff may be mildly deficient prior to repair
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8
Q

Reverse ball and socket

A

Small humeral socket that slides on a larger ball shaped glenoid component
Provides some stability with mobility for rotator cuff deficient shoulders that cannot be repaired

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9
Q

Constrained

A

Greatest amount of stability
Fixed fulcrum, ball in socket designs
Rarely used to due high rate of loosening and failure of components

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10
Q

TSA vs Hemiarthroplasty…may be accompanied by:

A
  • Rotator cuff repair
  • Subscapularis reattachment and lengthening if a contracture is present that significantly limits external rotation
  • Capsular tightening for chronic subluxation/dislocation (usually posterior) of GH joint
  • Anterior acromioplasty (if hx of impingement syndrome)
  • Bone graft of the glenoid
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11
Q

Postoperative complications of shoulder replacement

A

Pulmonary embolism, DVT

Infection

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12
Q

Postoperative complications during acute phase of care

A 
Axillary and/or suprascapular nerve damage. . . .
Dislocation
Fracture
Re-tearing a repaired rotator cuff
-suturing was insufficient
-ROM was too aggressive
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13
Q

Positioning

A

Sling for comfort; abduction splint for stability
Elbow flexed to 90; shoulder flexed 10-20 with slight abduction and IR
HOB at 30 degrees

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14
Q

Precautions

A 
Absolutely NO end-range stretching; esp. to subscapularis 
NO AROM in antigravity position
NO dynamic shoulder exercises
NO resistance exercises
NO weight bearing on operative UE
NO lifting
NO reaching behind the back
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15
Q

Interventions

A

Mobility of adjacent joints and of whole person!
Patient education of precautions
Splint use/positioning/protection of implant and healing tissues
Postural Rehab!!!!!

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16
Q

Shoulder mobility during maximum protective phase

A 
PROM in allowable range; attempt in supine
Pendulum exercises (Codman’s)
Scapular stabilization exercises in NWB position
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17
Q

At end of maximum protective phase

A

Self-assisted ROM (Other hand, wand, resting on table)

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18
Q

If rotator cuff was repaired during TSA, how long until AROM and light isometrics?

A

6 weeks

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19
Q

Rehab: hospital to home

A

Passive external rotation to neutral or to less than 30 degrees

  • avoid stress to the anterior capsule
  • teach scapular stabilization exercises on the non surgical shoulder; instruct patient to begin these at approx. 4 to 6 weeks post/op
20
Q

Criteria to advance to Moderate Protection/controlled motion phase 6-12 weeks

A

90 degrees passive elevation
45 degrees of ER
70 degrees of IR in the plane of the scapula with minimum pain; or full, PROM with little to no pain
NO subscapularis tendon pain with resisted, isometric IR

21
Q

Progressing TSA Weeks 12-16 Criteria to progress to Minimum Protection/Return to Functional Activity ;

A

Full, PROM of the GHJ (based on intraoperative ranges). . .or at least 130-140 degress PROM or AAROM shoulder flexion and 120 degrees of abduction
60 degrees pain free, PROM ER and 70 degrees IR in the plane of the scapula
AROM 100-120 degrees in the plane of the scapula with proper joint stability: NO OVERFIRING OF . . .TRAPS
Strength of rotator cuff and deltoid muscles 4/5

22
Q

Reverse TSA rehab protocol

A

Avoidance of shoulder extension past neutral and the combination of shoulder adduction and internal rotation should be avoided for 12
weeks postoperatively.

23
Q

Reverse TSA patients typically dislocate with the arm

A

in internal rotation and adduction in conjunction with extension.

24
Q

Rotator cuff repair performed when:

A

Are symptomatic and have functional limitations after a trial of nonoperative treatment (Neer classification stage II and stage III lesions).
Have acute, traumatic rupture of rotator cuff tendons, often combined with other GH joint trauma.
Subacromial decompression; deltoid splitting; deltoid detachment then repair

25
Q

Most commonly torn cuff tendon:

A

supraspinatus

26
Q

Common elements of rotator cuff repair:

A

Immediate or early post-op GH joint movement*
Control of the rotator cuff for dynamic stability
Gradual restoration of strength and muscular endurance

27
Q

How long is rotator cuff repair–maximum protection phase?

A

3-8 weeks post-op depending if surgery was for small or medium repair vs. large to massive repair

28
Q

When is the moderate protection phase of a rotator cuff repair?

A

begins 6 to 12 weeks post op

6 weeks for small tear repair

29
Q

Criteria for moderate protection phase of rotator cuff:

A

Well healed incision
Minimal pain with AAROM of shoulder
Progressive improvement in ROM

30
Q

Minimum Protection/Return to Function Phase for Rotator Cuff Repair

A

usually begins 12 to 16 weeks post-op

31
Q

Criteria for Minimum Protection/Return to Function Phase for Rotator Cuff Repair

A

Full, pain-free PROM
Progressive improvement of shoulder strength and muscular endurance
Stable GH joint

32
Q

Common sources of referred pain in the shoulder region

A

C3-C4
C4-C5
Nerve root C4
Nerve root C5

33
Q

Referred pain from related tissues

A 
C4 dermatome
C5 dermatome
Diaphragm
Heart
Gallbladder irritation
34
Q

Nerve disorders in the shoulder girdle region

A

Brachial plexus in the thoracic outlet
Suprascapular nerve in the suprascapular notch
Radial nerve in the axilla

35
Q

Possible nonoperative causes of GH joint hypomobility

A

Rheumatoid arthritis and osteoarthritis
Traumatic arthritis
Post immobilization arthritis or stiff shoulder
Idiopathic frozen shoulder (adhesive capsulitis)

36
Q

Three phases of frozen shoudler

A
  1. Freezing:
  2. Frozen
  3. Thawing
37
Q

Freezing shoulder:

A

intense pain, even at rest, and limitation of motion by 2-3 weeks after onset
may last 10-36 weeks

38
Q

Frozen shoulder

A

pain only with movement, significant adhesions, limited GH motions, substitute motions in scapula
Atrophy of deltoid, rotator cuff, bicep and triceps occurs
may last 4-12 months

39
Q

Thawing shoulder

A

No pain and no synovitis, but significant capsular restrictions from adhesions
may last 2-24 months, some patients never regain normal ROM

40
Q

GH treatment option goals

A

-control pain, edema, and joint effusion

41
Q

GH treatment options

A 
PROM
Passive joint mobilization techniques
Pendulum exercises
Self-mobilization techniques
Manual stretching
Self-stretching exercises
Ensure correct mechanics with shoulder movements
42
Q

Nonoperative causes of AC and SC joint hypomobility

A

Overuse syndromes
Subluxations or dislocations
Sustained faulty postures

43
Q

Painful shoulder syndromes

A

-tendinitis/bursitis
-shoulder instability/subluxation
Impaired posture
Muscle imbalance
Decreased thoracic ROM
Rotator cuff overuse or fatigue

44
Q

Primary mover in a RTSA

A

deltoid muscle becomes primary mover of GH joint

45
Q

Primary mover in a TSA?

A

functioning rotator cuff muscles move GH joint

Acute (16 decks)

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