Shoulder Management 2 Flashcards
The “speed limit” for rehab after repair
best environment for healing - first 6 weeks after repair
- immobilization
- limited PROM
The “speed limit” for rehab after repair
post-op stiffness > 6 mos is (common/uncommon)
uncommon
The “speed limit” for rehab after repair
% of pts who have post-op stiffness > 6 mos after RCR
3-10%
The “speed limit” for rehab after repair
Though post-op stiffness > 6 mos is not common, at risk pts benefit from additional focus on
PROM earlier in the immediate post-op period
RCR: Immobilization or early PROM?
insufficient evidence to provide conclusion or recommendation for immobilization or early PROM
RCR rehabilitation: Perform early PROM in this plane
scapular
RCR rehabilitation: Sagittal plane PROM places increased stress across this structure
supraspinatus tendon
RCR rehabilitation: What is SAAE
supported
active
assistive
exercises
RCR rehabilitation: Depending on surgical factors, begin AAROM/SAAE in this timeframe
between 3-8 weeks
RCR rehabilitation: Why should you be cautious with pulleys for therex?
upright pulley activity produces significantly more mm activity as compared to supine activities
Codman’s pendulums have minimal RC activation but are not truly
PROM
Standard RC protocol for medium sized tear:
PROM to tolerance until
6 weeks
Standard RC protocol for medium sized tear:
First 6 weeks…strengthening
light isometrics
Standard RC protocol for medium sized tear:
Progress from PROM to AROM when?
6-8 weeks
Standard RC protocol for medium sized tear:
When to initiate isotonic strengthening?
6-8 weeks
Standard RC protocol for medium sized tear:
When can you progress to 2-3# weight or medium band strengthening?
10 weeks
Standard RC protocol for medium sized tear:
When can you initiate prone ER at 90˚abduction?
10 weeks
Standard RC protocol for medium sized tear:
Prepare for DC when?
16 week and beyond
Shoulder surgical stabilization: What should be exhausted first
conservative management
Shoulder surgical stabilization: how many different types of surgeries for this?
over 250
Shoulder surgical stabilization: most common procedures
- capsular plication
- inferior capsular shift
- anterior capsulolabral repairs (ACLR)
- bankart repairs
Shoulder surgical stabilization: These procedures are considered the gold standard for treatment of anterior instability
bankart repairs
Shoulder imaging: radiographs
standard series views
- AP (ER/IR)
- axillary
- scapular Y
Shoulder imaging: radiographs
In addition to AP, axillary, and scapular Y view, trauma series also includes
lateral views
Shoulder imaging: CT
great for viewing these
- subtle or complex fx’s (Hill Sachs/Reverse Hill Sachs)
- arthritic changes
- loose bodies
Shoulder imaging: MRI
Need intra-articular contrast for better viewing of these
- labrum
- rotator cuff
