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Orthopaedic Physiotherapy > Shoulder Surgery & Rehab > Flashcards

Shoulder Surgery & Rehab Flashcards

1
Q

What are the common types of shoulder surgery?

A
  • Fracture repair (open reduction internal fixation ORIF)
  • Rotator cuff reconstruction
  • Shoulder arthroplasty
  • Stabilisation (anterior capsule reconstruction)
  • Superior Labral Anterior Posterior Repair (SLAP)
  • Acromioplasty
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2
Q

What is involved in a post-operative examination of a shoulder?

A
  • AROM of cervical spine/thoracic spine, elbow, wrist and fingers
  • If allowed, PROM of shoulder assessed in supine
  • Girth measurements at the elbow/wrist
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3
Q

What is involved in post-op stage 1 shoulder rehab?

A
  • Treatment & exercise
  • Mobility
  • Comfort - sling
  • Hygiene
  • Dressing
  • Education (safety, future progression)
  • Other joint health
  • Discharge planning
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4
Q

What are the common early active rehab strategies?

A
  • Sling management
  • Scapula setting
  • Neck, wrist, elbow AROM
  • +/- glenohumeral isometrics
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5
Q

What are common early passive rehab exercises?

A
  • Pendulum exercise: ROM without active contraction of shoulder joint muscles
  • Hand on bed, abduction, adduction, flexion, external/internal rotation
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6
Q

How is a proximal humeral fracture classified?

A
  • 4 parts of proximal humerus: greater/lesser tuberosities, humeral head, humeral shaft
  • By number of parts displaced
  • By displacement >1cm from humerus
  • By angulation of part >45 degrees
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7
Q

What are some of the considerations for early rehab of shoulder fractures?

A
  • Quality of hard/soft tissues
  • Degree of commutation
  • Difficulty/quality of repair
  • Stability of repair
  • Surgeon’s orders
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8
Q

What are the indications for shoulder arthroplasty (replacement)?

A
  • Severe arthritis
  • Rotator cuff failure (& OA)
  • Un-reconstructable fracture
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9
Q

What are the types of shoulder arthroplasties?

A
  • Total
  • Hemi (half)
  • Resurfacing hemi +/- glenoid
  • Cuff tear arthroplasty (CTA) head hemi
  • Reverse total
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10
Q

Why is a beach chair position often used for a shoulder arthroplasty?

A
  • Adequate exposure of humeral head/glenoid

- Ensures arm can be positioned correctly

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11
Q

What is the standard incision for shoulder arthroplasty?

A

Deltopectoral approach

  • Lateral to coracoid process, extends down proximal arm
  • Deltopectoral interval exposed from leading edge of clavicle to lower end of pec
  • Subscapularis may be detached
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12
Q

What are the common restrictions for a standard TSA?

A
  • Passive ROM for up to 6/52
  • Abduction pillow for up to 8/52
  • ER limited to 30 degrees with humerus at 0 degrees of adduction
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13
Q

What are the restrictions for a reverse TSA?

A
  • Inherently unstable 0-12 weeks
  • No combined adduction/IR/ER
  • No extension beyond neutral
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14
Q

What are the considerations for shoulder arthroplasty rehab?

A
  • Preop history/impairments
  • Surgical technique
  • Prosthetic type
  • Surgeon’s assessment of tissue status
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15
Q

What is the focus for the first 6 weeks of TSA rehab?

A
  • Protection of the healing structures

- Progression of ROM for prevention of muscular contraction & joint stiffness

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16
Q

What are some of the lesions associated with traumatic anterior instability?

A
  • Bankart lesion: Avulsion of anteroinferior glenoid labrum at attachment to IGHL complex
  • Hill-Sach’s lesion: Posterolateral humeral head indentation fracture from anterior shoulder dislocation
  • Rotator interval incompetence & capsular laxity
17
Q

What is the rotator interval?

A

Capsule between supraspinatus and subscapularis

18
Q

What are the 3 portals of shoulder stabilisation?

A
  • Posterior: 1.5-3cm distal/1-2cm medial to posterolateral tip of acromion in interval between infraspinatus and trees minor
  • Anterior superior: Anterior to biceps tendon
  • Anterior inferior: Above superior edge of subscapularis
19
Q

What does surgery for stabilisation of anterior/inferior shoulder ligaments involve?

A
  • Anterior glenoid rasped and decorticated in preparation
  • Anchors placed on edge of articular surface in 7/9/11 o’clock positions
  • Suture is passed through the tissue, reattaching ligaments to glenoid
  • Repair is evaluated for stable fixation
20
Q

What are the 2-4 week goals post anterior shoulder stabilisation?

A
  • Progress from PROM to AAROM to AROM while protecting anterior joint capsule
  • Progress scapular stabilisation exercises
  • Inhibit rotator cuff exercises
21
Q

What are the 4-8 week goals post anterior shoulder stabilisation?

A
  • Full ROM expected by 8 weeks
  • Progress dynamic scapular stabilisation and rotator cuff strengthening exercises
  • Return to ADLs and functional activities that don’t stress the anterior capsule
22
Q

What are some of the pathologies associated with rotator cuff injuries?

A
  • Traumatic
  • Degenerative
  • Congenital abnormalities
  • Scapulothoracic dysfunction
  • Glenohumeral instability
  • Degenerative changes (tears)
23
Q

What are the indications for surgery for rotator cuff?

A
  • Faulure of 3-6 months of conservative care

- Acute full thickness tear in an active patient younger than 50

24
Q

What types of surgeries are used for rotator cuff injuries?

A
  • Arthroscopic: Impingement
  • Arthroscopic/mini open:
    Partial thickness cuff tears
  • Open: Full thickness cuff tears
25
Q

What occurs in an open rotator cuff surgery?

A
  • Trough is created in proximal humerus lateral to articular surface
  • Sutures tied over the bone bridge in the greater tuberosity
26
Q

What are the 1-4 week goals post rotator cuff repair?

A
  • Protect, support, maintain
  • Increase ROM as tolerated
  • Scapular isometrics
  • Avoid AROM abduction/ER and PROM horizontal adduction, extension IR
  • Avoid leaning on elbow, sleeping on side, sudden movements, pushing/pulling/lifting
27
Q

What are the 5-8 week goals post rotator cuff repair?

A
  • Support, protect, maintain
  • Increase ROM and active strength
  • Avoid positions that compromise repaired tissues (horiztonal adduction, IR beyond 70 deg, extension)`
28
Q

What are the 8-13 week goals post rotator cuff repair?

A
  • Increase ROM
  • Avoid impingement problems
  • Gain near full ROM
  • Increase strength/function
29
Q

What are the 3 post-surgical phases for acromioplasty rehab?

A
  • Phase 1 (2-3 weeks): Support, protect, maintain, minimise effects of immobilisation
  • Phase 2 (3-6 weeks): Muscle strengthening, continued work on rotator cuff & scapular stabilising strengthening
  • Phase 3 (9-12 weeks): Enhancing kinaesthesia/joint position sense, building endurance, strengthening scapular stabilising, work-/sport-specific tasks

Orthopaedic Physiotherapy (11 decks)

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