Surgical Interventions and Postop Management Flashcards by Alli Volkens

4 types of TSA prosthetic desgins

unconstrained
semiconstrained
reverse ball and socket
constrained

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Which TSA designs allows for the greatest freedom of motion?

unconstrained

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Does the RC have to be intact for an unconstrained design?

yes it must be

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Does the RC have to be intact for a semiconstrained design?

It may be mildly impaired prior to repair

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Describe a reversed ball and socket

The glenoid is ball shaped and the humerus is the socket component

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What is the purpose of a reverse TSA?

It provides stability for RC deficient shoulders that cannot be repaired

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Describe the constrained TSA design

it provides the greatest amount of stability due to its fixed fulcrum ball and socket design

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Which TSA design is rarely used and why?

constrained because of its high rate of loosening and failure of components

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What is the major difference between a TSA and rTSA?

In a rTSA the deltoid becomes the primary mover of the GH joint because the RC is torn.
In a TSA, functioning RC muscles move the GH joint.

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What are 3 physiological complications after TSA?

Pulmonary embolism
DVT
Infection

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What are 4 anatomic complications after TSA?

axillary or suprascapular nerve damage
dislocation
fracture
re-tearing of the RC

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How is the extremity positioned after a TSA?

Elbow flexed to 90

Shoulder flexed 10-20 with slight abduction and IR

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What 7 things should you avoid after a TSA

end-range stretching (especially to subscapularis)
AROM in antigravity position
dynamic shoulder exercises
resistance exercises
weight bearing on operative UE
lifting
reaching behind the back

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

6 weeks

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Which aspect of the capsule should you avoid stress to after a TSA?

Avoid hyperextension and abduction

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Which 2 muscles should you concentrate on the most after TSA?

Serratus anterior and trapezius

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What are the 4 criteria to advance to the moderate phase after a TSA?

90 degrees of 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

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What are the 5 criteria to advance to the minimum phase after a TSA?

at least 130-140 degrees of PROM shoulder flexion
at least 120 degrees of PROM abduction
60 degrees pain free PROM ER
70 degrees PROM IR
Strength of rotator cuff and deltoid muscles 4/5

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What is the keystone to the rehab process after a TSA?

POSTURAL CORRECTION

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What motions should be avoided for 12 weeks following a rTSA?

shoulder extension past neutral and the combination of shoulder adduction and internal rotation

*This motion causes dislocation

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Which RC muscle is the most commonly torn?

Supraspinatus

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If a RC tear is greater than _ cm a surgical repair is pursued

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When is the maximum protection phase for a RC repair?

anywhere from 3-8 weeks post-op (depending on size of tear)

What type of exercises can be performed during the maximum protection phase?

pendulum and PROM exercises only

Why is PROM performed in the supine position during the maximum protection phase?

It offers scapular stabilization and also tends to decrease trap from firing

What else could PT concentrate on for early rehab post-RC repair?

POSTURAL REHAB

When does the moderate phase of RC repair rehab begin?

6-12 weeks post-operatively

What are the 3 criteria to progress to the moderate phase of rehab following a RC repair?

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

Name 3 type of exercises that would be appropriate in the moderate protection phase of a RC repair

- Wand/Cane - Towel - Pulleys *light weight bearing activities (ball on wall)

When does the minimum phase of RC repair rehab begin?

12-16 weeks post-op

What are the 3 criteria to progress to the minimum phase of rehab following a RC repair?

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

Rank the following in importance following a RC repair; stability, mobility, strength

Stability must come first; mobility second; strength third

What occurs during a Bankart repair?

Reattachment of the labrum to the glenoid lip

Where does a SLAP tear occur?

Where the long head of the biceps tendon anchors to the labrum

Immobilization of the GH joint must be longer if the tear is occurs in what direction?

after posterior or multidirectional instability repairs

After anterior stabilization procedures which movements are not recommended?

ER or horizontal abduction

After posterior stabilization procedures which movements are not recommended?

IR and overhead elevation of arm

What are the 2 types of total elbow arthroplasty designs?

- Linked (articulated) Semiconstrained - Unlinked (nonarticulated) Two separate, nonarticulated implants

Unlinked TEA also usually requires the repair of what?

supporting ligaments for stability

What movements should be avoided in the maximum protection phase following a TEA?

End range flexion/extension

If the triceps is reflected or split during a TEA what movements should be avoided and for how long?

- assisted flexion to 90-100 degrees for 3-4 weeks | - anitgravity extension

What types of exercises should be performed during the maximum protection phase following a TEA?

Low intensity isometrics of wrist, hand, and shoulder while in the splint

A TEA patient should not lift more than _ lbs for 3 months More than _ lbs for 6 months More than _ lbs for long term repetitive lifting Never more than _ - _ lbs for a single lift

1 2 5 10-15

When can low-load, closed-chain activities, such as wall push-ups be used following a TEA?

6 weeks

Wrist Arthroplasty is common in what type of patients?

Which motions are most important following a total wrist arthroplasty?

Extension over flexion

Slipped Capital Femoral Epiphysis typically occurs in what type of patient?

Young males; usually overweight.

What does CABG stand for?

Coronary Artery Bypass Grafting

What are the 3 sternal precautions following Cardiothoracic Surgery?

- No overhead movement of UEs - No pushing up from chair with UEs - No lifting greater than 5 lbs

LVAD stands for what?

Left Ventricular Assistive Device

How long do patients have to lay flat following an angioplasty?

8 hours

What are the precautions following placement of pacemakers?

No overhead reaching with UE for 4-6 weeks

What are the 3 precautions for craniotomy patients?

- ALWAYS have patient wear their helmet - Avoid Valsalva - Avoid lifting

What is a Ventriculostomy?

A procedure in which excess CSF fluid is removed from the ventricles caused by trauma or hydrocephalus

Why is a femoral-popliteal bypass performed?

to improve LE circulation

What is a carotid endarterectomy?

The removal of plaques from the common carotid artery