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624: Acute Care Therapeutic Exercises > Surgical Interventions and Postop Management > Flashcards

Surgical Interventions and Postop Management Flashcards

1
Q

4 types of TSA prosthetic desgins

A
  • unconstrained
  • semiconstrained
  • reverse ball and socket
  • constrained
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2
Q

Which TSA designs allows for the greatest freedom of motion?

A

unconstrained

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3
Q

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

A

yes it must be

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4
Q

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

A

It may be mildly impaired prior to repair

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5
Q

Describe a reversed ball and socket

A

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

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6
Q

What is the purpose of a reverse TSA?

A

It provides stability for RC deficient shoulders that cannot be repaired

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7
Q

Describe the constrained TSA design

A

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

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8
Q

Which TSA design is rarely used and why?

A

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

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9
Q

What is the major difference between a TSA and rTSA?

A

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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10
Q

What are 3 physiological complications after TSA?

A

Pulmonary embolism
DVT
Infection

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11
Q

What are 4 anatomic complications after TSA?

A
  • axillary or suprascapular nerve damage
  • dislocation
  • fracture
  • re-tearing of the RC
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12
Q

How is the extremity positioned after a TSA?

A

Elbow flexed to 90

Shoulder flexed 10-20 with slight abduction and IR

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13
Q

What 7 things should you avoid after a TSA

A
  • 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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14
Q

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

A

6 weeks

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15
Q

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

A

anterior

Avoid hyperextension and abduction

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16
Q

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

A

Serratus anterior and trapezius

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17
Q

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

A
  • 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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18
Q

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

A
  • 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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19
Q

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

A

POSTURAL CORRECTION

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20
Q

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

A

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

*This motion causes dislocation

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21
Q

Which RC muscle is the most commonly torn?

A

Supraspinatus

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22
Q

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

A

3

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23
Q

When is the maximum protection phase for a RC repair?

A

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

24
Q

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

A

pendulum and PROM exercises only

25
Q

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

A

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

26
Q

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

A

POSTURAL REHAB

27
Q

When does the moderate phase of RC repair rehab begin?

A

6-12 weeks post-operatively

28
Q

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

A
  • Well healed incision
  • Minimal pain with AAROM of shoulder
  • Progressive improvement in ROM
29
Q

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

A
  • Wand/Cane
  • Towel
  • Pulleys

*light weight bearing activities (ball on wall)

30
Q

When does the minimum phase of RC repair rehab begin?

A

12-16 weeks post-op

31
Q

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

A
  • Full, pain-free PROM
  • Progressive improvement of shoulder strength and muscular endurance
  • Stable GH joint
32
Q

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

A

Stability must come first; mobility second; strength third

33
Q

What occurs during a Bankart repair?

A

Reattachment of the labrum to the glenoid lip

34
Q

Where does a SLAP tear occur?

A

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

35
Q

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

A

after posterior or multidirectional instability repairs

36
Q

After anterior stabilization procedures which movements are not recommended?

A

ER or horizontal abduction

37
Q

After posterior stabilization procedures which movements are not recommended?

A

IR and overhead elevation of arm

38
Q

What are the 2 types of total elbow arthroplasty designs?

A
  • Linked (articulated)
    Semiconstrained
  • Unlinked (nonarticulated)
    Two separate, nonarticulated implants
39
Q

Unlinked TEA also usually requires the repair of what?

A

supporting ligaments for stability

40
Q

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

A

End range flexion/extension

41
Q

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

A
  • assisted flexion to 90-100 degrees for 3-4 weeks

- anitgravity extension

42
Q

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

A

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

43
Q

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

A

1
2
5
10-15

44
Q

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

A

6 weeks

45
Q

Wrist Arthroplasty is common in what type of patients?

A

RA

46
Q

Which motions are most important following a total wrist arthroplasty?

A

Extension over flexion

47
Q

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

A

Young males; usually overweight.

48
Q

What does CABG stand for?

A

Coronary Artery Bypass Grafting

49
Q

What are the 3 sternal precautions following Cardiothoracic Surgery?

A
  • No overhead movement of UEs
  • No pushing up from chair with UEs
  • No lifting greater than 5 lbs
50
Q

LVAD stands for what?

A

Left Ventricular Assistive Device

51
Q

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

A

8 hours

52
Q

What are the precautions following placement of pacemakers?

A

No overhead reaching with UE for 4-6 weeks

53
Q

What are the 3 precautions for craniotomy patients?

A
  • ALWAYS have patient wear their helmet
  • Avoid Valsalva
  • Avoid lifting
54
Q

What is a Ventriculostomy?

A

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

55
Q

Why is a femoral-popliteal bypass performed?

A

to improve LE circulation

56
Q

What is a carotid endarterectomy?

A

The removal of plaques from the common carotid artery

624: Acute Care Therapeutic Exercises (20 decks)

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