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MSK Shoulder > surgical treatment for impingement and RC > Flashcards

surgical treatment for impingement and RC Flashcards

1
Q

Full thickness, tears measurements

A

Small <1cm
Medium 1-3cm
Large 3-5cm
Massive >5 cm

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2
Q

partial thickness tears

A

Articular
bursa side
Intrasubstance

(acromial sided partial tear is easier to repair than a humeral sided tear because it is easier to visualize and access)

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3
Q

Subacromial decompression without repair

A

bursectomy
Acromioplasty
distal clavicle resection

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4
Q

bursectomy

A

Removal of the bursa, plica, and other soft tissues in the subacromial space to allow more space for the super spinatus and other muscles and tendon tissues

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5
Q

Acromioplasty

A

Resection of the underside of the hooked acromion to make more space in the supraspinatus outlet

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6
Q

Distal clavicle resection

A

removal of the distal 4-5 mm of the clavicle intended to reduce compression below the AC joint

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7
Q

Subacromial, decompression, and evidence?

A

no evidence that supports the use of subacromial decompression

No benefit or placebo or no treatment for pain function or for patients with rotator cuff or subacromial pain

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8
Q

biceps tenodesis

A

Tendon is detached from glenoid and anchored near the top of the bicipital groove

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9
Q

Subacromialdecompression rehab phase 1 timeline

A

0 to 2 weeks

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10
Q

Subacromial decompression, rehab phase 2 timeline

A

3 to 6 weeks

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11
Q

Subacromial decompression, rehab phase 3 timeline

A

7 to 12 weeks

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12
Q

Subacromial decompression rehab, phase 1 goals

A

Restore range of motion
Prevent muscle inhibition and atrophy

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13
Q

Subacromial decompression, rehab phase 2 goals

A

Regain muscle strength

Normalize arthrokinematics

Improve control control of shoulder

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14
Q

Subacromial decompression, rehab phase 3 goals

A

improve strength, power, endurance

Improve neuromuscular control

Prepare athlete for return to sport

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15
Q

Subacromial decompression, rehab phase 1 manual therapy

A

PROM> AAROM> AROM

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16
Q

Subacromial decompression, rehab phase 2 manual therapy

A

Joint mobilization for pain modulation and to improve arthrokinematics

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17
Q

Subacromial decompression rehab phase 1 exercises and modalities

A

pendulum/cane and stretching for mobility
Scapular strength
Rotator cuff isometrics

Cyro, IFC estim as needed

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18
Q

Subacromial, decompression, rehab, phase 2 exercise and modalities

A

isometric, isotonic, and PNF for shoulder and scapula
Upper extremity and endurance exercise

Cryotherapy and IFC as needed

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19
Q

Subacromial decompression, rehab phase 3 exercise

A

High speed strength
eccentric exercise
Progress Therabands to 90/90 posn
Plyometrics and diagonal patterns

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20
Q

Subacromial decompression rehab criteria to progress to phase 2

A

Full active range of motion
Minimal pain

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21
Q

Subacromial decompression, rehab criteria to progress to phase 3

A

Full painless range of motion
No pain on exam

22
Q

Surgical repair options for rotator cuff injuries

A

arthroscopy
Mini open deltoid splitting
Open with detachment of deltoid

23
Q

arthroscopy

A

2+ access portals allows scopes to visualize and debride

Holes into the humeral head to accept screws

Screws with sutures through the supraspinatus tendon anchored into humerus

24
Q

Mini open

A

Deltoid splitting

anterolateral arthroscopic portal extended 1-2cm, deltoid fibers beneath are split

Much of the procedure is still performed arthroscopically
Opening and splitting allows access for secure bone tendon fixation

25
Q

Open with detachment of deltoid

A

repair through a 3-6cm incision over anterior superior aspect of the shoulder

Deltoid is removed from the anterior acromion AC joint then split 3-5cm laterally

Subacromial decompression, debridement, and bone prep, then repair is performed

Deltoid reattached to acromion

26
Q

types of fixations for arthroscopic repair

A

Single row
Double row- screw goes to the bone and suture goes thru the muscle
Transosseous bridge- 4 anchors

27
Q

RC rehab small to medium tears: phase 1 timeline

A

0 to 6 weeks

28
Q

RC rehab small to medium tears: phase 1 goals

A

protect tissues- sling 4 weeks

Restore passive range of motion - week 4 external rotation

Manage pain and swelling

29
Q

RC rehab small to medium tears: phase 2 timeline

A

7 to 12 weeks

30
Q

RC rehab small to medium tears: phase 2 goals

A

D/C sling
Full active range of motion without scapular substitution
Improve control of shoulder
Normalize arthrokinematics

31
Q

RC rehab small to medium tears: phase 3 timeline

A

13+ weeks

32
Q

RC rehab small to medium tears: phase 3 goals

A

improve strength, power, endurance
Improve neuromuscular control
Prepare athlete for return to sport

33
Q

RC rehab small to medium tears: phase 1 manual therapy

A

PROM, grades 1-2 mobs for pain
AAROM AT THREE WEEKS SUPINE
No active range of motion

34
Q

RC rehab small to medium tears: phase 2 manual therapy

A

AROM per tolerance
Joint mobilization for improved arthrokinematics

35
Q

RC rehab small to medium tears: phase 1 exercise, and modalities

A

pendulum exercise
Scapular mobility and strength
Active exercise at six weeks

Cryo, IFC estim as needed

36
Q

RC rehab small to medium tears: phase 2 exercise, and modalities

A

light resisted at eight weeks
Shoulder and scapular, strength, prone, or close, kinetic chain
Upper extremity endurance exercise

Cryotherapy and IFC as needed

37
Q

RC rehab small to medium tears: phase 3 exercise

A

High-speed strength
Progress the band to 90/90 position
Plyometrics and diagonal patterns

38
Q

RC rehab small to medium tears: criteria to progress to phase 2

A

Full passive range of motion
Minimal pain

39
Q

RC rehab small to medium tears: criteria to progress to phase 3

A

Full active range of motion without scapular substitution

No pain or reactive inflammation with strength

40
Q

RC rehab small to medium tears: criteria to progress from phase 3

A

Full active range of motion without substitution

Five out of five RC strength

65 to 75% isokinetics

41
Q

RC rehab large to massive tears: phase 1 goals

A

Protect tissue- Abduction sling 6 to 8 weeks

Passive range of motion up to 130°

Manage pain and swelling

Full passive range of motion at 4 to 6 weeks

42
Q

RC rehab large to massive tears: phase 2 goals

A

D/C sling

Full active range of motion with without scapular substitution

Regain muscle strength

Return to ADLs pain-free

43
Q

RC rehab large to massive tears: phase 3 goals

A

Full function of upper extremity with restrictions

Five out of five RC strength

70% internal rotation, external rotation, isokinetics

Return to activity and sports week 16+

44
Q

RC rehab large to massive tears: phase 1 manual therapy

A

passive range of motion- flexion and external rotation only

Grade 2 and 3 GH and scapular mobs

45
Q

RC rehab large to massive tears: phase 2 manual therapy

A

assisted active range of motion to active range of motion per tolerance

Passive range of motion external rotation at 90/90

46
Q

RC rehab large to massive tears: phase 1 exercise, and modalities

A

pendulum and cane active assisted range of motion

stretching for mobility

Scapular mobility and strength

Cryotherapy and IFC as needed

47
Q

RC rehab large to massive tears: phase 2 exercises and modalities

A

UBE
Prone exercise for scapular strength
Closed kinetic chain, upper extremity activities
Isometrics proprioception

Cryotherapy and IFC as needed

48
Q

RC rehab large to massive tears: phase 3 exercises

A

High speed strength
Eccentric exercise
Progress resistance to 90/90 position
Plyometrics and diagonal patterns

49
Q

RC rehab large to massive tears: criteria to progress to phase 2

A

Full passive range of motion, 0 to 130° as tolerated
Minimal pain

50
Q

RC rehab large to massive tears: criteria to progress to phase 3

A

Full painless range of motion
No pain on exam

51
Q

Subscapularis repair precautions

A

no external rotation past 30° initially
No cross body adduction
No hand behind back or active internal rotation

52
Q

biceps tenodesis precautions

A

no extension
No horizontal abduction
No resisted elbow flexion
No shoulder flexion
No supination

For six weeks

MSK Shoulder (13 decks)

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