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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
Open with detachment of deltoid
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
types of fixations for arthroscopic repair
Single row Double row- screw goes to the bone and suture goes thru the muscle Transosseous bridge- 4 anchors
27
RC rehab small to medium tears: phase 1 timeline
0 to 6 weeks
28
RC rehab small to medium tears: phase 1 goals
protect tissues- sling 4 weeks Restore passive range of motion - week 4 external rotation Manage pain and swelling
29
RC rehab small to medium tears: phase 2 timeline
7 to 12 weeks
30
RC rehab small to medium tears: phase 2 goals
D/C sling Full active range of motion without scapular substitution Improve control of shoulder Normalize arthrokinematics
31
RC rehab small to medium tears: phase 3 timeline
13+ weeks
32
RC rehab small to medium tears: phase 3 goals
improve strength, power, endurance Improve neuromuscular control Prepare athlete for return to sport
33
RC rehab small to medium tears: phase 1 manual therapy
PROM, grades 1-2 mobs for pain AAROM AT THREE WEEKS SUPINE No active range of motion
34
RC rehab small to medium tears: phase 2 manual therapy
AROM per tolerance Joint mobilization for improved arthrokinematics
35
RC rehab small to medium tears: phase 1 exercise, and modalities
pendulum exercise Scapular mobility and strength Active exercise at six weeks Cryo, IFC estim as needed
36
RC rehab small to medium tears: phase 2 exercise, and modalities
light resisted at eight weeks Shoulder and scapular, strength, prone, or close, kinetic chain Upper extremity endurance exercise Cryotherapy and IFC as needed
37
RC rehab small to medium tears: phase 3 exercise
High-speed strength Progress the band to 90/90 position Plyometrics and diagonal patterns
38
RC rehab small to medium tears: criteria to progress to phase 2
Full passive range of motion Minimal pain
39
RC rehab small to medium tears: criteria to progress to phase 3
Full active range of motion without scapular substitution No pain or reactive inflammation with strength
40
RC rehab small to medium tears: criteria to progress from phase 3
Full active range of motion without substitution Five out of five RC strength 65 to 75% isokinetics
41
RC rehab large to massive tears: phase 1 goals
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
RC rehab large to massive tears: phase 2 goals
D/C sling Full active range of motion with without scapular substitution Regain muscle strength Return to ADLs pain-free
43
RC rehab large to massive tears: phase 3 goals
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
RC rehab large to massive tears: phase 1 manual therapy
passive range of motion- flexion and external rotation only Grade 2 and 3 GH and scapular mobs
45
RC rehab large to massive tears: phase 2 manual therapy
assisted active range of motion to active range of motion per tolerance Passive range of motion external rotation at 90/90
46
RC rehab large to massive tears: phase 1 exercise, and modalities
pendulum and cane active assisted range of motion stretching for mobility Scapular mobility and strength Cryotherapy and IFC as needed
47
RC rehab large to massive tears: phase 2 exercises and modalities
UBE Prone exercise for scapular strength Closed kinetic chain, upper extremity activities Isometrics proprioception Cryotherapy and IFC as needed
48
RC rehab large to massive tears: phase 3 exercises
High speed strength Eccentric exercise Progress resistance to 90/90 position Plyometrics and diagonal patterns
49
RC rehab large to massive tears: criteria to progress to phase 2
Full passive range of motion, 0 to 130° as tolerated Minimal pain
50
RC rehab large to massive tears: criteria to progress to phase 3
Full painless range of motion No pain on exam
51
Subscapularis repair precautions
no external rotation past 30° initially No cross body adduction No hand behind back or active internal rotation
52
biceps tenodesis precautions
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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