Total Shoulder Arthroplasty Flashcards
Patient who requires a TSA would have had injury to which structures?
Will have irreparable damage, destruction and deterioration to the:
- Humeral Head
- Glenoid Fossa
Primary indication for TSA?
Unremitting pain that have failed conservative management
What protocol is used to lay out guidelines for initiating isometric and active shoulder exercise post TSA?
Neer Shoulder Protocol
When should isometrics be utilized as per the Neer Shoulder Protocol?
3 weeks after surgery
When should Active Shoulder Exercises be utilized as per the Neer Shoulder Protocol?
6 weeks after surgery
What motions and to what degree are motions limited post TSA?
- IR and ER Beyond 35-45 degrees
- Extension past neutral
- Elevation of ARM up to 120 only (passed this is bad)
- Combined adduction, IR and extension
(Done to promote healing/protection of the anterior capsule)
What is a hemiarthroplasty?
Replacement of only one of the components (either the glenoid or humeral components)
What is a reverse TSA? Why would this be indicated?
Reversing the convex-concave relationship at the shoulder, via the prosthetic components
- Surgery of choice when patient has dysfunctional rotator cuff
Which approach is often utilized and what muscle is often detached?
- Anterior Approach
- Subscapularis muscle detached
Resisted motion to be avoided initially?
Resisted IR
- primarily anterior approach is used. Subscapularis is affected, therefore we would not want to produce resisted motion through this muscle
With a reverse total shoulder which approach is utilized?
Posterior Approach
- Also for repair of rotator cuff
Motion limitations of a reverse TS?
- NO extension or IR past neutral
- Only allowed 0-20 degrees ER and 90-120 degrees of elevation in scapular plane
Immobilizer use for TSA?
Not generally indicated unless RTC repaired
Sling used TSA vs rTSA?
TSA: sling for comfort
rTSA: 24/day for first 3-4 weeks. Removed only for pendulum exercises
