Total Shoulder Replacement Flashcards
indications
severe OA
inflammatory arthritis
RA
post-traumatic arthritis
RC tear
shoulder fx or severe trauma
AVN
no relief from PT, injections, medication, etc.
RC tear –> indications
a combo of severe arthritic and a massive non-reparable RC tendon tear
primary goal of TSH
pain relief
secondary goals of TSH
improve motion, strength and fxn
dx tests
plain radiographs
what do plain radiographs show
bone spurs
damaged joint surfaces
narrowed joint surfaces
how long does the procedure take
2 hours
a TSH is an
open repair
pt is given general anesthesia and a nerve block
procedure
separate deltoid and pec muscles
incise subscap
remove humeral head
debride glenoid
place prosthesis
TSR is
most common
conventional
what is a TSR
highly polished metal humeral head attached to a stem w/ a plastic glenoid
components of TSR
come in various sizes
if the bone is of good quality –> TSR
may use press fit humeral component
if bone is soft –> TSR
may need to cement the humeral component
what is the glenoid component –> TSR
cemented
types of prostheses
conventional
hemi-arthroplasty
conventional prosthesis
pts w/ bone on bone arthritis and intact RC
hemi-arhtoplasty
can replace only the humeral component if glenoid is in good condition
phase 1
0-3 weeks
precautions –> phase 1
no AROM
when supine, use towel roll under elbow
no supporting of body weight on hand or lifting anything
when supine, use towel roll under elbow –> precautions phase 1
avoid hyperextension, anterior capsule stretch and subscap stretch
PROM goals –> phase 1
90 degrees F/E
45 degrees ER in scaption
90 degrees ABD w/o rotation
70 degrees IR in scaption
AAROM –> phase 1
allowed w/ caution
post-op day 1
PROM
avoid stress on anterior capsule and subscap
PROM –> post op day 1
to tolerance (but not past 90)
ER in scaption to about 30 degrees
IR to chest
post up day 2-20
AAROM flexion, ABD, ER in scaption
submax pain free isometrics w/ shoulder in neutral
AAROM elbow
pulleys
when could we do pulleys –> post up 2-20
if flexion and ABD PROM > 90
post op days 10-21
progress PROM, AAROM in pain free ranges
strengthen elbow, forearm, wrist and hand
sling –> post op days 10-21
abduction w/ pillow for comfort
while sleeping
when do we d/c pillow –> post op 10-21
gradually by week 3-4
PROM goals –> weeks 3-6
140 flexion
120 ABD
60 or more ER
70 IR in scaption
active motion –> weeks 3-6
FE to 100 w/ good mechanics
what do we re-establish –> weeks 3-6
dynamic shoulder stability
use the sling –> weeks 3-6
as needed
precautions –> weeks 3-6
lifting no heavier than a coffee cup
no supporting of BW w/ hands or arms
no sudden movements
what should we focus on in week 3
scapula strengthening
continue w/ PROM, AAROM, isometrics
scap strengthening –> week 3
begin horizontal ADD
initiate rhythmic stabilization
what should we do in week 4
begin AROM
progress scapula strengthening
begin AROM –> week 4
FE, IR, ER and ABD in supine
in pain free ROM
progress scap strengthening –> week 4
begin isometrics of RC periscapular exercises
phase 3
weeks 6-12
moderate strengthening
goals of weeks 6-12
gradual restoration of shoulder strength, power and endurance
what do we want to increase –> weeks 6-12
NM control
there is a –>weeks 6-12
gradual return to fxnal activities w/ UE
precautions –> weeks 6-12
no lifting >5 lbs
no sudden lifting or pushing activities
no sudden jerking motions
what should we increase in week 6
anti-gravity FE, ABD
AROM IR & ER in scaption
PROM w/ light stretching
what should be initiated –> week 6
assisted IR behind the back
what should we begin –> week 6
light fxnal activities
what should we begin –> week 8
progressive strengthening of FE in supine
1-3#
what should we begin –> weeks 10-12
resisted flexion, ABD, ER w/ elastic band
what should we progress –> weeks 10-12
strengthening of IR/ER
strengthening of IR/ER –> weeks 10-12
progress IR from behind back from AAROM –> AROM
still avoid stress on anterior capsule
phase 4
weeks 12-16
advanced strengthening
goals of phase 4
full, pain free AROM
enhance fxnal use of UE
improve muscle strength, power, endurance
advance to more advanced fxnal activities
precautions of phase 4
avoid exercises that stresses anterior capsule
ie: no combo of ER and ABD above 80 degrees of ABD
weeks 12+ –> rehab
pt is now on HEP to progress strengthening
can return to moderately challenging fxnal activities
4-6 months –> rehab
return to recreational hobbies
