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msk 4 > week 2 > Flashcards

week 2 Flashcards

1
Q

start of 2024 Student_Soft Tissue Shoulder Surgery

A
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2
Q

Baseline considerations

A

read post op report

in post op report the surgeon will have information for you to possibly follow

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3
Q

Surgery for Impingement Syndrome

A

Subacromial Decompression (Acromioplasty)
* Indicated if patients not improved after >6 months
* Goal of decompression is pain relief and improved function
* Any inflamed bursa is resected
* Coraco-acromial ligament may also be removed or cut
* Removal of osteophytes

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4
Q

What is Subacromial Decompression (Acromioplasty)

A

Subacromial Decompression, also known as Acromioplasty, is a surgical procedure designed to relieve impingement in the shoulder. This condition, often known as shoulder impingement syndrome, occurs when the tendons of the rotator cuff are compressed during shoulder movements. The surgery involves removing or shaving part of the acromion, the bony projection on the scapula (shoulder blade), to create more space in the subacromial space. This helps to reduce pressure on the tendons and bursa, alleviate pain, and improve shoulder function. The procedure is typically performed arthroscopically, using small incisions and a camera to guide the surgical instruments.

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5
Q

what are the four rotator cuff muscles

A

sits

supraspinatus, infraspinatus, teres minor, subscapularis

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6
Q

need to know what is scapular plane vs cardinal plane

A

adduction and abduction occur in the frontal plane the scapular plane is in and down with the arm about 30 degrees forward. This is known as scaption. cardinal plane I think is following the frontal plane

AI definition

Scapular Plane:

Definition: The scapular plane is the plane in which the scapula (shoulder blade) naturally rests, which is approximately 30 to 45 degrees forward of the coronal (frontal) plane.

Movement: Movement in this plane, often called “scaption,” refers to shoulder elevation in this plane, combining elements of both flexion and abduction. This position is considered more natural and functional for many shoulder movements.

Significance: Exercises and movements in the scapular plane are often less stressful on the shoulder joint and rotator cuff tendons, making them beneficial in both rehabilitation and strengthening contexts.

Cardinal Plane:

Definition: The cardinal planes refer to the three primary planes of movement: sagittal, coronal (frontal), and transverse (horizontal) planes.

Sagittal Plane: Divides the body into right and left halves. Movements include flexion and extension.

Coronal (Frontal) Plane: Divides the body into anterior (front) and posterior (back) halves. Movements include abduction and adduction.
Transverse (Horizontal) Plane: Divides the body into superior (top) and inferior (bottom) halves. Movements include rotation.

Movement: Each cardinal plane describes a distinct axis of movement. For the shoulder:

Sagittal Plane: Shoulder flexion and extension.
Coronal Plane: Shoulder abduction and adduction.

Transverse Plane: Shoulder internal and external rotation.

Significance: Understanding movements in these planes helps in analyzing and instructing proper movement patterns, ensuring balanced muscle development and reducing the risk of injury.

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7
Q

something you have been wondering is what to do when there are surgeries and major injuries. Don’t forget that you will have a post op report

A
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8
Q

What surgical procedure is performed for impingement syndrome that involves removing part of the acromion?

A

Subacromial Decompression (Acromioplasty).

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9
Q

When is surgery indicated for patients with impingement syndrome?

A

Surgery is indicated if patients have not improved after more than 6 months.

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10
Q

What are the goals of decompression surgery for impingement syndrome?

A

The goals of decompression surgery are pain relief and improved function.

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11
Q

What is done to any inflamed bursa during surgery for impingement syndrome?

A

Any inflamed bursa is resected during the surgery.

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12
Q

Which ligament may be removed or cut during surgery for impingement syndrome?

A

The Coraco-acromial ligament may be removed or cut.

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13
Q

What is removed during surgery for impingement syndrome to help alleviate symptoms?

A

Osteophytes (bone spurs) are removed during the surgery.

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14
Q

What procedure involves the removal of a portion of the anterior acromion for treating impingement syndrome?
Answer: Acromioplasty.

A

Acromioplasty.

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15
Q

How is a portion of the anterior acromion removed during an acromioplasty?

A

It is removed with a burr through an arthroscope.

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16
Q

What is the expected success rate for acromioplasty?

A

Around 90% of cases can expect a satisfactory result.

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17
Q

What are the advantages of the arthroscopic method of acromioplasty?

A

Cosmesis and cost advantages.

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18
Q

What determines the choice between open or arthroscopic acromioplasty?

A

The expertise of the surgeon.

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19
Q

What did Brox report regarding outcomes between physical therapy and surgery at 2 years?

A

Brox reported similar outcomes between physical therapy and surgery at 2 years.

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20
Q

What is used for comfort after arthroscopic decompression surgery?

A

Sling for comfort.

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21
Q

When are exercises started after arthroscopic decompression surgery?

A

Exercises are started the day of the surgery.

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22
Q

What type of exercises are initiated post-arthroscopic decompression?

A

Range of motion exercises.

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23
Q

When can resisted exercises be performed after arthroscopic decompression?

A

Resisted exercises can be performed as tolerated.

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24
Q

How long are sports and work activities restricted after arthroscopic decompression surgery?

A

Sports and work activities are restricted for 2-3 months.

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25
Q

What exercises are started on Day 1 post-op after acromioplasty?

A

PROM, AAROM (scaption), pendulums, and wand exercises.

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26
Q

When can a patient progress to AROM exercises after acromioplasty?

A

As tolerated.

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27
Q

Which muscles are focused on for scapular stabilization post-acromioplasty?

A

Lower traps and serratus.

28
Q

What type of exercises are performed at multiple angles post-acromioplasty?

A

Isometric exercises.

29
Q

Which muscle groups are emphasized during post-acromioplasty rehabilitation?

A

Scapula, rotator cuff (RC), and other glenohumeral (GH) joint muscles.

30
Q

Who usually determines the specific exercise progressions after acromioplasty?

A

Surgeons usually have their own protocol about exercise progressions.

31
Q

What occurs to the tendon in calcific tendinitis?

A

Degeneration of tendon with fibrillation.

32
Q

What is seen on an x-ray in cases of calcific tendinitis?

A

Calcium deposits.

33
Q

How do calcium deposits affect the tendon in calcific tendinitis?

A

Deposits increase tendon size, leading to impingement and swelling.

34
Q

What condition can result from the rupture of calcium deposits in calcific tendinitis?

A

Subacromial bursitis.

35
Q

What imaging technique has been shown to be beneficial for calcific tendinitis?

A

Ultrasound (US).

36
Q

What 3 Item cluster would test for a full thickness tear?

A

Drop arm sign,

painful arc

infraspinatus muscle test

37
Q

How is the Drop Arm Sign performed?

A

Active elevation of the arm in the scapular plane, then reverse.

38
Q

What indicates a positive Drop Arm Sign?

A

Pain or the arm drops.

39
Q

How is the Painful Arc test performed?

A

Elevate the arm in the scapular plane.

40
Q

What indicates a positive Painful Arc test?

A

Pain or catching between 60-120 degrees.

41
Q

How is the Infraspinatus muscle test described by authors?

A

With the arm at the side.

42
Q

What indicates a positive Infraspinatus muscle test?

A

Pain, weakness, or lag.

43
Q

What is the positive likelihood ratio (LR) when 3 tests are positive and the patient is over 60 years old?

A

+LR is 28.0.

44
Q

What is the positive likelihood ratio (LR) when 3 tests are positive regardless of age?

A

+LR is 15.6.

45
Q

What is the negative likelihood ratio (LR) when 3 tests are negative?

A

-LR is 0.16.

46
Q

What is the positive likelihood ratio (LR) when 2 tests are positive?

A

+LR is 3.6.

47
Q

Partial thickness tear happens on what sides of the shoulder

A

acromial side or the humeral side

48
Q

what are the types of full thickness tears

A

Small (<1cm)
* Medium (1 – 3 cm)
* Large (3 – 5 cm)
* Massive (> 5 cm)

49
Q

What are the different grades of tears for rotator cuff injuries

A

grade IA- horizontal tears

grade IB- longitudinal tears

50
Q

What is one type of surgical intervention for a rotator cuff injury?

A

Arthroscopic.

51
Q

What is the mini-open/deltoid splitting approach for rotator cuff injury surgery?

A

A surgical intervention for rotator cuff injury that involves a small incision and splitting of the deltoid muscle.

52
Q

What does the open surgical approach for rotator cuff injury involve?

A

Detachment of the deltoid muscle.

53
Q

What are the surgical interventions for rotator cuff injury

A
  • Transverse tears
  • Vertical tears
  • Tears with retraction
  • Avulsion of cuff
  • Massive avulsion of cuff
54
Q

What type of rotator cuff tear involves a tear that runs horizontally across the tendon?

A

Transverse tears.

55
Q

What type of rotator cuff tear runs vertically along the tendon?

A

Vertical tears.

56
Q

What type of rotator cuff tear involves the tendon pulling away from its attachment?

A

Tears with retraction.

57
Q

What factors is post-operative management of rotator cuff repair dependent on?

A

Surgical approach, size & location of tear, quality of soft tissue & bone, quality of fixation.

58
Q

Who decides the specifics of post-operative management for rotator cuff repair?

A

The surgeon.

59
Q

Why is communication with the surgeon critical for post-operative management?

A

To request a copy of the surgical report, protocol, and review referral (if referred) for post-op guidelines.

60
Q

Is there a consensus for post-op rotator cuff repair protocol?

A

No, it is crucial to know the particular surgeon’s protocols or guidelines.

61
Q

What is Biceps Tenodesis used to treat?

A

A torn long head (LH) bicep tendon.

62
Q

Where is the tendon removed from during a Biceps Tenodesis?

A

From the proximal insertion at the supraglenoid area.

63
Q

Where is the bicep tendon attached after being removed in a Biceps Tenodesis?

A

Attached to the humerus.

64
Q

What is an example of a surgical technique used in Biceps Tenodesis?

A

Sub-pectoral.

65
Q

What is important to consult for post-operative rehabilitation after Biceps Tenodesis?

A

The operative report and the surgeon’s protocol/guidelines.

66
Q

END OF 2024 soft tissue shoulder surgery

A
67
Q
A

msk 4 (21 decks)

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