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South College MSK 4 > Week 2: Surgical Treatment of Impingement and Rotator Cuff Tears > Flashcards

Week 2: Surgical Treatment of Impingement and Rotator Cuff Tears Flashcards

1
Q

Test item cluster for full thickness tear

A
  • Drop arm sign
  • Painful arc
  • Infraspinatus muscle test
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2
Q

Drop arm sign

A
  • Active elevation of the arm in the scapular plane, then reverse
    • with pain or arm drops
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3
Q

Painful arc

A
  • Elevate in the scapular plane

- + is pain or catching b/t 60-120 degrees

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4
Q

Infraspinatus muscle test

A
  • Resisted contraction

- + with pain, weakness, or lag

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5
Q

How are RC injuries classified?

A
  • Partial thickness

- Full thickness

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6
Q

How are partial thickness tears described?

A
  • Acromial side

- Humeral side

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7
Q

Acromial vs Humeral side

A

Acromial is easier to see and fix

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8
Q

How are full thickness tears described?

A

By size:

  • Small (< 1 cm)
  • Medium (1-3 cm)
  • Large (3-5 cm)
  • Massive (> 5 cm)
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9
Q

How is direction of a RC tear described?

A
  • Horizontal (grade IA)

- Longitudinal (IB): easier to fix

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10
Q

RC Treatment options

A
  • Non-operative management
  • Decompression w/o repair
  • Repair
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11
Q

Decompression w/o repair

A

Underside of acromion is rasped

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12
Q

Post operative management of subacromial decompression

A
  • Phase I (0-2 weeks)
  • Phase II (3-6 weeks)
  • Phase III (7-12 weeks)
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13
Q

Phase I (0-2 weeks) for Post operative management of subacromial decompression

A
  • ROM: No OH lifting, but can return to AROM/PROM as symptoms allow
  • Modalities: Cryo 3-5x/day; IFC is pt complains of pain
  • Ex: pendulums, cans w/in painfree ROM, isometrics, rhythmic stabilizations, grade I-II MMT
  • Goals: decrease pain and inflammation, return ROM, minimize strength loss
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14
Q

Phase II (3-6 weeks) for Post operative management of subacromial decompression

A
  • ROM: progressing to full ROM at end of 6 weeks
  • Modalities: cryo and IFC is pt complains of pain
  • Ex: Unweighted GH ex, IR/ER in scaption, sidelying ER, prone ER w/ h. ABD, lower and mid traps, bi/tri, rhythmic stab
  • Goals: Improve strength, normalize scapulohumeral rhythm
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15
Q

Phase III (7-12 weeks) for Post operative management of subacromial decompression

A
  • ROM: Full ROM
  • Modalities: cryo or hot back
  • Ex: scap stabilization, OKC/CKC total arm, perturbation training, plyo
  • Goals: return of static strength and endurance, normal scap motion, return to sport
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16
Q

How does subacromial decompression compare with conservative care?

A

No significant difference, but conservative care costs less

17
Q

Surgical intervention for RC

A
  • Arthroscopic
  • Mini-open/deltoid splittiing
  • Open w/ detachment of deltoid
18
Q

Factors impacting management of surgery for RC repair

A
  • Surgical approach
  • Size/location of tear
  • Quality of soft tissue and bone
  • Quality of fixation
19
Q

Post-operative Management of Rotator

Cuff Repair – Small / Medium Tears

A
  • Arthroscopic or deltoid splitting approach:
  • Primary goal is to protect the repair
  • Sling for 4 weeks (can be d/c earlier based on MD recommendations and for PROM)
  • Emphasis on PROM for 4 weeks – except ER
  • No AROM or resistance
  • Ice and stim for pain control
  • Grade I/II Mobs for pain relief
  • Active-assisted motion in supine can be added week 3
  • Active-assisted motion in sitting or standing
    can be added week 4
  • Progress to active exercise after 6 weeks
  • Light resisted exercises for RC may be initiated after 8 weeks if active motion is satisfactory
20
Q

Post-operative Management of Rotator

Cuff Repair – Large / Massive Tears

A
  • Large tears with open deltoid detachment:
  • Primary early goal is to protect the repair and reduce pain
  • Passive motion within limits imposed by surgeon after 1 to 2 weeks
  • Sling for 6-8 weeks (can be d/c earlier based on MD recommendations and for PROM)
  • Emphasis on passive motion for 4 weeks
  • No elevation for 6-8 weeks because of deltoid takedown
  • Continue passive motion for 3-4 weeks
  • AAROM can begin 4-6 weeks. Avoid elevation, ER in scapular plane
  • Active motion after 6 to 8 weeks
  • Progress to active exercise after 8 weeks
  • Light resisted exercises for RC may be initiated after 10 weeks if active motion is satisfactory
  • Full ROM should be achieved between 12-16 weeks
21
Q

Is there a possibility for accelerated rehab?

A

NO, if aggressive PT is applied it could cause further harm

South College MSK 4 (14 decks)

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