Shoulder Management 2

Question 1

The “speed limit” for rehab after repair

best environment for healing - first 6 weeks after repair

Answer 1

• immobilization

- limited PROM

Question 2

The “speed limit” for rehab after repair

post-op stiffness > 6 mos is (common/uncommon)

Answer 2

uncommon

Question 3

The “speed limit” for rehab after repair

% of pts who have post-op stiffness > 6 mos after RCR

Answer 3

3-10%

Question 4

The “speed limit” for rehab after repair

Though post-op stiffness > 6 mos is not common, at risk pts benefit from additional focus on

Answer 4

PROM earlier in the immediate post-op period

Question 5

RCR: Immobilization or early PROM?

Answer 5

insufficient evidence to provide conclusion or recommendation for immobilization or early PROM

Question 6

RCR rehabilitation: Perform early PROM in this plane

Answer 6

scapular

Question 7

RCR rehabilitation: Sagittal plane PROM places increased stress across this structure

Answer 7

supraspinatus tendon

Question 8

RCR rehabilitation: What is SAAE

Answer 8

supported
active
assistive
exercises

Question 9

RCR rehabilitation: Depending on surgical factors, begin AAROM/SAAE in this timeframe

Answer 9

between 3-8 weeks

Question 10

RCR rehabilitation: Why should you be cautious with pulleys for therex?

Answer 10

upright pulley activity produces significantly more mm activity as compared to supine activities

Question 11

Codman’s pendulums have minimal RC activation but are not truly

Answer 11

PROM

Question 12

Standard RC protocol for medium sized tear:

PROM to tolerance until

Answer 12

6 weeks

Question 13

Standard RC protocol for medium sized tear:

First 6 weeks…strengthening

Answer 13

light isometrics

Question 14

Standard RC protocol for medium sized tear:

Progress from PROM to AROM when?

Answer 14

6-8 weeks

Question 15

Standard RC protocol for medium sized tear:

When to initiate isotonic strengthening?

Answer 15

6-8 weeks

Question 16

Standard RC protocol for medium sized tear:

When can you progress to 2-3# weight or medium band strengthening?

Answer 16

10 weeks

Question 17

Standard RC protocol for medium sized tear:

When can you initiate prone ER at 90˚abduction?

Answer 17

10 weeks

Question 18

Standard RC protocol for medium sized tear:

Prepare for DC when?

Answer 18

16 week and beyond

Question 19

Shoulder surgical stabilization: What should be exhausted first

Answer 19

conservative management

Question 20

Shoulder surgical stabilization: how many different types of surgeries for this?

Answer 20

over 250

Question 21

Shoulder surgical stabilization: most common procedures

Answer 21

• capsular plication
• inferior capsular shift
• anterior capsulolabral repairs (ACLR)
• bankart repairs

Question 22

Shoulder surgical stabilization: These procedures are considered the gold standard for treatment of anterior instability

Answer 22

bankart repairs

Question 23

Shoulder imaging: radiographs

standard series views

Answer 23

• AP (ER/IR)
• axillary
• scapular Y

Question 24

Shoulder imaging: radiographs

In addition to AP, axillary, and scapular Y view, trauma series also includes

Answer 24

lateral views

Question 25

Shoulder imaging: CT

great for viewing these

Answer 25

• subtle or complex fx’s (Hill Sachs/Reverse Hill Sachs)
• arthritic changes
• loose bodies

Question 26

Shoulder imaging: MRI

Need intra-articular contrast for better viewing of these

Answer 26

• labrum

- rotator cuff