Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MSK 1 > 9/27 - Rotator Cuff Lesions & Post-Op > Flashcards

9/27 - Rotator Cuff Lesions & Post-Op Flashcards

(77 cards)

Start Studying
1
Q

what are influencing factors of how a postop RC tear will heal (6)

A

age
activity level
type of repair
tissue quality
size of tear
location of tear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what ab the tissue quality dictates how a postop RC heals

A

soft tissue integrity
- repair and surrounding tissue
osseous integiry
- fixation strength

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the type of RC repair

A

open (delt taken down)
mini-open (delt split)
arthroscopic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the size categories of RC tears

A

small <1cm
medium 1-3cm
large 3-5cm
massive >5cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are size measurements of the RC tear really looking at and what do they tell you

A

looking at how much shoulder footprint has been disrupted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

where do most RC tears start and how do they extend

A

start in supra
- extend either posteriorly or anteriorly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are possible locations of the RC tear

A

isolated to supraspinatus
suprapinatus + infraspinatus
subscapularis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what demographics led to a positive outcome in postop RC tears (2)

A

younger age
male

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what clinical factors led to a positive outcome in postop RC tears (5)

A

higher BMI
no DM
no obesity
inc pre-op ROM
inc sports activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what about cuff integrity led to positive outcomes in post op RC tears (4)

A

smaller sagittal size
LESS RETRACTION
less fatty infiltrate
no multiple tendon involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what happens anatomically when there is a RC tear

A

retraction (under tension)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what role does time since injury play in success of a surgical intervention

A

longer it has been torn, tissue becomes scarred
- might never restore anatomic footprint

window for when you can get a successful repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what surgical procedure factors led to positive outcomes in postop RC tears (2)

A

no concomitant biceps
no concomitant AC procedures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what had the most significant impact on a failed RC repair

A

fatty infiltration
- see retears

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what had moderate impacts on a failed RC repair (3)

A

multiple tendon involvement
larger tear size
lower pre-op strength

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is an important consideration for RC repairs in older age

A

no impact on function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is an arthroscopic acromioplasty used for?

A

impinging lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what does an arthroscopic acromioplasty do

A

acromial spur removed
coracoacromial ligament released
AC joint osteophytes excised

all this allows for more space in the subacromial region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is an open repair done for

A

full thickness RC tears

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

pros of an open repair (2)

A

exposes all involved anatomy
allows for mobilization of tendons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

cons of open repair (5)

A

release of delt
hospital stay
longer rehab
unable to examine GH joint/subacromial space
dec cosmesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what do you see arthroscopically assisted mini-open repairs

A

full thickness RC tear
- usually w larger tears

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

pros of arthroscopically assisted mini-open repair (3)

A

visualization of cuff tear (open)
no deltoid release (arthroscopy)
possibly better fixation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is the basics of what happens during a RC repair

A

take the delt away
restore anatomic footprint to where RC should be attached
suture to bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what does a mini open repair create and what are the pros and cons to this
bleeding area - helps w healing con - uncomfortable bc of how many nerve endings in bone
26
when is an arthroscopic RC repair done
full thickness RC tear
27
pros to an arthroscopic RC repair (4)
no delt release limited morbidity accelerated rehab improved cosmesis
28
what is a con to arthroscopic RC repairs
technically demanding
29
what are rehab considerations after as surgical repair (2)
careful w activating ms early on - only sutures holding it there ms is gonna want to return to retracted position
30
what is an important consideration when looking at anatomic integrity
doesn't correlate w functional outcomes or pt satisfaction
31
what does a more conservative approach mean for outcomes
healing might be better *may improve rate of tendon healing (less re-tears) see some early stiffness but usually regain mobility *no long term stiffness (1yr)
32
what was seen in early vs delayed ROM in post-op
no significant differences
33
what dictates how long until mobilization post-op
depends on surgeon depends on tear and tissues
34
what risk accompanies early ROM
inc risk of re-tear
35
what is the general rule of thumb for post-op rehab
don't add load until good ROM don't add resistance until good mobility mobility before inc resistance for strength
36
4 PT exercises in phase 1 post op
*protection & early motion* PROM flex - distal elbow, wrist supine ER w dowel (PROM) supine AAROM flex forward bow (arm supported)
37
3 PT exercises in phase 2 post op
*AA-AROM* AAROM flex >> AROM flex ball roll (yoga ball on table) supported wall slide (use foam roller)
38
3 PT exercises in phase 3 post op
*strengthening* AROM flex resisted ER, IR, ext, rows forward punch
39
5 PT exercises in phase 4 post op
*late strengthening* AROM flex/ABD SL ER standing ER @90deg prone ER @90deg prone H-ABD (Ts and Ys)
40
why are patients immobilized in ABD sling in first 6wks post op
prevents "wringing out" dec tension on repair
41
why is PROM beneficial in phase 1
may assist w proper orientation of type 1 collagen assist w proper tendon gliding
42
what should be avoided during PROM in phase 1
"stretching"
43
what are we trying to establish in phase 1
voluntary ms control
44
why should pendulums be prescribed w caution in early rehab
highly variable RC activation performed incorrectly using shoulder vs body
45
what are interventions at phase 1 other than other therex (4)
pt ed immediate PROM manual scap strength cryotherapy
46
what are qualities of immediate PROM in phase 1
@ elbow, wrist, and hand - modify w biceps involvement achieve stage ROM goals in scap plane caution w excessive ABD & IR
47
why is cryotherapy utilized in phase 1
control post-op pain dec swelling & ms spasm
48
what dictates the stage the pt is in
milestones not time
49
what milestones must be achieved to progress from phase 1 to 2
appropriate healing - compliant w immobilization - compliant w precautions staged ROM goals on target - scaption (90-120) - ER @20deg ABD (20-45) - ER @45deg ABD (40-60) minimal pain w ROM - ~2/10
50
what are interventions in phase 2 (10)
dc sling (consider pain & compliance) progress to full PROM initiate self-assisted AAROM >> AROM strengthening (no resisted RC) dynamic stability of ST independent w ADLs (by end of phase) cont pec minor P-AA - AROM cont rhythmic stabilization scap PNF - middle and lower traps strength low level functional activities
51
where is stability focused in phase 2
scapulothoracic
52
what strengthening interventions can be implemented at the end of phase 2 (3)
isometrics scaption w ER (full can) SL ABD to 45deg - inc supraspinatus w dec risk of impingement
53
what is important to be aware of w interventions in phase 2
don't want to recreate shoulder pain - avoid painful exercises
54
what are milestones to progress from phase 2 to 3 (3)
staged AROM achieved - 0-2/10 pain - without compensation strengthening activities progressing - 0-2/10 pain normal scapular position - static and dynamic - normal upward rotation
55
phase 3 interventions/goals (7)
full P/AROM dynamic shoulder stability shoulder strength & endurance CKC activities neuro re-ed (ie joint reposition - IR/ER) return to work activities initiate modified rec activities
56
guidelines for phase 3 interventions (3)
in scapular plane initially no compensatory patterns high rep focus
57
milestones to progress from phase 3 to 4 (2)
adequate strength and dynamic stability for progression to work / sport activity normal scapular position - static and dynamic
58
what are 3 interventions in phase 4
replicate demands of ADL and work activity plyometric program initiate interval sport program
59
what is the surgery of choice in younger populations for massive RC tears? where is RC tear for this to be a viable option?
lat dorsi transfer - posterosuperior tears
60
why do a lot of RC tears develop into massive RC tears
atrophy fatty infiltrate
61
who is a good candidate for a non-op management of an irreparable massive RC tear? what is a con of this management?
low demand pts OA over time
62
pros and cons of partial repair and debridement of an irreparable massive RC tear
pros - good results cons - limited long-term data
63
who is a good candidate for a reverse TSA of an irreparable massive RC tear
elderly pts w advanced OA
64
who is a good candidate for a lat dorsi transfer for an irreparable massive RC tear? what is a con of this management?
younger pts w posterosuperior tears high complication rates
65
what are 2 techniques for superior capsule reconstruction
fascia lata autograft dermal allograft
66
what is needed for a superior capsule reconstruction to be successful
functioning delt and subscap
67
what is the point of a superior capsule reconstruction
prevents superior migration
68
what are treatment options for irreparable massive RC tears (5)
non op partial repair and debridement reverse TSA lat dorsi transfer superior capsule reconstruction
69
goals for phase 1 after a superior capsule reconstruction for a massive RC tear (4)
*maximal protection* protect repair min pain/inflammation maintain mobility accessory joints pt ed
70
interventions for phase 1 after a superior capsule reconstruction for a massive RC tear (6)
immobilized in ABD sling x6wks cryotherapy AROM cervical spine AROM elbow, wrist, hand out of sling ball squeezes scap retraction/depression
71
goals for phase 2 after a superior capsule reconstruction for a massive RC tear (5)
*ROM and endurance* restore ROM inc RC endurance restore SH rhythm initiate LIGHT ADLSs wean sling
72
interventions for phase 2 after a superior capsule reconstruction for a massive RC tear (4)
PROM / AROM to tolerance - ex: SL ABD, SL H-ABD delt activation ER function (dependent on tissue quality) scap and GH isometrics
73
goals for phase 3 after a superior capsule reconstruction for a massive RC tear (3)
*strength* advanced strength restore functional ROM resume higher level functional activities
74
interventions for phase 3 after a superior capsule reconstruction for a massive RC tear (3)
progressive resisted ROM initiate CKC exercises ** normal SH rhythm**
75
goal for phase 4 after a superior capsule reconstruction for a massive RC tear
advanced strength and return to activity - as appropriate on pt case basis
76
interventions for phase 4 after a superior capsule reconstruction for a massive RC tear (4)
***ENDURANCE*** overhead strength advanced CKC plyometrics
77
what are the 7 keys to success to rehab
establish PROM restore ER strength establish shoulder balance improve scap position & movement gradually inc loads avoid aggressive activities early on gradual return to functional activities

MSK 1 (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions