Flashcards in [AC] Orthopaedics Upper Limb Deck (18):
The rotator cuff functions as two muscles divided by the biceps tendon
1) Anterior .. ?
2) Poster ... ?
1) Anterior - Subscapularis
2) Posterior - Supraspinatus , infraspinatus, teres minor
With rotator cuff dysfunction (infero-medial pull of humerus), the superior directed pull of the deltoid predominates which can lead to:
1) Cuff fatigue
3) Partial tears
4) Full thickness tears
Post op rehabilitation principles remain constant regardless of whether the patient has had post injury or post surgery with specific focus on what areas (for shoulder surgery) ?
1) Rotator cuff
4) Capsuloligamentous complex (CLS)
5) Scapulothoracic muscles (serratus anterior, rhomboids, trapezius etc)
Pre-requisites for post op rehabilitation of shoulder?
1) Patient must be compliant with program
2) Surgeon must provide therapist with surgical findings, modifications and precautions
3) Therapist must interact with surgeon regarding patients progress
Isometric short arc to long arc; sub maximal to maximal are some ideas of progression of exercises for
post op shoulder rehabilitation
Rehabilitation program is individualised based on what for post - op shoulder?
- Tissue reactivity / elasticity
- Personality / goals
- Surgical concerns / complications
Results of conservative therapy is dependent on the status of cuff:
1) Cuff intact gives generally greater than 80% satisfactory results
2) Cuff torn generally 50% or worse results
With rotator cuff tears, most patients are encouraged to continue exercises for at least how long?
How long is recommended for return to sports?
Continue exercise for at least a year
Return to sports 6-9 months
What is the recurrence rate following shoulder dislocations? (ACC Shoulder Guidelines)
What does this mean?
Aged 11 - 20 years = 94%
Aged 20 - 30 years = 79%
Aged >40 years = 10%
So recurrence rate is much higher for those aged under 20 and thus we may refer for stabilisation surgery
What is the predominant clinical feature of glenohumeral arthritis?
What is the primary indication for surgery?
Comment on the prevalence of total shoulder placement surgery in comparison to knee and hip?
Shoulder joint replacement surgery is NOT common but we will encounter it
After total shoulder joint surgery patients are usually in a
polyswing; which limits arm movement away from the body
What is the common cause of an olecranon fracture?
Fall and land on point of elbow
What is a complication of a shaft of humerus fracture?
Radial nerve palsy; as it wraps around the humerus.
Results in loss of wrist extension
diagnosis of a scaphoid fractures can involve?
1) Compression test
2) Anatomical snuff box tenderness
3) Scaphoid tubercle tenderness
A rupture of extensor pollicis longus resulting in a loss of thumb extension can be associated with what kind of fracture?
Distal radius fracture as it wraps around listers tubercle before turning 45 degrees towards the thumb
What patient group would a distal radius fracture be more common in?
Elderly...more common in women