medsibridge UE surgery Flashcards
(39 cards)
what precautions are there post SAD
None, there is no repaired structures or surgical debridement of bone
what are the complications associated with SAD
- 2-3% incident rate
- infection
- scalene block nerve injury or pneumothorax
- patient positioning nerve injury
- portal placement suprascapular nerve or vascular injury
- resection incomplete or excessive
- adhesive capulets
what is the prognosis for SAD outcome
Good outcome
Jaeger 2016
1. 90% satisfaction in individuals with partial thickness impact on RTC
2. 70% satisfaction in individuals with full thickness RTC
3. 65% satisfaction in idvidauls with calcific tendonitis
Magaji 2012
individual with positive response to steroid injection, consistent HK test, mid arc pain and positive radiographic impingement reviewed more benefit than individual with 2 or less of the criteria
why is the supraspinatus thought to be more susceptible to tear
- it has a relatively avascular zone at it humeral insertion
how are overhead athlete RTC tears different that routine RTC tears
- routine tears are most often associated with mechanical/degenerative changes or compression of the RTC
- overhead athletes are associated with overuse of the muscles and not a mechanic impingement of the RTC
What is happening that the surgical site of a RTC during the reparative phase of recovery
- 5-8 weeks
- tendon to bone healing - fibroblast are actively producing collagen, callus formation is occurring in the bone tunnels
what is the typical time frame for the remodeling phase of a RTC
8-13 weeks - intitial strength program
13-22 functional return expectation
what complicates are most common with RTc repair
- persistent stiffness - most will improve with continued rehab
- repair failure (older people)
- infection
- CRPS
- DVT
what are the predictors to success of a RTC repair
- good for younger, earlier surgery, smaller tears and non smokers
- poor - over 65, manual laborers, comorbidites particularly with bone health, 5cm or greater tear, work comp injuries, incorrect diagnosis
COLE 2007
Which heals faster tendon to tendon healing or tendon to bone healing
tendon to tendon is fast than tendon to bone
what factors are commonly associated with SLAP injuries
- traction force on the arm
- repetitive overhead activity
- impingement
- instability
what patients have poor prognosis for labral reparis
- individuals over 40 with concomitant RTC tears
- heavy smokers and drinkers
type 1 SLAP lesion are commonly associated with predisposing factors
age, RTC disease, OA
- fraying of the superior labrum, but attachment is intact
type 2 SLAP lesion are commonly associated with what predisposing factors
overhead throwing athletes due to the forceful max ER and ABd position
- labrum and bicep have detached from the top of the glenoid
type 3 SLAP lesions are commonly associated with what predisposing factors
manual laborers
- bucket handle labral tear with intact biceps where the tear is dropping down into the GH joint
How long should you usually wait to start direct bicep strengthening following SLAP repair
12 weeks
return to sport of work typically occurs how long after SLAP repair
4-6 months
what are the common complication after SLAP repair
Weber 2012 4.7%
- repair failure or re tear
- persistent pain
- loss of motion
- infection
- instability
At what rate to individuals return to their prior level of activity after SLAP repair and what is the typical satisfaction rate of the surgery
- 80% good to excellent satisfaction rate
- 70% previous level of activity
- 60% of throwing athletes return to previous level of performance
what percentage of individual report persistent pain and loss of function post SLAP repair
- 70% report persistant pain
- 80% report loss of function
what type of throwing athlete injury responds best to a SLAP repair
- traumatic
- insidious onset has lower potential for successful outcomes post op
What are the different ways in which the subs cap is taken down in TSA
- tenotomy or osteotomy of the lessor tubercle
at what point would you expect an osteotomy subscapularis uncemented stem to transition to lamellar bone healing post TSA
12 weeks
what are the typical ROM expectation following TSA
- flexion 140 and abduction to 120 degrees
- IR 60 ER 70
