Reverse Shoulder Replacement

Question 1

when is a RTSR used

Answer 1

RC is completely torn

severe arthritis

failed conventional TSR

Question 2

what are switched in rTSR

Answer 2

glenoid and humeral head components

Question 3

where is the “ball” attached

Answer 3

where the glenoid was

Question 4

where is the glenoid attached

Answer 4

attached to the top of the humerus

Question 5

how does the deltoid move

Answer 5

raises the arm overhead instead of the RC

Question 6

what is there a higher risk of

Answer 6

dislocation

after rTSR than conventional TSR

Question 7

what should we avoid

Answer 7

shoulder extension beyond neutral

combination of shoulder ADD and IR for 12 weeks post-op

Question 8

how can the shoulder dislocation

Answer 8

with IR and ADD w/ extension

Question 9

expectation

Answer 9

normal/full AROM of shoulder is not expected post rTSR

Question 10

what should we expect after rTSR

Answer 10

105 active flexion

Question 11

what is the stability and mobility of the shoulder dependent on

Answer 11

deltoid and peroscapula muscles

Question 12

what is the main shoulder muscle for rTSA

Answer 12

deltoid

Question 13

what does the prosthesis change

Answer 13

the center of rotation

by moving it medially and inferiorly

Question 14

changing the center or rotation causes

Answer 14

increase deltoid moment arm

deltoid tension to give a better line of pull

Question 15

what does the deltoid replace

Answer 15

RC

becomes the primary elevator of the shoulder

Question 16

general guidelines of rTSR

Answer 16

AROM, AAROM to neck, forearm, wrist and hand

delto-pectoral approach

AROM can begin @ 6 weeks

isometrics to deltoid can begin at 4 weeks

isotonic deltoid at about 12 weeks

shoulder flexion to 105-120 in scapular plane as tolerated

Question 17

delo-pectoral approach –> guidelines

Answer 17

defer AROM for 6 weeks to allow for adequate deltoid healing

Question 18

isometrics to deltoid can begin at 4 weeks –> guidelines

Answer 18

beginning deltoid and periscapular isometrics will assist in restoring initial deltoud fxn

provide stability to the GH joint

Question 19

phase 1

Answer 19

0-4 weeks

Question 20

goal of phase 1

Answer 20

maintain the integrity of the replaced joint

while restoring passive ROM

Question 21

when is the pt in ABD splint –> phase 1

Answer 21

all the time besides therapy, bathing, HEP

Question 22

there is no –> phase 1 guidelines

Answer 22

shoulder AROM, AAROM or PROM into IR

no reaching behind back, esp into IR

lifting objects

supporting of BW w/ hands

Question 23

what should we place under the elbow –> phase 1 guidelines

Answer 23

small pillow/towel

while laying on back to avoid shoulder hyperextension

Question 24

interventions –> phase 1

Answer 24

swelling management

ROM/mobility

Question 25

swelling management --> phase 1

Answer 25

ice compression

Question 26

PROM --> ROM/mobility --> phase 1

Answer 26

ER in the scapular plane of tolerance flex/scaption

Question 27

exercises --> PROM --> ROM/mobility --> phase 1

Answer 27

seated GH table slides pendulums seated horizontal table slides

Question 28

AAROM --> ROM/mobility --> phase 1

Answer 28

none

Question 29

AROM --> ROM/mobility --> phase 1

Answer 29

elbow wrist hand

Question 30

when do we progress to phase 2

Answer 30

gradual increase in PROM (scapular plane) PROM ER b/w 30-45 (scapular plane) PROM IR to 0 pain < 4/10 no complications

Question 31

phase 2 precautions

Answer 31

no reaching behind back, esp into IR no lifting objects heavier than a coffee cup no supporting of BW w/ hands

Question 32

what do we do with a small towel/pillow --> phase 2

Answer 32

place under elbow while lying on back to avoid shoulder hyperextension

Question 33

phase 2 is

Answer 33

weeks 4-6

Question 34

rehab --> phase 2

Answer 34

ROM/mobility strengthening

Question 35

ROM/mobility --> phase 2

Answer 35

AAROM AROM inferior glide

Question 36

AAROM --> phase 2

Answer 36

shoulder flexion w/ cane cane ER stretch washcloth press seated shoulder elevation w/ cane

Question 37

AROM --> phase 2

Answer 37

supine flexion supine punch

Question 38

strengthening of --> phase 2

Answer 38

periscapular deltoid

Question 39

peroscapular --> phase 2

Answer 39

scap retraction standing scapular setting supported rowing (avoid HE)

Question 40

deltoid --> phase 2

Answer 40

isometrics in the scapular plane avoid HE

Question 41

when to progress to phase 3

Answer 41

gradual increase in PROM, AAROM, AROM 0 degrees shoulder PROM into IR palpable muscle contraction felt in scapular musculature pain < 4/10 no complications

Question 42

phase 3

Answer 42

weeks 7-8 moderate strengthening

Question 43

phase 3 rehab

Answer 43

advance strengthening precaution should be present

Question 44

phase 4

Answer 44

weeks 9-11 continued strengthening on HEP basis

Question 45

phase 4 rehab

Answer 45

gradual return to some sporting activity

Question 46

goals of phase 3

Answer 46

minimize pain initiate shoulder PROM in scapular plane initiate motor control exercise pt education

Question 47

gradually --> goals of phase 3

Answer 47

progress shoulder PROM progress shoulder AAROM progress shoulder AROM

Question 48

progress --> goals of phase 3

Answer 48

deltoid strengthening periscapular strengthening

Question 49

phase 3 rehab should include

Answer 49

ROM/mobility strengthening motor control

Question 50

PROM --> ROM/mobility --> phase 3

Answer 50

full in all planes gradual PROM IR in scapular plane

Question 51

AAROM--> ROM/mobility --> phase 3

Answer 51

incline table slides wall climbs pulleys seated shoulder elevation w/ cane w/ active lowering

Question 52

AROM --> ROM/mobility --> phase 3

Answer 52

seated scaption seated flexion supine forward elevation w/ elastic resistance to 90

Question 53

strengthening --> phase 3

Answer 53

periscapular deltoid

Question 54

periscapular --> phase 3

Answer 54

row on physioball SA punches

Question 55

deltoid --> phase 3

Answer 55

seated shoulder elevation w/ cane seated shoulder elevation w/ cane active lowering of ball on wall

Question 56

motor control --> phase 3

Answer 56

IR/ER in scaption plane flex 90-125 (rhythmic stabilization) in supine stretching SLing HADD triceps and lats

Question 57

phase 4 rehab includes

Answer 57

ROM/mobility strengthening motor contro

Question 58

ROM/mobility --> phase 4

Answer 58

full ROM in all planes

Question 59

strengthen --> periscapular phase 4

Answer 59

resistance band shoulder extension resistance band seated rows rowing robbery lawn mowers tripod pointer

Question 60

strengthen --> deltoid phase 4

Answer 60

gradually add resistance w/ deltoid exercises

Question 61

motor control --> phase 4

Answer 61

IR/ER and flex 90-125 (rhythmic stabilization) quadruped alternation isometrics and ball stabilizations on wall field goals

Question 62

motor control --> PNF --> phase 4

Answer 62

D1 diagonal lifts D2 diagonal lifts