Flashcards in Surgical Interventions and Postop Management Deck (56):
4 types of TSA prosthetic desgins
- reverse ball and socket
Which TSA designs allows for the greatest freedom of motion?
Does the RC have to be intact for an unconstrained design?
yes it must be
Does the RC have to be intact for a semiconstrained design?
It may be mildly impaired prior to repair
Describe a reversed ball and socket
The glenoid is ball shaped and the humerus is the socket component
What is the purpose of a reverse TSA?
It provides stability for RC deficient shoulders that cannot be repaired
Describe the constrained TSA design
it provides the greatest amount of stability due to its fixed fulcrum ball and socket design
Which TSA design is rarely used and why?
constrained because of its high rate of loosening and failure of components
What is the major difference between a TSA and rTSA?
In a rTSA the deltoid becomes the primary mover of the GH joint because the RC is torn.
In a TSA, functioning RC muscles move the GH joint.
What are 3 physiological complications after TSA?
What are 4 anatomic complications after TSA?
- axillary or suprascapular nerve damage
- re-tearing of the RC
How is the extremity positioned after a TSA?
Elbow flexed to 90
Shoulder flexed 10-20 with slight abduction and IR
What 7 things should you avoid after a TSA
- end-range stretching (especially to subscapularis)
- AROM in antigravity position
- dynamic shoulder exercises
- resistance exercises
- weight bearing on operative UE
- reaching behind the back
If the rotator cuff was repaired during TSA, how long until AROM and light isometrics?
Which aspect of the capsule should you avoid stress to after a TSA?
Avoid hyperextension and abduction
Which 2 muscles should you concentrate on the most after TSA?
Serratus anterior and trapezius
What are the 4 criteria to advance to the moderate phase after a TSA?
- 90 degrees of passive elevation
- 45 degrees of ER
- 70 degrees of IR in the plane of the scapula with minimum pain; or full, PROM with little to no pain
- NO subscapularis tendon pain with resisted, isometric IR
What are the 5 criteria to advance to the minimum phase after a TSA?
- at least 130-140 degrees of PROM shoulder flexion
- at least 120 degrees of PROM abduction
- 60 degrees pain free PROM ER
- 70 degrees PROM IR
- Strength of rotator cuff and deltoid muscles 4/5
What is the keystone to the rehab process after a TSA?
What motions should be avoided for 12 weeks following a rTSA?
shoulder extension past neutral and the combination of shoulder adduction and internal rotation
*This motion causes dislocation
Which RC muscle is the most commonly torn?
If a RC tear is greater than _ cm a surgical repair is pursued
When is the maximum protection phase for a RC repair?
anywhere from 3-8 weeks post-op (depending on size of tear)
What type of exercises can be performed during the maximum protection phase?
pendulum and PROM exercises only
Why is PROM performed in the supine position during the maximum protection phase?
It offers scapular stabilization and also tends to decrease trap from firing
What else could PT concentrate on for early rehab post-RC repair?
When does the moderate phase of RC repair rehab begin?
6-12 weeks post-operatively
What are the 3 criteria to progress to the moderate phase of rehab following a RC repair?
- Well healed incision
- Minimal pain with AAROM of shoulder
- Progressive improvement in ROM
Name 3 type of exercises that would be appropriate in the moderate protection phase of a RC repair
*light weight bearing activities (ball on wall)
When does the minimum phase of RC repair rehab begin?
12-16 weeks post-op
What are the 3 criteria to progress to the minimum phase of rehab following a RC repair?
- Full, pain-free PROM
- Progressive improvement of shoulder strength and muscular endurance
- Stable GH joint
Rank the following in importance following a RC repair; stability, mobility, strength
Stability must come first; mobility second; strength third
What occurs during a Bankart repair?
Reattachment of the labrum to the glenoid lip
Where does a SLAP tear occur?
Where the long head of the biceps tendon anchors to the labrum
Immobilization of the GH joint must be longer if the tear is occurs in what direction?
after posterior or multidirectional instability repairs
After anterior stabilization procedures which movements are not recommended?
ER or horizontal abduction
After posterior stabilization procedures which movements are not recommended?
IR and overhead elevation of arm
What are the 2 types of total elbow arthroplasty designs?
- Linked (articulated)
- Unlinked (nonarticulated)
Two separate, nonarticulated implants
Unlinked TEA also usually requires the repair of what?
supporting ligaments for stability
What movements should be avoided in the maximum protection phase following a TEA?
End range flexion/extension
If the triceps is reflected or split during a TEA what movements should be avoided and for how long?
- assisted flexion to 90-100 degrees for 3-4 weeks
- anitgravity extension
What types of exercises should be performed during the maximum protection phase following a TEA?
Low intensity isometrics of wrist, hand, and shoulder while in the splint
A TEA patient should not lift more than _ lbs for 3 months
More than _ lbs for 6 months
More than _ lbs for long term repetitive lifting
Never more than _ - _ lbs for a single lift
When can low-load, closed-chain activities, such as wall push-ups be used following a TEA?
Wrist Arthroplasty is common in what type of patients?
Which motions are most important following a total wrist arthroplasty?
Extension over flexion
Slipped Capital Femoral Epiphysis typically occurs in what type of patient?
Young males; usually overweight.
What does CABG stand for?
Coronary Artery Bypass Grafting
What are the 3 sternal precautions following Cardiothoracic Surgery?
- No overhead movement of UEs
- No pushing up from chair with UEs
- No lifting greater than 5 lbs
LVAD stands for what?
Left Ventricular Assistive Device
How long do patients have to lay flat following an angioplasty?
What are the precautions following placement of pacemakers?
No overhead reaching with UE for 4-6 weeks
What are the 3 precautions for craniotomy patients?
- ALWAYS have patient wear their helmet
- Avoid Valsalva
- Avoid lifting
What is a Ventriculostomy?
A procedure in which excess CSF fluid is removed from the ventricles caused by trauma or hydrocephalus
Why is a femoral-popliteal bypass performed?
to improve LE circulation