Total Shoulder Replacement

Question 1

indications

Answer 1

severe OA

inflammatory arthritis

RA

post-traumatic arthritis

RC tear

shoulder fx or severe trauma

AVN

no relief from PT, injections, medication, etc.

Question 2

RC tear –> indications

Answer 2

a combo of severe arthritic and a massive non-reparable RC tendon tear

Question 3

primary goal of TSH

Answer 3

pain relief

Question 4

secondary goals of TSH

Answer 4

improve motion, strength and fxn

Question 5

dx tests

Answer 5

plain radiographs

Question 6

what do plain radiographs show

Answer 6

bone spurs

damaged joint surfaces

narrowed joint surfaces

Question 7

how long does the procedure take

Answer 7

2 hours

Question 8

a TSH is an

Answer 8

open repair

pt is given general anesthesia and a nerve block

Question 9

procedure

Answer 9

separate deltoid and pec muscles

incise subscap

remove humeral head

debride glenoid

place prosthesis

Question 10

TSR is

Answer 10

most common

conventional

Question 11

what is a TSR

Answer 11

highly polished metal humeral head attached to a stem w/ a plastic glenoid

Question 12

components of TSR

Answer 12

come in various sizes

Question 13

if the bone is of good quality –> TSR

Answer 13

may use press fit humeral component

Question 14

if bone is soft –> TSR

Answer 14

may need to cement the humeral component

Question 15

what is the glenoid component –> TSR

Answer 15

cemented

Question 16

types of prostheses

Answer 16

conventional

hemi-arthroplasty

Question 17

conventional prosthesis

Answer 17

pts w/ bone on bone arthritis and intact RC

Question 18

hemi-arhtoplasty

Answer 18

can replace only the humeral component if glenoid is in good condition

Question 19

phase 1

Answer 19

0-3 weeks

Question 20

precautions –> phase 1

Answer 20

no AROM

when supine, use towel roll under elbow

no supporting of body weight on hand or lifting anything

Question 21

when supine, use towel roll under elbow –> precautions phase 1

Answer 21

avoid hyperextension, anterior capsule stretch and subscap stretch

Question 22

PROM goals –> phase 1

Answer 22

90 degrees F/E

45 degrees ER in scaption

90 degrees ABD w/o rotation

70 degrees IR in scaption

Question 23

AAROM –> phase 1

Answer 23

allowed w/ caution

Question 24

post-op day 1

Answer 24

PROM

avoid stress on anterior capsule and subscap

Question 25

PROM --> post op day 1

Answer 25

to tolerance (but not past 90) ER in scaption to about 30 degrees IR to chest

Question 26

post up day 2-20

Answer 26

AAROM flexion, ABD, ER in scaption submax pain free isometrics w/ shoulder in neutral AAROM elbow pulleys

Question 27

when could we do pulleys --> post up 2-20

Answer 27

if flexion and ABD PROM > 90

Question 28

post op days 10-21

Answer 28

progress PROM, AAROM in pain free ranges strengthen elbow, forearm, wrist and hand

Question 29

sling --> post op days 10-21

Answer 29

abduction w/ pillow for comfort while sleeping

Question 30

when do we d/c pillow --> post op 10-21

Answer 30

gradually by week 3-4

Question 31

PROM goals --> weeks 3-6

Answer 31

140 flexion 120 ABD 60 or more ER 70 IR in scaption

Question 32

active motion --> weeks 3-6

Answer 32

FE to 100 w/ good mechanics

Question 33

what do we re-establish --> weeks 3-6

Answer 33

dynamic shoulder stability

Question 34

use the sling --> weeks 3-6

Answer 34

as needed

Question 35

precautions --> weeks 3-6

Answer 35

lifting no heavier than a coffee cup no supporting of BW w/ hands or arms no sudden movements

Question 36

what should we focus on in week 3

Answer 36

scapula strengthening continue w/ PROM, AAROM, isometrics

Question 37

scap strengthening --> week 3

Answer 37

begin horizontal ADD initiate rhythmic stabilization

Question 38

what should we do in week 4

Answer 38

begin AROM progress scapula strengthening

Question 39

begin AROM --> week 4

Answer 39

FE, IR, ER and ABD in supine in pain free ROM

Question 40

progress scap strengthening --> week 4

Answer 40

begin isometrics of RC periscapular exercises

Question 41

phase 3

Answer 41

weeks 6-12 moderate strengthening

Question 42

goals of weeks 6-12

Answer 42

gradual restoration of shoulder strength, power and endurance

Question 43

what do we want to increase --> weeks 6-12

Answer 43

NM control

Question 44

there is a -->weeks 6-12

Answer 44

gradual return to fxnal activities w/ UE

Question 45

precautions --> weeks 6-12

Answer 45

no lifting >5 lbs no sudden lifting or pushing activities no sudden jerking motions

Question 46

what should we increase in week 6

Answer 46

anti-gravity FE, ABD AROM IR & ER in scaption PROM w/ light stretching

Question 47

what should be initiated --> week 6

Answer 47

assisted IR behind the back

Question 48

what should we begin --> week 6

Answer 48

light fxnal activities

Question 49

what should we begin --> week 8

Answer 49

progressive strengthening of FE in supine 1-3#

Question 50

what should we begin --> weeks 10-12

Answer 50

resisted flexion, ABD, ER w/ elastic band

Question 51

what should we progress --> weeks 10-12

Answer 51

strengthening of IR/ER

Question 52

strengthening of IR/ER --> weeks 10-12

Answer 52

progress IR from behind back from AAROM --> AROM still avoid stress on anterior capsule

Question 53

phase 4

Answer 53

weeks 12-16 advanced strengthening

Question 54

goals of phase 4

Answer 54

full, pain free AROM enhance fxnal use of UE improve muscle strength, power, endurance advance to more advanced fxnal activities

Question 55

precautions of phase 4

Answer 55

avoid exercises that stresses anterior capsule ie: no combo of ER and ABD above 80 degrees of ABD

Question 56

weeks 12+ --> rehab

Answer 56

pt is now on HEP to progress strengthening can return to moderately challenging fxnal activities

Question 57

4-6 months --> rehab

Answer 57

return to recreational hobbies