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TSA and reverse TSA Flashcards

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1
Q

How many degrees of FLX is pure GH joint movement?

A

90 degrees

180 degrees is achieved by the GH joint and ST joint.

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2
Q

Range of shoulder EXT.

A

60 degrees

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3
Q

Range of shoulder IR.

A

70 degrees

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4
Q

Range of shoulder ER

A

90 degrees

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5
Q

What mucles perform GHJ FLX?

A

deltoid
coracobrachialis
biceps
pec major (clavicular head)

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6
Q

What muscles perform GHJ EXT?

A

posterior deltoid
lats
teres major
Triceps (Long head)

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7
Q

What muscles perform GHJ ABD?

A

middle deltoid
supraspinatus
biceps brachii (with ER)

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8
Q

What muscles perform GHJ IR?

A

subscapularis
Teres Major
Lats
Pec major

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9
Q

What muscles perform GHJ ER?

A

infraspinatus
teres minor

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10
Q

What spinous processes does the scapula normally extend to?

A

T2-T9

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11
Q

What position is a patient in for Shoulder replacements?

A

Beach-chair position

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12
Q

What nerve block is ideally given for a TSA?

A

interscalene nerve block

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13
Q

Skin incision for TSA extends distally from the posterior of the ______ to the anterior _______ area.

A

posterior of the AC joint to the anterior deltoid/pectoral area

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14
Q

______ fibers are split and reflected with temporary sutures to reveal the GHJ when performing a superior approach of a traditional TSA.

A

anterior deltoid

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15
Q

(true/false) The Long head of the biceps removed from the bicipital groove and dislocated posteriorly during a traditional TSA procedure

A

true

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16
Q

(minimal/maximal) resection of the humeral head is needed for a TSA.

A

minimal

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17
Q

What is the order of muscle closure when the TSA is complete?

A
  1. pectoral
  2. deltoid
  3. cutaneous tissue
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18
Q

What is different about a humeral hemiarthroplasty compared to a TSA?

A

Similar procedure but only the humeral head is replaced

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19
Q

What are the indications for a humeral hemiarthroplasty?

A
  • avascular necrosis of HH
  • OA/RA or degeneration of the glenoid
  • 2+ proximal humeral fractures
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20
Q

What are the indications for a TSA?

A
  • chronic pain relief
  • improve function of the GHJ
  • OA/RA
  • proximal humeral fracture
  • necrosis
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21
Q

What must a person have to get a TSA performed?

A

intact glenoid component and sufficient RTC muscles

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22
Q

What are contraindications of TSA?

A
  • infection
  • dysfunction/paralysis of RTC muscles
  • septic arthritis of GHJ
  • severe bone loss >40%
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23
Q

Neuropraxia of the ____ related to traction is a common nerve injury assoc. with shoulder arthroplasty

A

brachial plexus

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24
Q

What should a patient’s positioning be like when in early post-operative care?

A

HOB 30-60 degrees
towel/pillow under involved arm w/ relaxed shoulders
avoiding hunched position

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25
A sling for post-operative care of TSA should prevent _____.
extension because it places stress on the subscapularis tendon
26
What devices decrease the likelihood of a deep vein thrombosis?
antiembolic devices
27
(true/false) PT cannot be started the day of surgery.
false
28
Initial focus of TSA acute rehab is _____.
PROM/early mobilization
29
What are the two phases of outpatient rehabilitation?
1. stretching 2. strengthening
30
When is strengthening exercises initiated after surgery?
When the patient is pain free and edema free.
31
What are isometric exercises for strengthening once activity is initiated in outpatient care?
ER/IR, ABD, FLX
32
What are isotonic exercises for strengthening once activity is initiated in outpatient care?
w/ Theraband: ER/IR, FLX/EXT w/o Theraband: FLX and wall climbs
33
Hydrotherapy is recommended (before/after/before and after) TSA surgery
before and after
34
What is the goal of hydrotherapy when treating TSA?
Regain NM equilibrium rather than strength of each muscle group
35
What are the restrictions of TSA? For how long?
No resisted IR for 6 weeks Avoid heavy pushing/pulling/lifting for 6 weeks NWB activity for 3 months
36
How long does it take to perform a reverse TSA?
two hours or less
37
How long is a hospital stay s/p Reverse TSA?
2-4 days
38
Where is the incision made for a reverse TSA?
clavicle to the middle of the lateral forearm (deltoid is cut in the direction of its fibers)
39
During a reverse TSA, the humeral head is resected to face (medially/laterally) using an oscillating bone saw
medially
40
Once the reverse TSA is complete, the ___ tendon is secured back onto the humerus but the remaining RTC is not detached.
subscapularis
41
What are indications for reverse TSA?
- elderly patient - IRREPARABLE RTC TEAR - pseudoparalysis - Fx to proximal humerus w/ poor bone and RTC quality - proximal humerus tumor - RA with RTC tear - failed TSA or hemiarthroplasty
42
What are contraindications of a reverse TSA?
- axillary nerve deficiency - infection - inadequate glenoid bone stock - young age - metal allergy - severe neurologic deficiencies
43
How long can a reverse TSA component last?
7-10 years
44
Risk of infection with a reverse TSA is ___-___%
4-5%
45
(true/false) the biomechanics between a traditional TSA and reverse TSA prosthetic are the same.
FALSE
46
Traditional TSA uses a ____ approach.
deltopectoral --> minimizes surgical trauma to the anterior deltoid
47
Early ____ activity is contraindicated when a superior approach of a traditional TSA is used.
deltoid activity
48
There is a higher risk of dislocation of a prothesis when what shoulder motions are performed?
IR, ADD, EXT
49
What are the shoulder dislocation precautions? How long do they last?
12 weeks No shoulder motion behind the lower back and hip No combined shoulder ADD, IR, and EXT No GH joint EXT beyond 0 degrees
50
Stability and mobiity of the shoulder joint is largely dependent on the ___ and ___ muscles.
deltoid, periscapular
51
Active shoulder ROT is dependent on the post operative condition of the _____.
teres minor
52
Normal/full AROM (is/is not) expected with TSA.
is not
53
what are the phases of treatment for TSA?
1. immediate post-surgical/joint protection 2. active ROM/early strengthening 3. moderate strengthening 4. independent/HEP
54
What are the precautions of Phase I of TSA rehabilitation?
- sling (3-4 weeks) - When supine, distal humerus and elbow should be supported to avoid EXT - no shoulder AROM, lifting, WB
55
What is the criteria to progress from Phase I to Phase II of TSA rehab?
- toleration of shoulder PROM - toleration of elbow, wrist, hand AROM - able to isometrically activate the deltoid and periscapular muscles
56
During week 6 of TSA rehab, you can start PROM IR, if tolerated but it cannot exceed ___ degrees.
50 degrees
57
When should shoulder AAROM and AROM be introduced during TSA rehab?
weeks 6-8
58
What grade of joint mobilizations can be used during phase II of TSA rehab?
Grades I and II at GH and ST joint
59
What are the criteria to progress from phase ii to phase iii of TSA rehab?
- improving shoulder function - ability to isotonically activate the deltoid and periscapular muscles - gaining strength
60
What are the precautions for phase III of TSA rehab?
- no lifting of more than 6 pounds - no sudden lifting or pushing activities
61
What is the criteria for discharge in phase IV?
- able to maintain pain free shoulder AROM - Proper shoulder mechanics (80-120 degrees of ELEV and Function ER of 30 degrees)
62
(true/false) Reverse shoulder surgery first developed in response to a weak or dysfunctional rotator cuff.
true
63
(true/false) In a reverse total shoulder replacement, the socket and metal ball are switched. The metal ball is fixed to the glenoid and the plastic cup is fixed to the proximal end of the humerus.
true
64
(true/false) There is NOT a risk for glenoid loosening, destruction of implanted screws and glenosphere disengagement with a reverse shoulder procedure.
false (there is a risk)
65
Why does rehab differ with a reverse TSA?
Because there is a absent or minimally functional RTC

Clinical Interventions (25 decks)

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