HSS TSA

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Author:
shmvii
ID:
181776
Filename:
HSS TSA
Updated:
2012-11-05 10:50:14
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HSS TSA
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HSS TSA
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  1. pre-op presentation of a pt who's a candidate for TSA
    • loss of shoulder ROM in a capsular pattern
    • muscle atrophy
    • tightness in subscap/pec minor/lats
    • decreased scap mobility
    • possible cervical spine ROM restrictions
  2. pre-op goals for TSA
    • pt edu on goals, expectations, precautions
    • ROM
    • strength
    • maximize scap-hum rhythm
  3. medical indications for TSA
    • osteoarthritis
    • severe fracture
    • osteonecrosis (avascular necrosis)
    • rheumatoid arthritis
    • post traumatic arthritis
    • rotator cuff arthropathy
    • failure of conservative management
  4. contraindications for TSA
    • paralysis of deltoid and RC muscles
    • active infection
    • pt unwilling to participate in rehab post-op

    there are other issues that are "considerations" but we can work with these
  5. which part of the shoulder capsule is leas supported and most lax?
    inferior
  6. primary bursa in the shoulder w any pathology
    subacromial
  7. when does ER kick in with humerus elev, and why?
    • at 75 degrees ER occurs
    • it prevents compression of greater tubercle against the acromion
  8. 2 "force couples" muscle pairs of the shoulder
    • deltoid + supraspinatus
    • upper trap + serratus
  9. in a TSA what's cut, retracted, or released
    • cut: clavipectoral fascia
    • medial retraction: coracobrachialis, pec minor, short head of biceps
    • released: coracoacromial lig, subscap (tendon?) may be divided or released
  10. when reattaching the subscap tendon, how can you do it to improve an IR contracture?
    • attach tendon more medially on prox humerus
    • 1cm = 10 degrees ER
  11. week 1 of phase 1 post op
    • max protection phase
    • work on transfers
    • distal ROM
    • pendulums
    • cryotherapy
    • AA/P ROM FF and ER to neutral
  12. reasons to work in scapular plane (30 degrees from coronal plane)
    • humeral head is centered in glenoid fossa
    • optimal length tension rel
    • max elevation
    • more comfortable for pt
    • joint compression/stability
  13. what position relaxes the subscap?
    45 degrees abd
  14. weeks 2-4 of phase 1 post op TSA
    • advance FF in supine
    • scap ROM exercises in sidelying
    • do sub-max deltion isometrics in neutral (against a wall)
    • humeral head control exercises
    • ER isometrics
  15. generic info for phase I of TSA
    • cryotherapy
    • control edema
    • indep HEP
    • avoid lifting beyond normal ADLs (nothing heavier than a toothbrus)
    • keep ROM w/i MD's limits
    • GOAL: get ROM to 120 ff and ER to 30
  16. TSA phase II weeks 4-10
    • restrictions are gradually lifted
    • pt should use arm in ADLs
    • hydrotherapy
    • pulleys
    • theraband
    • CKC scap stabilizing exercise - wt shifting on a ball or wall
    • airdyne/UBE
    • GOAL: PROM FF to 150, ER to 45
  17. what happens at 6 weeks post TSA
    • ER/IR isometrics in neutral pos
    • AROM FF in supine
    • work on IR (use towel or wand)
  18. phase III TSA wks 10-16
    • progress ROM
    • normalize scap-hum rhythm up to horizontal
    • gentle joint mobs
    • isometrics awy from neutral
    • rhythmmic stabilization
    • "thumbs up" exercise for scaps
  19. goals in phase III wks 10-16
    • FF to 160
    • ER to 60
    • IR to T12
    • MMT to 4/5
  20. phase IV weeks 16-22
    • assess/address remaining deficits in ROM, flexibility, strength
    • PNF - initiate supine manual resistance D1 & D2
    • return to sport, but not contact sports!
  21. ultimate ROM goals for TSA
    attain approx 2/3 or ROM
  22. advantage and disadvantages of reverse shoulder arthroplasty
    • ad: deltoid has a longer moment arm so it can generate more force
    • disad: decreased ROM, increased impingement due to changes of center of rotation

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