Shoulder Surgery and Post Op Rehab

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Author:
dmshaw9
ID:
243339
Filename:
Shoulder Surgery and Post Op Rehab
Updated:
2014-02-13 10:59:24
Tags:
Shoulder Surgery Post Op Rehab
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MS1
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MS1
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  1. Total Shoulder Arthroplasty: Indications
    • Osteoarthritis
    • Osteonecrosis
    • Fractures of the humeral head
  2. TSA General Rehab Guidelines: Phase 1 (0-4 weeks)
    • Pain management
    • Mobility
    • Maximize function in uninvolved regions
    • Education on joint protection

    • Post op day 1: elbow, hand and forearm ROM
    • Day 1-2: PROM for elevation, abduction, ER
    • Week 3: AAROM
  3. TSA General Rehab Guidelines: Phase 2 (4-8 weeks)
    • Maximize AROM (4-6 weeks = AROM, isometrics)
    • Increase shoulder strength (6-8 weeks = strengthening) 
    • Increase function w/ ADLs
  4. TSA General Rehab Guidelines: Phase 3 (8-10 weeks+)
    • Maximize return to ADL's
    • Maximize GH motion
    • Return to recreational sport activity
  5. TSA Complications (more common → less common)
    • Prosthetic loosening (glenoid)
    • Glenohumeral instability (anterior = torn subscapularis; superior = RC deficiency)
    • RC tear
    • Periprosthetic fracture
    • Infection
    • Implant failure
  6. TSA: ROM Goals
    • Elevation: 140 degrees (limited patients (RC deficiency, RA) = 90 degrees)
    • ER: 40-60 degrees
    • IR: 70 degrees, thumb to approximately L2 
    • Flexion: 120 degrees
    • Abduction: 100 degrees
  7. Reverse Shoulder Prosthesis: Patient Selection
    • Irreparable rotator cuff
    • Co-existent instability of the GH joint
    • TSA revisions
    • Reserved for its > 70 w/ low functional demands and severe pain w/ limited function related w/ RC deficiency
  8. Reverse Shoulder Rehab Considerations
    • Immobilizer 4-6 weeks
    • Passive ROM day 1 (limit to 90 degrees elevation, 0 degree ER)
    • AAROM 4-6 weeks (sling used)
    • AROM 8-10 weeks
    • Resistive exercises 12 weeks (*caution w/ subscapularis strengthening)
  9. Reverse Shoulder ROM Expectations
    • Flexion = 90 (max) (likely 70-90)
    • Abduction = 70
    • ER < 40
  10. Subacromial Decompression (SAD): Indications
    • Primary shoulder impingement (acromion type II or III (curved, hooked))
    • Acromioclavicular osteophytes
  11. Subacromial Decompression Rehab Considerations
    • No soft tissue to repair (bony involvement) → no specific restrictions
    • Early motion important
    • Typical recovery = min of 6-8 weeks
  12. Rotator Cuff Repair: Arthroscopic Categories
    • Arthroscopically assisted OPEN repair:
    • → Arthroscopic decompression 
    • → Open repair of rotator cuff w/ deltoid splitting approach

    • Arthroscopically assisted MINI-OPEN:
    • → Arthroscopic decompression & tendon debridement
    • → Mini-open repair w/ deltoid splitting approach

    • COMPLETE arthroscopic repair:
    • → All arthroscopic (decompression, tendon debridement, bone-tendon fixation)
    • → Minimize risk to deltoid
  13. Rotator Cuff Repair Rehab Considerations
    • Size of tear
    • Quality of tissue
    • Status of articular surfaces
    • Etiology of tear

    *Regardless of surgical technique used, tendon heals at the same rate!
  14. Rotator Cuff Repair: Small Tear (<1 cm)
    • PROM: day 1
    • AAROM: 1 week
    • AROM: 3-4 weeks
    • Isometrics: 1 week
    • Isotonics: 4-6 weeks
    • Recreation: 4-5 months
  15. Rotator Cuff Repair: Moderate Tear (1-5cm)
    • PROM: Day 1
    • AAROM: 1-3 weeks
    • AROM: 5-6 weeks
    • Isometrics: 1-4 weeks
    • Isotonics: 7-12 weeks
    • Recreation: 5-6 months
  16. Rotator Cuff Repair: Massive Tear (>5cm)
    • PROM: Day 1
    • AAROM: 3-6 weeks
    • AROM: 6-8 weeks
    • Isometrics:3-6 weeks 
    • Isotonics: 10-14 weeks
    • Recreation: 9 months-1 year
  17. SLAP Repair Rehab Considerations
    • Avoid early external rotation (< 3 weeks) → ER will stress posterior-superior labrum
    • Avoid early strain on biceps (type II and type IV)
    • Sling 1-4 weeks
    • Flexion, abduction to 90 first 4 weeks
    • MECHANISM OF INJURY SHOULD GUIDE REHAB PROCESS!
  18. Bankart Repair Rehab Considerations
    • 2-4 weeks PROM (limit stress on repaired tissue (subscapularis))
    • 4-6 weeks AAROM
    • 6 weeks initiation AROM
    • 3-6 months throw program (position of ER and abduction)
    • 6 months return to contact sport
  19. AC Joint Reconstruction: Indications for Surgical Treatment
    • Grade III: prolonged, unsuccessful, non-surgical management
    • Grades IV to VI: early operative reconstruction
  20. AC Joint Reconstruction Rehab Considerations
    SLOW REHAB! (ligament disrupted → need significant time for ligament to heal)

    • Sling immobilization 0 to 6-8 weeks
    • PROM = begin 4-7 weeks (very delayed; gravity eliminated)
    • AAROM = begin 12 to 16 weeks
    • AROM, initiate strengthening = begin weeks 13-24
    • No contact/heavy lifting until 9 months

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