common UL orthopaedic surgeries

Sub acromial decompression wpourpose

to increase space avalible for structures passing under acromial arch (when conservitave treatment failed)

structures under acromial arch

• Supraspinatus tendon

• Subacromial bursa

• Long head of biceps tendon, which runs in the region of the superior shoulder

what happend is a SAD

arthroscopicallly or open

• clearing of subacromial arch

• removal or bursal

• coracolig release

• reshape undersurface of actopion

• may take out 1/3 or clavicle

why is immediate active movemnt in an SAD allowed

Arthroscopic surgery does not involve  Disruption or repair of muscle  Disruption or repair of tendon  Disruption to the joint

post op presentation of SAF

arm in clise (for comfort remove asap)

post op management

• respiratory check

• 0-1 commence early mobilisaiton moement (rom other jnts)

• commence AAROM shoulder exercises day 1

• patient educaiton ice for pain relief and sling use

• ± no ABD 3-6 weeks

RC repair goal

• to reattach good quality tendon to bone ffrom whre it was torn

• groove made in normal attachment sight

• sutures drawa edge of tendon into groove where it will heal

why can’t immediate acttive movement happen with a RC repaire

RC repair involves

• Disruption or repair of muscle with deltoid split

• Disruption or repair of tendon of rotator cuff

RC repair post op presentation

• arm in sling + binder

• ± abduciton wedge or brace

RC cuff repair rehab 0-6 weeks

1. sling education

2. passive and pendulum exercises

3. other jnt ROM exercises

4. posture/scap stabilisation

5. education re pain relief + ice

RC repair 0-6 weeks sling use

• richards slign at all times including night

• can come out of sling 3-4 times/ day for only exercises

RC repair 0-6 weeks passive and pendulum exercises

ONLY PASSIVE MOVEMENT (active pulls suture apart)

surgon guids post op ROM

sh, F 90-120 ER 0-20

ADLs = limits on grip and carrying capacity

RC repair rehab 6-12 weeks

restore active ROM

strengthen RC

increase multiple plane neuromuscular control

work/sport functional integration

RC repair rehab 6-12 weeks

• pain-free arcs

• active pendulum

• AAROM above 90 ABD

• AAROM then AROM in IR and ER

RC repair 12-16 weeks

• Strengthening of the Rotator Cuff muscles

  • diagonal and multiplanar motions with theraband

  • Plyometrics

• 
  

• Increase multiple-plane neuromuscular control

• Sport/Work Specific Activity

ant sh, stab indicated when

after:

acute dislocaiton

recurrent instbaility

ant sh, stab - techniques

bankar leision repair

subscap (putti platt, magnuson stack)

coracoid transfers

ant sh, stab - bankart leision repair

• bankart lesion = avulsion of anteroinferior glenoid labrum at its attachemtn to IGHL complex

• procedure: resuture of capsule and glenoid labrum through dill holes of AGR

why can’t ant stablilisations commense immediate active movement post op

involves either

• Disruption or repair of subscapularis muscle

• Disruption or repair of the labrum

• Repair of the ligament

sh. ant stab ppost op

• avoid stressing repaired structures

• other joint exercises immediate

• active elbow ROM in IR and upper supported

• early gentle iso to sh.

• passive sh. F <90 and ER<0

Total shoudler replacement

prosthesis replaces both the humeral and glenoid surfaces

TSR indicaiton

• relieve pain (unresponsive ro conservitave)

• OA, RA<, AVN, TRAUMA

• decreased ROM loss of function

TSR procedure

• GA

• extended delto-pectoral incision approach

• sh, abducted + ER

• subscap divided

• humeral head dislocated +replaced

• glenoid surface plyethylene component placed

• capsulse and subscapularis re-approximated and wound closed

why can patient’s NOT commence immediate active movement post op

involve Disruption and repair of subscapularis tendon

dislocation in ABD + ER risk

TSK post op presentaiton

Arm in Sling and Binder and PCA for pain relief

TSR day 1 post op

• Chest check and exercises if indicated

• Exercises for neck, wrist, fingers, and elbow Ice

• Ambulate and SOOB as tolerated

• Posture/ Scap stabilisation, lower traps exercises

• Thoracic spine exercises to improve thoracic extension

• Pendular shoulder exercises

• Passive shoulder exercises: Flexion 0-60 degrees ,Abduction 0-60 degrees, ER to neutral

RTSR indicaitons

GH disease

Rc arthopathy

must have funcitoning deltoid

RTSR what

reversal of ball and socket positon

increases lever arm of deltoid

improves mechanical ability to elevate arm without RC

dislocation risk with ADD and IR

trimmed wrist fixation system

• ORIF meets pinning

• minimaly invasive

• mostrly used with good boned pt

trimed fixaiton indications

comminuted distal fragments

unstable/displaced

intraarticaluar #’s

PAH protocol

cock-up splint 6 weeks

take splint off for wrist ext/flex, RD UD

supination + pronation w/ splint on

wound and odema Mx