Adhesive capsulitis, GH osteoarthritis, TSA, Reverse TSA

gleohumeral capsule: blends with mm of _____, ____ shoulder yet allows it to be _____

RTC, reinforces, mobile

adhesive capsulitis: inflamed _____ causing _____, leading to _____

GH capsule, fibrosis, restriction of motion

adhesive capsulitis risk factors:

• _____

• ____ disease

• _____

• _____ yrs

diabetes, thyroid, women, 40-65

adhesive capsulitis MOI =

insidious

clinical presentation of adhesive capsulitis

• pain that ____

• restricted ___ in _____ pattern (___/___/___)

• s/s persists at least ____

• may have mid range ____

• may have decreased ___ with ___/___/____

wakes you up, rom, capsular, ER, ABD, IR, 1 month, catching, strength, ER, IR, flexion

stages of adhesive capsulitis

stage 1, freezing stage, frozen stage, thawing stage

adhesive capsulitis - stage 1 (____-____)

• sharp pain at ____

• ____ pain

• ____ rom

0-3 months, end rom, night, normal

adhesive capsulitis - stage 2 (____-____)

• increased ____ because of increased ____

• decreased ____

3-9 months, pain, inflammation, ROM

adhesive capsulitis - stage 3 (____-____)

• ____ persists

• decreased ____, increased _____

• decreased _____

9-15 months, pain, inflammation, fibrosis, ROM

adhesive capsulitis - stage 4 (____-____)

• decreased ____

• restricted ___ due to contracture

15-24 months, pain, ROM

adhesive capsulitis - high irritability - classification CPG

• ___/10 on VAS

• _____ pain

• pain before ____

• AROM ____ PROM

• ____ score on disability OM

>7, constant, end ROM, less than, high

adhesive capsulitis - moderate irritability - classification CPG

• ___/10 on VAS

• _____ pain

• pain ____

• AROM ____ PROM

• ____ score on disability OM

4-6, intermittent night, at end ROM, similar to, moderate

adhesive capsulitis - low irritability - classification CPG

• ___/10 on VAS

• _____ pain

• pain with ____

• AROM ____ PROM

• ____ score on disability OM

<3, no night, overpressure PROM, equal, low

adhesive capsulitis - high irritability - treatment CPG

• modalities: _____

• grade ____ joint mobs

• ther ex:

heat/e-stim, I-II, pain free AROM/PROM

adhesive capsulitis - moderate irritability - treatment CPG

• modalities: _____

• grade ____ joint mobs

• ther ex:

• neuro re-ed

heat/estim, III, arom and stretching

adhesive capsulitis - low irritability - treatment CPG

• modalities: _____

• grade ____ joint mobs

• ther ex:

• neruo re-ed

none, IV, stretching

joint mobs for adhesive capsulitis

GH inferior traction, GH A-P, GH inferior glide

surgical treatment of adhesive capsulitis

• manipulation ___

• send immediately to ____

• do ____ after procedure

under anesthesia, PT, re-eval

GH osteoarthritis = degeneration of ____ on _____

cartilage, humeral head

GH osteoarthritis risk factors

• _____

• _____ yrs

• PMHx ____ injury/___ tears

• ____ sports

• occupational _____

women, 65+. shoulder, RTC, overhead, heavy lifting

GH osteoarthritis MOI =

insidious

clinical presentation of GH OA

• pain with ____ activities (especially ___)

• _____ pain that is ____

overhead, ER, night, positional

conservative treatment of GH OA

• eduaction: ___, ____ injeciton

• modalities: _____, _____

• manual: _____

• ther ex: ____, ____

NSAIDS, corticosteroid, heat, estim, STM, flexibility, strengthening

two types of surgical treatment of GH OA

total shoulder and reverse total shoulder arthroplasty

total shoulder arthroplasty: replacement of ____ and ____ resurfacing

humeral head, glenoid

indications of total shoulder arthroplasty

• pain at ____

• decreased ability to do ___

night, ADLs

considerations for total shoulder arthroplasty

• shallow glenoid = increased _____, risk _____

  • _____ to prevent

sheer forces, loosening, cemented

total shoulder arthroplasty: deficient bone = no _____

glenoid resurfacing

shoulder arthroplasty: deficient RTC =

reverse TSA

outcomes of total shoulder arthroplasty

• ____ relief

• restore _____

• good ____ survival rate at ____ yrs

pain, ROM, prothesis, 10

complications of total shoulder arthroplasty

• prosthesis ____

• ____ failure because gets ____ and ____

• accidental ____ injury

• ____

• ____

• _____ fracture

• ____/____ injury

loosening, subscapularis, detached, reattached, RTC, stiffness, infection, periprosthetic, vascular, axillary

total shoulder arthroplasty post-op precautions

• limit ____

  • weeks 2-4 = ____ degrees

  • weeks 4-6 = _____ degrees

• no ____/____

• _____ strengthening until ___ wks

ER, 0-30, 0-45, active, resisted, IR, 12

reverse total shoulder arthroplasty

• reverses ____

  • glenoid = ____

  • humerus = _____

arhtrokinematics, convex, concave

reverse total shoulder arthroplasty - moves center of rotation _____ and ____, increases mechanical advantage of ____

inferior, medial, deltoid

indications reverse total shoulder arthroplasty

• need TSA but deficient ____ mm

• proximal ____ in elderly

• failed _____

RTC, humeral head, TSA

pt characteristics reverse total shoulder arthroplasty

• low ____ demand

• _____ yrs +

• sufficient _____ stock

• working ____ mm

• intact ____ n

functional, 70, glenoid bone, deltoid, axillary

outcomes of reverse total shoulder arthroplasty

• don’t improve ____/____ (may do ____ transfer to help)

IR, ER, latissimus

approaches to reverse total shoulder arthroplasty

deltopectoral, anterosuperior

reverse TSA deltopectoral

(+) = preserves _____ mm, decreases risk to ____

(-) = detach and repair _____, may cause _____

deltoid, axillary n, subscap, instability

reverse TSA anterosuperior

(+) = preserves _____, decreased _____

(-) = increased risk of ____ injury, splits ____

subscap, post op instability, axillary n, anterior delt

post op precautions of reverse TSA

• sling ____ wks, no _____

• no ____, ____, ____ motions

• dont _____ into pain

• no UE WB ____ wks

• possible ____ precautions

  • no ___ PROM past neutral x___wks

  • no active ____ x____wk

• _____ in scaption only

4-6, driving, IR, ext, ADD, stretch, 12, subscap, ER, 4, IR, 8, forward deviation

long term post op precautions after reverse TSA

• no ____ or _____

• ____lb limit below shoulder hight

• ____lb limit above shoulder height

psuh ups, bench press, 15, 10