updates, figures and table 2

Question 1

What muscles are impacted with Total shoulder arthoplasty

Answer 1

• deltoid retracted
• suscapularis released by tendon inscision or less or tubercle release
• pec major - upper part is released

Question 2

How can the surgeon know if they have optimal soft tissue balance follow totals shoulder

Answer 2

• humeral head will sublux no more than about 50% of its diameter

Question 3

How does the pathophysiology leading to a shoulder arthroplasty impact the ROM outcomes

Answer 3

Flex/ER

1. OA- 140/40
2. RA - 103/45
3. Acute fx - 100/30

Question 4

What considerations must you take into account with TSA following shoulder fracture?

Answer 4

1. fractures with 3 or 4 parts typically have lower range of motion return, but better symptom
2. thorough examination of pre- and post- surgery for nerve injury (particularly axillary)

Question 5

How much ER ROM will the patient get after a TSA

Answer 5

they will never gain more than was mechanically allowed during surgery

Question 6

When is a reverse total shoulder indicated?

Answer 6

1. massive or irreparabel rotator cuff damage
2. Proximal humeral fracture in a deficient rotator cuff
3. revsion of previous total arthroplasty
4. situations where conventional surgical approach may result in inferior outcomes

Question 7

What muscle must work well for good functional outcomes followign a reverse total shoulder

Answer 7

deltoid

Question 8

How much depth does the laburm add to the glenoid?

Answer 8

increased depth by 50%

Question 9

desribe the relation of the superior GH to the biceps tendon

Answer 9

they all attach to the labrum

Question 10

what is the IGHLC

Answer 10

inferior glenohumeral ligament complex

1. anterior band
2. posterior band
3. interposed axillary pouch

Question 11

what is the primary restraint to posterior glide of the GH joint?

Answer 11

1. capsule
2. posterior band of the IGHLC
3. muscles

Question 12

what is the rotator interval

Answer 12

1. triangular region between the border of the supraspinatus and subscapularis
2. superior glenomueral ligament
3. coracohumeral ligament

Question 13

describe superior migration of the humeral head

Answer 13

• 60 deg center humeral head rose 2 mm of center of glenoid
• decreased to 1 mm at 90 and 120
• decreased to 0.5mm at 150

Question 14

Follow subacromial decompression when is a reasonable time frame for full ROM and return to sport

Answer 14

1. full ROM 10-12

2. reuturn to sport 12-14

Question 15

What is arthroscopic rempilssage

Answer 15

arthorscopic procedure to fill in Hill Sach lesions

Question 16

What shoulder x-ray view is best for identification of posterior dislocations

Answer 16

1. axillary view, but…
   - y-scapular view for posterior
   - AP is pretty good for anterior if there is over lap with the glenoid and humeral head

Question 17

what is the A/P for couple

Answer 17

IS and SC and are active in mid range

Question 18

what is a shoulder flip sign

Answer 18

medial border flips off the thoracic wall

Question 19

what ROM place the peak amount of compression on the RTC

Answer 19

85-136

Question 20

what nerve is most often injuries with anterior dissociation and what muscle will it effect

Answer 20

axillary, deltoid and teres minor

Question 21

what is the puttie platt procedure

Answer 21

subscap and capsular shortening

Question 22

how many types are SLAP tears are described

Answer 22

4

1. degenerative changes
2. avulsion of superior labrum
3. bucket handle tear of labrum
4. same as 2 and 3 with inclusion of the biceps tendon

Question 23

Labral tear tests typical use what muscle to test the integrity of the labrum

Answer 23

use the biceps

• obrien IR with pronation
• resisted ER and supination postion