week 1

Question 1

ideal scapula position

Answer 1

sits between T2 and T7 and approximately 7cm from midline

Question 2

Common Shoulder Surgeries

Answer 2

 Subacromial Decompression (SAD)
 Rotator Cuff repair
 Shoulder Stabilisation
 Total Shoulder Replacement (TSR)
 Reverse TSR
 Trimed fixation of distal radius fractures

Question 3

what is a Subacromial Decompression (SAD)

Answer 3

Operation performed to increase the space available for structures that pass under the acromial arch where conservative measures have failed

Question 4

what does the Subacromial Decompression (SAD) surgery involve

Answer 4

 Clearing of subacromial arch
 Removal of subacromial bursa
 Coracoacromial ligament release
 Reshaping undersurface of the
acromion (Acromioplasty)

Question 5

what muscles make up the rotator cuff

Answer 5

 Supraspinatus
 Infraspinatus
 Teres Minor
 Subscpaularis

Question 6

what is the goal of a rotator cuff repair

Answer 6

is to reattach good quality tendon to the bone from which it has torn

Question 7

Rotator Cuff Repair Involves

Answer 7

 Disruption or repair of muscle with deltoid split
 Disruption or repair of tendon of rotator cuff
- active movement can NOT be commenced immediately

Question 8

rotator cuff repair rehab 0-6 weeks

Answer 8

 1. sling use (24/7)
 2. passive and pendulum exercises (passive movements only)
- Shoulder Flexion: min 90 max 120
- External Rotation: min 0 max 20
 3. other joint ROM exercises (adj jts)
 4. Posture / scapula stabilisation (lower trap exercises)
 5. Education re pain relief including ice

Question 9

rotator cuff repair rehab 6-12 weeks

Answer 9

 Restore active ROM
pain-free arcs, Active pendulum exercises, Active assisted motion above 90 abduction, active IR & ER w scapula stabilised
 Strengthening of the Rotator Cuff muscles
 Increase multiple-plane neuromuscular
control
 Sport/Work Specific Activity

Question 10

how does An acute dislocation usually happen

Answer 10

a fall on the outstretched hand

Question 11

how does Recurrent Instability occur

Answer 11

may result from recurrent dislocations or from repeated activities that stress and
subsequently stretch the capsule e.g.
baseball pitching, cricket bowling

Question 12

Anteroinferior Glenohumeral
Ligament function

Answer 12

restraint to anterior and
anteroinferior instability

Question 13

what is a banker lesion

Answer 13

avulsion of Anteroinferior Glenohumeral
Ligament from the antero inferior glenoid labrum
IGHL must fail for anterior dislocation to occur

Question 14

Traditional examples of Surgical Techniques for Recurrent Instability

Answer 14

 Bankart Lesion Repair
 Subscapularis Procedures
 Coracoid transfers

Question 15

what does a Bankart Lesion Repair involve

Answer 15

the resuture of the capsule and glenoid
labrum through drill holes of the anterior glenoid rim. Expect a little loss of ER post operatively

Question 16

Anterior stabilisation surgery involves either

Answer 16

 Disruption or repair of subscapularis muscle
 Disruption or repair of the labrum
 Repair of the ligament

Question 17

Anterior Stabilisation
Post Operative Management:

Answer 17

 Aim of initial post op management is to avoid stressing the repaired structures until fibrous healing occurs at approx 6 weeks.
 Exercises commenced Day 1 and patients usually discharged from hospital
Day 1-2
Neck, wrist, hand and scapular retraction exercises commenced immediately
Active elbow ROM exercises in IR and upper arm supported
Early gentle isometrics to shoulder
Passive shoulder flexion <90 and ER <

Question 18

types of Shoulder Replacement

Answer 18

Hemiarthroplasty
Total Shoulder Replacement
Reverse Total Shoulder Replacement

Question 19

Hemiarthroplasty process

Answer 19

Single prosthesis replacing humeral head and retaining patients own glenoid fossa. Suitable for conditions that only affect the humerus such as proximal humeral fracture

Question 20

Total Shoulder Replacement process

Answer 20

prosthesis replaces both the humeral and
glenoid surfaces- suitable for conditions that affect both sides of the joint
such as arthritis

Question 21

Reverse Total Shoulder Replacement process

Answer 21

Glenoid surface is replaced with a
ball and the humeral surface is replaced with a socketparticularly useful in patients with deficient rotator cuff

Question 22

in what positions is a shoulder venerable after a TSR

Answer 22

shoulder abduction and external rotation

Question 23

post op Objectives of physiotherapy after TSR

Answer 23

Increasing range of movement, initially PASSIVELY, then progressing through active-assisted movements, and finally active exercises
 Progressively gain strength of the soft tissues after healing has occurred
 Regain an optimal upper quadrant environment to maximise glenohumeral function

Question 24

Reverse Total Shoulder Replacement dislocating position

Answer 24

With shoulder adduction and IR
Such as reaching to back pocket

Question 25

what is a Trimed Wrist fixation system

Answer 25

Minimally invasive, Used with displaced intra articular fractures with > 1-2mm displacement/ step,

Question 27

what is the PAH Protocol

Answer 27

 Cock-up splint for 6 weeks  Take splint off for wrist ext/flex, radial and ulnar dev  Supination and pronation with splint on  Usual management of swelling, scar