week 4

Question 1

Progression through rehab guidelines
Influenced by

Answer 1

• Protocol timelines- to allow tissue healing
• Quality of tissue and repair type
• Pain control
• Co-morbidities
• Compliance and assistance with HEP

Question 2

indications for Sub-Acromial Decompression surgery

Answer 2

to relieve pain and improve function where conservative measures have failed

Question 3

Post-op Management SubAC Decompression

Answer 3

• Follow Post-op Protocol
• Arm supported in sling for comfort only
• Advice and Education
• Maintain ROM-C/sp, Elbow, Wrist/ Hand
• Scapular stabilisation
• Commence active assisted shoulder ROM exercises on Day 1 and progress as pain allows
• Provide warnings/ CI’s

Question 4

advice and edu given

Answer 4

➢ Surgical procedure and protocol
➢ Ice for pain relief
➢ Instructions- what can/can’t do
➢ D/C and HEP planning

Question 5

SubAC Decompression EBP

Answer 5

Surgery provides small but negligible improvement in pain compared to exercise

Question 6

what classifies a tear

Answer 6

greater than 3cm

Question 7

Open surgery (superior-lateral incision) may be
necessary in patients with

Answer 7

• Musculotendinous retraction into joint
• Poor tissue quality
• Weak bones

Question 8

what is the repair failure of a rotator cuff repair

Answer 8

50%

Question 9

rotator cuff repair EPB

Answer 9

• Equivalent outcome of well structured and graduated exercise program when compared with surgery
  injection/CS injection- placebo/unclear

Question 10

Protocol Rotator Cuff Repair

Answer 10

➢ No active movement of the affected shoulder
➢ 6 weeks of passive movement to allow tissue healing
➢ Sling/binder/abduction wedge
- advice and education
➢ Other joint ROM maintenance
➢ Scapular stabilisation
➢ GOOB/mobilise
➢ D/C planning

Question 11

0-6 weeks RCR management

Answer 11

1. Sling use 24/24
2. Exercise sessions out of sling 3-4 x/day
3. PROM
4. Maintain other joints
5. Scapular control
6. A&E- ADL’s

Question 12

0-6 weeks RCR CIs/ directives

Answer 12

No Active movements
ER limits 0-20 deg
Flexion limits 90- 120deg
No abduction
No driving

Question 13

6-12 weeks RCR management

Answer 13

Restore Active ROM
Maintain/ progress CV fitness and other joints

Question 14

6-12 weeks RCR CIs/ directives

Answer 14

Start within pain-free arcs
Active pendulum exercises
Active assisted motion above 90° abduction
Active assisted

Question 15

12-24 weeks RCR management

Answer 15

Cuff strengthening
Plyometrics
Sport/Work Specific Activity

Question 16

Anterior Stabilisation surgery indicators

Answer 16

< = 25 years (traumatic)
Extrinsic risk factors- occupation/ recreation
demands ongoing symptoms
* Bony lesions

Question 17

0-6 Anterior Stabilisation surgery management

Answer 17

Passive ROM
Active elbow ROM exercises
Early gentle isometrics to
shoulder (not IR or FLEX if subscap has been detached)
Grip strength

Question 18

0-6 Anterior Stabilisation surgery CI

Answer 18

No active movements if subscap repaired (Usual)
Passive shoulder flexion <90 and ER <0

Question 19

6-12 weeks Anterior Stabilisation surgery management

Answer 19

Strengthening of cuff
Proprioception

Question 20

6-12 weeks Anterior Stabilisation surgery CIs

Answer 20

closed to open chains
Pushing activities prioritised

Question 21

12-18 weeks Anterior Stabilisation surgery management

Answer 21

Functional capacity Plyometrics

Question 22

12-18 weeks Anterior Stabilisation surgery directives

Answer 22

Add load, power, intensity, chaos

Question 23

18-24 weeks Anterior Stabilisation surgery management

Answer 23

return to sport

Question 24

18-24 weeks Anterior Stabilisation surgery directives

Answer 24

According to patient occupation or sporting demands

Question 25

Shoulder Replacement Indications

Answer 25

* Severe OA or RA * Significant trauma/ dysfunction * Avascular necrosis

Question 26

0-6 weeks shoulder replacement CIs/directives

Answer 26

No Active movements * TSR risk of dislocation with abduction and ER * Reverse TSR risk of dislocation with adduction and IR

Question 26

0-6 weeks shoulder replacement management

Answer 26

1. Sling use 24/24 2. Exercise sessions out of sling 3-4 x/day 3. PROM. 4. Maintain other joints 5. Scapular control 6. A&E- ADL’s

Question 27

6-12 weeks shoulder replacement management

Answer 27

Restore Active ROM Maintain/ progress CV fitness and other joint

Question 28

6-12 weeks shoulder replacement CIs/directives

Answer 28

Start within pain-free arcs Active pendulum exercises Active assisted motion above 90° abduction

Question 29

12-24 weeks shoulder replacement management

Answer 29

Cuff strengthening Scap strengthening CV fitness and lifestyle mods as required ADL specific- function

Question 30

12-24 weeks shoulder replacement CIs/directives

Answer 30

May not achieve full ROM- often 120 degrees limit Include diagonal and multiplanar motions with theraband Closed and Open chain as required for functional demands

Question 31

* Cuff function – 3 main jobs

Answer 31

* Pushing or flexion activities- preferentially activates the posterior cuff * Pulling or extension activities- preferentially activates anterior cuff * Abduction or scaption plane activates the whole cuff

Question 32

Workplace considerations

Answer 32

* sustained positions- high/ low load * 5-7 days / week * Minimal rest periods * 8-12 hour days * Nutrition / heat / hydration issues * Underlying fitness and health issues * Consider Bio- Psycho-Social Contributors