REHABILITATION FOLLOWING SCR AND RTSA 2017 Ortho Summit December 9, - - PowerPoint PPT Presentation

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Jun 08, 2023 257 likes •563 views

REHABILITATION FOLLOWING SCR AND RTSA 2017 Ortho Summit December 9, 2017 Ellen Shanley PhD, PT, OCS I (and/or my co-authors) have nothing to disclose. Detailed disclosure information is available through the Orthopedic Summit The Paradigm

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2017 Ortho Summit December 9, 2017 Ellen Shanley PhD, PT, OCS

REHABILITATION FOLLOWING SCR AND RTSA

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I (and/or my co-authors) have nothing to disclose. Detailed disclosure information is available through the Orthopedic Summit

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The Paradigm

PATHOLOGY IMPAIRMENT PROCEDURE PROBLEM TREATMENT GOALS

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rTSA compared to SCR

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Influence on Choice & Progression

Cuff Deficient Shoulder Pseudo Paralysis Pain ⇣ Function

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Managing Expectations Appropriate For Each Patient Our Responsibility…

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Implications for Rehabilitation

Young ⇡Age

PATHOLOGY Massive RCT IMPAIRMENT Function vs Pain GOALS

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 Type of implant/component  Humeral bone quality,  Deltoid status  Integrity of remaining RC,  Concomitant RC repair  Overall component stability.

Intra operative findings- rTSA

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 Scapular notching  Component Failure/

disassociation

 Dislocation  Infection  Acromial Stress fracture

Common complications RTSA

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 3 Key Rehab Concepts:

1. Joint protection
2. Deltoid function
a. Remainder of RTC
3. Est appropriate

functional goals

a. ROM

Key Concepts- rTSA

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Priorities

ROM- 90º FE; 20º-ER Submax Iso’s Scapular Ex

AROM & ant deltoid Strength No body wgt Limit cycles of ROM

Adv strength Limit cycles protect stability & Limit stress

Hold vs. cycles….

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rTSA

 rTSA higher risk for

dislocation vs. conventional TSA (Boudreau et al., 2007)

 Dislocation typically occurs

in IR, adduction and extension (reaching behind back)

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Early expectations

3-4 weeks….

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DC Outcomes

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Implications for Rehabilitation

Young ⇡Age

PATHOLOGY Massive RCT IMPAIRMENT Function vs Pain GOALS

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SCR Implications for Rehab

 Allograft Best tissue @ day 1 post-op  “soft tissue rTSA

” (Thay Lee, PhD)

Augmented massive RCR  Rotational stress Tenodesis effect of subscapularis & infraspinatus  Long axis stress Gravity ”distraction” (Mihata et al AJSM ’16)

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Intra-operative Findings- Expectations

 Restoration of PROM

Amt Subscap/ Infra Remaining Tissue Mobilization Position

 AROM- Amount of native tissue

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SCR Treatment Pathway

 Massive RCR Pathway  Failure of Massive RCR- 98% in 1st 6 months  Repairs of tears > 4cm fail < 12 wks (Miller et al AJSM ‘11)

☐ Increased risk of “re-tear/non healing” with

early AROM

☐< 3cm early 1.63x ☐> 3m early 2.5x ☐> 5cm 6x

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Priorities

Education & Protection 5 weeks- distal UE ROM only ER then FE- ROM Protect healing tissue Care Mobility ADL’s Joint Protection Functional Box

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Protected ROM

Rehabilitation plan to match the surgery and the patient

Graft type
Other cuff status
Patient goals/context

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Demands

Loading

Position
Reps

Goals

Work
Sport

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All suggested exercises < 40%

rotator cuff EMG 25-50% 40-60% >50%

Controlled Loading for Function

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Great < 90 then Fight Gravity

Restore Force Couple

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Patient Outcome Expectation

n=9 n=8

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AROM Return After SCR

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The real story on AROM return

n= 22 n=12

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Return to Function

➔No heavy lifting 4-6 months ➔Sport progressions

Golf > 20 weeks
Tennis >26 weeks
Swimming >26 weeks

(Fealy S et al. ’02; McKee MD et al. 00; Ellman et al ‘86; Charousset et al ‘08)

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Time to Function Healing

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