presented by Haideh V. Plock
This course is part of our OCS Prep-Program. Learn more about the full prep-program here: MedBridge OCS Prep-Program.
This is the second course in a three-part series. Course I covered the principles of tissue healing along with common spinal surgeries and Course III covers lower extremity surgical interventions. I would encourage you to watch course I in preparation for this course on upper extremity surgical interventions. This course will discuss how tissue healing affects management of upper extremity post-surgical patients and present rehabilitation considerations for more common upper extremity surgical procedures encountered in an outpatient setting.
This is part two of a three part series covering postsurgical management. Be sure to watch:
Post Surgical Management Part 1: Basic Principles and Spinal Surgery
Post Surgical Management Part 3: Lower Extremity Surgical Interventions
Haideh graduated with a double major in Kinesiology and Psychology from the University of California, Los Angeles in 1991. Upon completion of her Master’s in Physical Therapy from Boston University in 1993, she accepted a position at the Kerlan-Jobe Orthopedic Clinic. She worked there for the next 11 years specializing in orthopedic and sports related injuries. Haideh is also a 2002 graduate of the Kaiser Permanente Northern California Orthopaedic Manual Physical Therapy Fellowship and a Fellow of the American Academy of Orthopedic Manual Physical Therapists (AAOMPT). In 2005, she received her certification as an Orthopedic Clinical Specialist. Haideh currently serves as the Vice President for the AAOMPT. She recently relocated to Reno, NV after working for the past 10 years as the manager of the Palo Alto Medical Foundation’s Department of Physical Therapy. She enjoys snowboarding with her husband, hiking, crossfit, and yoga and is looking forward to living life near the Sierras.
There are numerous extrinsic and intrinsic factors that contribute to subacromial impingement syndrome of the shoulder. Surgical interventions may be indicated with cases that do not respond to conservative measures to remove mechanical anatomical contributions to impingement syndrome.
Many of the same extrinsic and intrinsic factors that contribute to subacromial impingement syndrome can contribute to development of rotator cuff tears. In cases that do not respond to conservative care, acute traumatic tears, or active individuals with full thickness tears, surgical intervention may be necessary. An understanding of the surgical procedure, including the specific anatomical structures involved, is crucial to determine the appropriate rehabilitation course.
A common tear of the glenoid labrum occurs along the superior labrum in an anterior to posterior direction (SLAP). Forces that cause the humeral head to pull on the superior labrum and biceps anchor can cause tearing of these structures off the glenoid. These forces can be from multiple sources, including shoulder dislocation, repetitive overhead lifting, and throwing. A SLAP repair is often indicated when nonoperative interventions fail and require a guided rehabilitation program following surgery.
The most common indication for total shoulder arthroplasty is advanced osteoarthritis with pain and range of motion limitations inhibiting functional ability. Most surgeons have very specific protocols following shoulder arthroplasty; however, clinical judgement should not be discarded. An understanding of tissue healing as well as the impact of comorbidities and general health on the rehabilitation progression needs to be included in the post-operative plan.
When symptoms associated with median nerve compression at the carpal tunnel do not resolve with conservative treatment, carpal tunnel release surgery may be indicated. Many factors contribute to the success of carpal tunnel surgery and can impact the length of the rehabilitation after this procedure.