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Icd 9 post surgical shoulder pain, aerobic video 80s - For Begninners

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Most common site of injury to the axillary artery is in the third part(named in relation to the pec minor) of the artery at the origin of the anterior and posterior humeral circumflex arteries. Minimally displaced = sling, PT within 2 wks.  Functional outcome, ROM and pain are significantly better when PT is started within first two weeks.
Synthes proximal humeral locking plate-plate should be 8mm distal to RTC insertion, higher placement=subacromial impingement, Remember to remove insertion guide.
Total shoulder replacement, also known as total shoulder arthroplasty (TSA), is a tremendously successful procedure for treating the severe pain and stiffness that often result at the end stage of various forms of arthritis or degenerative joint disease of the shoulder joint. Painful shoulder arthritis refers to the disappearing of the normally smooth cartilage surfaces of the shoulder, which permit the ball and socket to smoothly glide against one another. In recent years, a new type of shoulder replacement, the "reverse" shoulder [Figure 6] has entered the armamentarium of shoulder surgeons to treat arthritis. The design rationale for the reverse shoulder replacement is based on the fact that since in nature the shoulder ball “rests against” the socket, rather than being deeply contained within the socket, it relies on the tendons surrounding the ball socket to both hold it in place and to move it. The design of the reverse shoulder puts the ball on the patients own socket, and it is the plastic socket which is placed on the humerus bone. The most common indication for TSA is shoulder pain due to arthritis that cannot be controlled with non-operative treatment such as anti-inflammatory medications by mouth or injection, or rest.
A series of standard x-rays are taken to determine the condition of the shoulder joint (See Figure 1). In some chronic arthritic conditions such as ankylosing spondylitis, which may be associated with a stiff elbow and a stiff shoulder, TSA may be considered to improve overall function in the shoulder and arm, regardless of the pain level experienced by the patient. For many shoulder conditions involving the surrounding ligaments, muscles and tendons, such as a torn or diseased rotator cuff or a labral tear, a minimally invasive shoulder arthroscopy procedure is frequently recommended, and they are among the most common and frequently indicated shoulder procedures. Either regional anesthesia with interscalene block or general anesthesia, frequently together, is used for total shoulder replacement arthroplasty. There are many different types of implants that are used for an anatomic shoulder replacement.
In a reverse shoulder (See Figures 5&6), these components, while still metal and plastic, are “reversed”, the metal ball is attached to the patient socket, and the plastic socket is attached to the upper humerus. The surgeon begins by separating the deltoid and pectoral muscles, accessing the shoulder in a largely nerve-free area to minimize nerve damage.
Based on the range of motion and stability of the implant, physical therapy begins on the first postoperative day, following x-rays documenting that the implant is properly positioned.

The patient is permitted to use the hand and wrist soon after surgery, and the whole arm, including shoulder, for light activity beginning at approximately six weeks after surgery. The pre-surgical condition of the shoulder muscles and tendons play the biggest role in the patient’s outcome. At six months, most patients are pain-free (although weather does have an effect), and have motion and strength about two-thirds normal. At one year, approximately 95% of TSA patients will be pain-free, and the remaining will usually have no more than a weather ache or an occasional ache with excessive activity.
The most common complications involved in TSA, which occur only rarely, include shoulder stiffness, instability (the ball slipping out of the socket), infection, nerve damage, and glenoid loosening. An arthritic shoulder is often very tight to begin with, however if post-operative stiffness is a problem in a shoulder in which motion was restored during surgery, the stiffness is usually a result of incomplete rehabilitation.
Total shoulder arthroplasty is a highly beneficial surgical procedure intended to reduce pain and restore mobility in patients with end stage shoulder arthritis, and occasionally after certain severe shoulder fractures.
It is important to understand that proper and extensive post-operative rehabilitation is a key factor in achieving the maximum benefit of shoulder replacement surgery.
After one year, 95% of TSA patients enjoy pain-free function, which enables them to exercise the shoulder area sufficiently to promote restoration of strength and motion.
The primary goal of shoulder replacement surgery is pain relief, with a secondary benefit of restoring motion, strength, function, and assisting with returning patients to an activity level as near to normal as possible.
This disappearance of cartilage covering results in a “bone on bone” joint and can be quite painful. HSS surgeons have led the design team of both traditional, or “anatomic” shoulder replacement, and the Reverse shoulder. Accompanying the pain is a progressive stiffness and loss of motion, with the patient often experiencing a grinding or grating sensation within the shoulder joint that is disturbing and painful. Most candidates, however, will not experience lasting relief from these injections, making TSA a necessary next step if pain is uncontrolled. Total shoulder replacement, however, requires open surgery, with an incision along the front of the shoulder and upper arm. The Comprehensive Reverse Shoulder, which these surgeons have also designed, is entirely cementless, with both sides of the joint featuring the ability for native bone to grow into, and become part of, the implant. The shoulder is covered by the rotator cuff, which must be opened by cutting one of the anterior (front) rotator cuff muscles.

Continued rehabilitative efforts are usually effective in restoring shoulder motion and strength. With this in mind, TSA is generally considered to be as successful in relieving pain as total hip or knee replacement.
Because of this, most patients successfully return to the activities they enjoy, making the procedure a highly valued choice for a wide variety of patients suffering from significant shoulder pain due to cartilage loss. If greater tuberosity is fractured it is pulled superiorly and posteriorly by the supraspinatus and infraspinatus.
2] Metal on plastic surfaces (rather than metal on metal) are the hallmark of virtually all shoulder replacement implant systems. Because of this, an anatomic shoulder has no soft tissue to hold it in place and or to move it.
It also is moved by the deltoid muscle, not the rotator cuff tendon, so it is an ideal choice when the damaged shoulder needs new surfaces, but does not have healthy enough soft tissues for stabilization and movement.
Those with possible nerve damage may also undergo an EMG test, or Nerve Conduction test, to evaluate the nerves which feed the important muscles of the shoulder. Likewise, some patients experiencing early osteoarthritis may consider more conservative management (such as physical therapy, medication, cortisone injections, or even shoulder arthroscopy) before TSA is deemed a necessary measure. The goal of shoulder replacement is to remove the patient’s arthritic humeral head, replace it with the metal “ball” component attached to a stem that extends down inside the patient’s humerus (upper arm bone), and then place a plastic socket over the surface of the patient’s own glenoid (See Figure 2). This “opens the door,” allowing the surgeon to view and manipulate the arthritic parts of the shoulder ball and socket. Partial shoulder replacement (or hemi-replacement) may also be indicated with certain severe shoulder fractures of the humeral head. Shoulder arthroscopy, while attractive because it is minimally invasive, plays a very limited role in the shoulder with arthritis, but may be of value before the joint has truly become "bone on bone". Dines, MD, have designed and utilized a new implant, The Comprehensive Primary Shoulder System, (See Figure 3) with a ball made of cobalt chrome and a stem made of titanium metal, featuring modular (separate) components; the ball, stem, and socket all fit together to provide a more customized fit.

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