January- Post Op

[Kyle Feldman]

A 68 year old female comes into your clinic 3 weeks s/p L RTSA. Her MD provided a very generic protocol so, you decided to do what a great clinician would do, and do a literature review on post op protocols.

You come across the attached article.

Initial question:

What does this tell you about protocols?

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[Farisshd]

This article tells me that at the time of it’s writing, there was not a lot of high level evidence behind these protocols (at least not full text available in English). It highlights the fact that whether RTSA or anatomical TSA there is a lot of variability behind protocols. It highlights the common concern for subscapularis tendon integrity, as well as potential stress fractures. Essentially, take them with a grain of salt, consider the anatomy involved, review the op report if available and consider the involved structures and the stages of healing when progressing your patient.

[zcanova]

I think articles like this are great for bringing awareness of an issue that I believe relates to many post op protocols. The major take away from this article is that there are inconsistencies in protocols and we need to utilize factors such as tissue healing time frames, exercise loading principles, and biomechanical principles to provide care that is individualized to the patient. This becomes more apparent when patients have multiple procedures preformed and we have to consider multiple structures that may have completely different functions. Overall I think that protocols are a great place to start, but we do need to consider many other factors that affect tissue healing and loading that are not typically discussed in the protocols.

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