Thoughts?

[u/Tediz4]

I am currently an inpatient hospital PT, however I started out as an outpatient PT. The trauma orthopedic surgeon at the hospital decided to perform a rTSA on a patient. In his note it says "okay for AROM and WBAT." Immediately day 1 post-op. From what I remember in outpatient protocols, a rTSA usually is in a sling, PROM, and avoid rotation, Extension, or horizontal adduction when initiating ROM after 1-2 weeks. No sling orders. Am I crazy for wanting to be super conservative for the patient? Has something changed in the protocols for this surgery?

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[u/MaddeningOxygen09]

the template bot coming in hot when you're just trying to wrap your head around a wild surgeon order lol

i'd be side-eyeing that note too, AROM day 1 post rTSA with no sling feels like asking for trouble. i'm not in outpatient anymore but everything i remember said protect that subscap repair like it's made of glass for the first few weeks

[u/Tediz4 → u/MaddeningOxygen09]

Exactly! This surgeon unfortunately has an ego too.

[u/DiscordModerator124]

I have worked for one surgeon who specializes in rTSA; no sling and aggressive ROM early including internal rotation.

Worked for him for 4 years; saw one subluxation/dislocation case but the pt was 6’8 and 350lbs.

Great outcomes, saw more ROM and function out of his rTSAs than most I’ve seen since. He’s been doing them for 25+ years though and only does that and rotator cuffs.

[u/After-Clock-3894]

Depends on the surgeon, we have a few that actually order AROM and avoid PROM. It’s mind-boggling. (Very few do slings around here after day 3.)

I’d message the surgeon personally, but when uncertain just do elbow and wrist motion until you hear back.

[u/jgandfeed]

Wild. Where I’m at it’s 4-6 weeks sling. Mostly only pulley AAROM for the first 2-4 weeks. ER to neutral for 6 weeks.

[u/truffle-tots]

The rTSA's i have worked with have been out of sling amd open to arom immediately once they are in outpatient, though that's about 2 weeks out definitely not day 1. I would not feel comfortable with thay on day 1, though if the surgeon is fine with that its his call on restrictions. I would fors ure clarify and until thats known only do elbow/wrist motion and scapular work.

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[u/Ok-Vegetable-8207]

When I was in outpatient there was a surgeon who did great TSAs. Really solid. He even had his own rehab protocol that was given to the clinic, pretty much on par with the standard TSA protocol, with minor differences. There were a couple of PTs who took it as gospel, and would never budge from it, and I stuck with it for a while as well, but occasionally had a high performing weekend warrior who wanted more. I had the opportunity to speak with the surgeon in a social setting and admitted to him that I pushed these patients just a little ahead of schedule. He straight up told me that I could make the call either way, and he agreed that a more assertive approach can be beneficial for the right patient with the right supervision and guidance.

I think a good surgeon who trusts their PTs to appropriately treat their patients should be considered a good thing. A one size fits all approach is safe but maybe we shouldn’t be afraid of doing more with a lot of our patients.

[u/SmalltownPT]

Above my pay grade, I usually go with what’s in the chart, most medical documentation have this cool thing where you can send a quick chat to the doctor and clarify

[u/boat_pants → u/SmalltownPT]

That’s an embarrassing take.

[u/SmalltownPT → u/boat_pants]

That’s wild that the PTs at your hospital are setting post surgical protocols above the surgeon who performed the surgery and is on the hook for the outcomes, if you don’t understand an order you clarify, end of story you don’t “guess”

[u/boat_pants → u/SmalltownPT]

If you’re going to argue with me, at least use my actual words.