Subacromial Balloon Spacer: Difference between revisions
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'''Original Editor '''- | |||
'''Original Editor '''- Jessica Galasso | |||
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} | '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} | ||
</div> | </div> | ||
== Description | == Description == | ||
'''This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work!''' | |||
InSpace (Orthospace) biodegradable balloon system is also known as a subacromial balloon spacer. These spacers are composed of polylactide and ε-caprolactone copolymer.<ref name=":0">Stewart RK, Kaplin L, Parada SA, Graves BR, Verma NN, Waterman BR. Outcomes of subacromial balloon spacer implantation for massive and irreparable rotator cuff tears. ''Orthop. J. Sports Med.7(10), 2325967119875717. DOI: 10.1177/2325967119875717. 1-10.'' </ref>The spacers are biodegradable and are believed to last 12 months or less.<ref name=":0" />Placement of these spacers is typicaly minimally invasive with low rates of complications. <ref name=":0" /> | |||
= | Subacromial balloon spacer are used for massive rotator cuff tears. Other typical intervention for massive rotator cuff tears are partial tendon repairs, subacromial decompression, bicep tenodesis, and reverse total shoulder arthroplasty. <ref name=":1">Knapik DM, Williams BT, Verma NN. Balloon spacers in the management of massive rotator cuff tears: a focus on clinical outcomes. ''Ann Joint.'' 2021;6:19. dx.doi.org/10.21037/aoj-20-35. 1-10. </ref>There is no gold standard to treatment at this time. The selection of treatment depends on a multitude of factors including the patient's age, medical history, and condition of the shoulder. | ||
The surgical procedure of a subacromial balloon spacer is typically performed arthroscopically through the lateral shoulder.<ref name=":0" />This device allows for improved biomechanics of the shoulder when the rotator cuff cannot be repaired.<ref name=":0" /> It reduces subacromial friction so that the humeral head is closer against the glenoid cavity.<ref name=":0" /> | |||
== Indication == | |||
Subacromial balloon spacers can be indicated for massive rotator cuff tears or irreparable tears. A massive rotator cuff tear is considered a tear ≥5 cm or involving 2 or more tendons.<ref name=":1" /> Irreparable tears consist of tears that can not be repaired to a natural footprint, or if repaired it will retear.<ref name=":1" /> Common signs of irreparable tears includes fatty infilitation of 50% or more, static superior migration of the humeral head, and absent acromiohumeral interval.<ref name=":0" /> The subacromial balloon spacer can also be used in younger patients to allow for additional time before a more radical procedure is performed, like shoulder arthroplasty.<ref name=":1" /> | |||
It is important to select appropriate patients when considering a subacromial balloon spacer. Individuals with glenohumeral arthritis, irreparable subscapularis tears, patients with infections, and those with allergies to the device materials.<ref name=":1" /> | |||
== Clinical Presentation == | == Clinical Presentation == | ||
The subacromial balloon spacer functions to restore normal biomechanics to the shoulder. The spacer depresses the humeral head so that it has a more centralized position in the glenoid cavity.<ref name=":1" /> This restores the coupling forces between the subscapularis and teres minor, as well as improves the function of the deltoid.<ref name=":1" />This improves abduction and pain-relief by reducing impignement. The balloon spacer also reduces friction, redistributes forces, and facilitates smooth gliding of the humeral head.<ref name=":1" /> | |||
After surgery, the spacer remains inflated for 6-12 months.<ref name=":0" />,<ref name=":1" />This allows the retraining of the muscles around the shoulder joint to improve muscle balance and biomechanics.<ref name=":1" /> | |||
Complication rates range from 2-16.7%.<ref name=":1" /> The most common complication is spacer migration.<ref name=":1" />The next surgical intervention is a reverse total shoulder arthroplasty.<ref name=":1" /> | |||
== Diagnostic Tests == | == Diagnostic Tests == | ||
MRI and X-rays are typically used to determine diagnosis and extent of shoulder damage. This will lead to determining what the appropriate intervention is for the patient. | |||
== Pre-Op == | == Pre-Op == | ||
Patients typically go through a variety of conservative treatments prior to discussing surgical intervention. Patients will usually be treated by a physical therapist to improve ROM, stability, and strength of the shoulder. Patients may also undergo injections and other treatments. Once these interventions have failed, then the patient will undergo a surgical consult to discuss what the best course of action is for that individual patient. | |||
== Post-Op == | == Post-Op == | ||
There is currently no clear standard for a rehabilitation protocol for optimal management of a post-operative subacromial balloon spacer. The physical therapist should always discuss surgical precautions with the referring physician. Typical surgical protocols include use of a sling for 4-6 weeks. | |||
Precautions after surgery typically include: immobilization for 4-6 weeks; no sudden movements, repetitive movements, or lifting for 3 months.<ref name=":2">Shoulder Balloon Implant Protocol. OrthoIllinois Rehabilitation, 2021.</ref>,<ref name=":3">Post-Operative Protocol for Patients Following InSpace Implantation. Ortho Space. 2022.</ref> | |||
A general protocol is provided below. Always check with your referring surgeon on specifics for each individual patient. | |||
'''Phase I (Day 0-4 weeks):''' | |||
* Use of immobilizing sling<ref name=":2" /> | |||
* Modalities as needed<ref name=":2" /> | |||
* PROM, A/AROM exercises to stay within pain threshold. Shoulder should be limited to 0-60<sup>0</sup> <ref name=":2" /> | |||
* Pendulum exercises<ref name=":2" /> | |||
'''Phase II (4-6 weeks):''' | |||
* Decrease use of sling (use only for comfort).<ref name=":2" /> | |||
* PROM/AROM to achieve full motion. <ref name=":2" /> | |||
* Driving can resume once the patient can safely use both hands on the steering wheel and is free from use of prescription pain medications that may impact driving abilities.<ref name=":3" /> | |||
'''Phase III (6-12 weeks):''' | |||
* Temporary discomfort is normal at this phase. <ref name=":2" /> | |||
* Continue progressing ROM and include strengthening. <ref name=":2" /> | |||
* Start to return to normal activity.<ref name=":2" /> | |||
'''Phase IV (12+ weeks)''' | |||
* Rehabilitation may continue through 6 months post-op.<ref name=":2" /> | |||
== Resources <br> == | == Resources <br> == | ||
Ortho Illinois Shoulder Balloon Implant Protocol: | |||
* https://www.orthoillinois.com/wp-content/uploads/2022/01/Shoulder-Balloon-Implant-Protocol-12-22-21.pdf<ref name=":2" /> | |||
Ortho Space Post-Operative Protocol for Patients Following InSpace<sup>TM</sup> implantation: | |||
* https://www.nth.nhs.uk/content/uploads/2019/02/inspace-balloon-spacer-postop-protocol.pdf<ref name=":3" /> | |||
== References == | == References == | ||
<references /> | <references /> | ||
Latest revision as of 19:47, 28 November 2022
Original Editor - Jessica Galasso
Top Contributors - Jessica Galasso
Description[edit | edit source]
This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work!
InSpace (Orthospace) biodegradable balloon system is also known as a subacromial balloon spacer. These spacers are composed of polylactide and ε-caprolactone copolymer.[1]The spacers are biodegradable and are believed to last 12 months or less.[1]Placement of these spacers is typicaly minimally invasive with low rates of complications. [1]
Subacromial balloon spacer are used for massive rotator cuff tears. Other typical intervention for massive rotator cuff tears are partial tendon repairs, subacromial decompression, bicep tenodesis, and reverse total shoulder arthroplasty. [2]There is no gold standard to treatment at this time. The selection of treatment depends on a multitude of factors including the patient's age, medical history, and condition of the shoulder.
The surgical procedure of a subacromial balloon spacer is typically performed arthroscopically through the lateral shoulder.[1]This device allows for improved biomechanics of the shoulder when the rotator cuff cannot be repaired.[1] It reduces subacromial friction so that the humeral head is closer against the glenoid cavity.[1]
Indication[edit | edit source]
Subacromial balloon spacers can be indicated for massive rotator cuff tears or irreparable tears. A massive rotator cuff tear is considered a tear ≥5 cm or involving 2 or more tendons.[2] Irreparable tears consist of tears that can not be repaired to a natural footprint, or if repaired it will retear.[2] Common signs of irreparable tears includes fatty infilitation of 50% or more, static superior migration of the humeral head, and absent acromiohumeral interval.[1] The subacromial balloon spacer can also be used in younger patients to allow for additional time before a more radical procedure is performed, like shoulder arthroplasty.[2]
It is important to select appropriate patients when considering a subacromial balloon spacer. Individuals with glenohumeral arthritis, irreparable subscapularis tears, patients with infections, and those with allergies to the device materials.[2]
Clinical Presentation[edit | edit source]
The subacromial balloon spacer functions to restore normal biomechanics to the shoulder. The spacer depresses the humeral head so that it has a more centralized position in the glenoid cavity.[2] This restores the coupling forces between the subscapularis and teres minor, as well as improves the function of the deltoid.[2]This improves abduction and pain-relief by reducing impignement. The balloon spacer also reduces friction, redistributes forces, and facilitates smooth gliding of the humeral head.[2]
After surgery, the spacer remains inflated for 6-12 months.[1],[2]This allows the retraining of the muscles around the shoulder joint to improve muscle balance and biomechanics.[2]
Complication rates range from 2-16.7%.[2] The most common complication is spacer migration.[2]The next surgical intervention is a reverse total shoulder arthroplasty.[2]
Diagnostic Tests[edit | edit source]
MRI and X-rays are typically used to determine diagnosis and extent of shoulder damage. This will lead to determining what the appropriate intervention is for the patient.
Pre-Op[edit | edit source]
Patients typically go through a variety of conservative treatments prior to discussing surgical intervention. Patients will usually be treated by a physical therapist to improve ROM, stability, and strength of the shoulder. Patients may also undergo injections and other treatments. Once these interventions have failed, then the patient will undergo a surgical consult to discuss what the best course of action is for that individual patient.
Post-Op[edit | edit source]
There is currently no clear standard for a rehabilitation protocol for optimal management of a post-operative subacromial balloon spacer. The physical therapist should always discuss surgical precautions with the referring physician. Typical surgical protocols include use of a sling for 4-6 weeks.
Precautions after surgery typically include: immobilization for 4-6 weeks; no sudden movements, repetitive movements, or lifting for 3 months.[3],[4]
A general protocol is provided below. Always check with your referring surgeon on specifics for each individual patient.
Phase I (Day 0-4 weeks):
- Use of immobilizing sling[3]
- Modalities as needed[3]
- PROM, A/AROM exercises to stay within pain threshold. Shoulder should be limited to 0-600 [3]
- Pendulum exercises[3]
Phase II (4-6 weeks):
- Decrease use of sling (use only for comfort).[3]
- PROM/AROM to achieve full motion. [3]
- Driving can resume once the patient can safely use both hands on the steering wheel and is free from use of prescription pain medications that may impact driving abilities.[4]
Phase III (6-12 weeks):
- Temporary discomfort is normal at this phase. [3]
- Continue progressing ROM and include strengthening. [3]
- Start to return to normal activity.[3]
Phase IV (12+ weeks)
- Rehabilitation may continue through 6 months post-op.[3]
Resources
[edit | edit source]
Ortho Illinois Shoulder Balloon Implant Protocol:
- https://www.orthoillinois.com/wp-content/uploads/2022/01/Shoulder-Balloon-Implant-Protocol-12-22-21.pdf[3]
Ortho Space Post-Operative Protocol for Patients Following InSpaceTM implantation:
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Stewart RK, Kaplin L, Parada SA, Graves BR, Verma NN, Waterman BR. Outcomes of subacromial balloon spacer implantation for massive and irreparable rotator cuff tears. Orthop. J. Sports Med.7(10), 2325967119875717. DOI: 10.1177/2325967119875717. 1-10.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 Knapik DM, Williams BT, Verma NN. Balloon spacers in the management of massive rotator cuff tears: a focus on clinical outcomes. Ann Joint. 2021;6:19. dx.doi.org/10.21037/aoj-20-35. 1-10.
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 Shoulder Balloon Implant Protocol. OrthoIllinois Rehabilitation, 2021.
- ↑ 4.0 4.1 4.2 Post-Operative Protocol for Patients Following InSpace Implantation. Ortho Space. 2022.
