Rehabilitation Of Anterior Shoulder Dislocation

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Presentation given in fall of 2008.

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  • 09/08/09 00:56 © 2007 Microsoft Corporation. All rights reserved. Microsoft, Windows, Windows Vista and other product names are or may be registered trademarks and/or trademarks in the U.S. and/or other countries. The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION.
  • 09/08/09 00:56 © 2007 Microsoft Corporation. All rights reserved. Microsoft, Windows, Windows Vista and other product names are or may be registered trademarks and/or trademarks in the U.S. and/or other countries. The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION.
  • 09/08/09 00:56 © 2007 Microsoft Corporation. All rights reserved. Microsoft, Windows, Windows Vista and other product names are or may be registered trademarks and/or trademarks in the U.S. and/or other countries. The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION.
  • Rehabilitation Of Anterior Shoulder Dislocation

    1. 1. Chris Blake,MA,LATC,CSCS Owner/Pro Coach Pro Athletic Training & Development, LLC
    2. 2. <ul><li>95% of anterior shoulder dislocations due to shoulder instability caused from traumatic injury [1] </li></ul><ul><li>Patients’ age at time of injury is inversely related to recurrence rate. [1] </li></ul><ul><li>Younger than 20 years, recurrent dislocation rates as high as 90% in athletic population [1] </li></ul>Starting Point in Rehabilitation
    3. 3. <ul><li>Ages 20-25 recurrent dislocation rates between 50-75% [1] </li></ul><ul><li>Older than 40 years, lower rates of instability, higher rates of rotator cuff tears. [1] </li></ul><ul><li>Rotator Cuff and Parascapular Musculature offers Dynamic Stabilization. </li></ul>
    4. 4. <ul><li>1 st Time Dislocation </li></ul><ul><li>Other Damage Control </li></ul><ul><ul><li>RC Tears </li></ul></ul><ul><ul><li>Labral Tears/Repairs </li></ul></ul><ul><ul><ul><li>Howell and Galinat: Labrum contributes 50% of the total depth of socket. </li></ul></ul></ul><ul><ul><ul><li>Labrum damage in Bankhart lesion plays into recurrences. </li></ul></ul></ul><ul><ul><li>Chondral defects. </li></ul></ul><ul><ul><li>Osseous lesions </li></ul></ul>
    5. 5. <ul><li>Very Controversial </li></ul><ul><li>Decision Based On: </li></ul><ul><ul><li>Age </li></ul></ul><ul><ul><li>Sport </li></ul></ul><ul><ul><li>Activity Level </li></ul></ul><ul><ul><li>Injured Athlete </li></ul></ul><ul><li>Bottoni et al 88% follow-up at an average of 3 year, recurrent instability was noted in 11.1% of arthroscopic group versus 75% of nonop group [2] </li></ul>
    6. 6. <ul><li>Not many open being performed. </li></ul><ul><ul><li>Risk of Infection </li></ul></ul><ul><ul><li>Patient Comfort Level </li></ul></ul><ul><ul><li>Cosmetic Reasoning </li></ul></ul><ul><li>Either Open or Arthroscopic…..It Doesn’t Make A Big Difference Rehabilitation-wise* </li></ul><ul><li>* Some rehab protocols state aggressive for Open Bankart Repair. </li></ul>
    7. 7. <ul><li>Nonoperative </li></ul><ul><ul><li>Immobilization in a sling for approx. 1 week </li></ul></ul><ul><ul><li>Range of motion exercises as tolerated with progression to strengthening. </li></ul></ul><ul><ul><li>Strengthening Phase: Emphasis on Periscapular and Dynamic Stabilizers. [1] </li></ul></ul><ul><ul><li>Later Stages: Proprioception and Dynamic Stabilization along with Sport Specific Situations. </li></ul></ul><ul><li>Post-Op Bankart Repair </li></ul><ul><ul><li>Shoulder Immobilization 4 weeks. </li></ul></ul><ul><ul><ul><li>Pendulum exercises? </li></ul></ul></ul><ul><ul><ul><li>AROM of the elbow </li></ul></ul></ul><ul><ul><ul><li>Maintain Light Grip Strength </li></ul></ul></ul><ul><ul><li>At 4 weeks: </li></ul></ul><ul><ul><ul><li>Supine Forward Elevation/Flexion to 90 deg. </li></ul></ul></ul><ul><ul><ul><li>ER Limited to 15-20 degrees </li></ul></ul></ul><ul><ul><ul><li>Sling use is discontinued 4-6 weeks, Submax Isos </li></ul></ul></ul><ul><ul><li>6-8 Weeks: </li></ul></ul><ul><ul><ul><li>Pulleys, Cane ER, Supine Flexion </li></ul></ul></ul>
    8. 8. <ul><li>Nonoperative </li></ul><ul><ul><li>Pace of Rehab Based on comfort level. </li></ul></ul><ul><ul><li>Limit ER to 45 degrees for first 4-8 weeks, then to 90 degrees 8-12 weeks. </li></ul></ul><ul><ul><li>12 weeks: Athlete will feel good. Test out shoulder </li></ul></ul><ul><ul><li>Avoid: Overhead Presses </li></ul></ul><ul><ul><ul><li> Upright Rows </li></ul></ul></ul><ul><ul><ul><li> Deep Bench Press </li></ul></ul></ul><ul><ul><ul><li> Dips </li></ul></ul></ul><ul><ul><li>A Good-Solid RC Program is a Must!!!! </li></ul></ul><ul><li>Post-Op Bankart Repair </li></ul><ul><ul><li>6-8 Weeks Contin: </li></ul></ul><ul><ul><ul><li>Scapular Squeezes </li></ul></ul></ul><ul><ul><ul><li>Light to Max Iso’s (8 wks) </li></ul></ul></ul><ul><ul><ul><li>ER to 70 @ 90/90 degrees (8 wks)* </li></ul></ul></ul><ul><ul><ul><li>Flexion to Full (8 wks)* </li></ul></ul></ul><ul><ul><li>8-12 Weeks </li></ul></ul><ul><ul><ul><li>Begin Light Sport Cord Rows </li></ul></ul></ul><ul><ul><ul><li>Continue to work Periscapulars </li></ul></ul></ul><ul><ul><li>12 Weeks: The Gloves Come Off!!!! </li></ul></ul><ul><ul><ul><li>Full ROM </li></ul></ul></ul><ul><ul><ul><li>Back/Shoulder/Chest exercises </li></ul></ul></ul>
    9. 9. WK 1-2 WK 3-4 WK 5-6 WK 7-8 WK 8-10 WK 10-12 SLING X X PROM FF: 60 90 135 FULL FULL FULL SCAPTION: 60 115 135 FULL FULL FULL IR: 45 60 FULL FULL FULL FULL ER: 0-10 15-20 30 70 @90/90 FULL @ 90 abd. FULL ABDUCTION: X 75-85 120 160 FULL FULL begin 90/90 ISOMETRICS FF: X SUBMAX MAX DISCONTINUE DISCONTINUE ABD: X SUBMAX MAX DISCONTINUE DISCONTINUE IR: X SUBMAX MAX DISCONTINUE DISCONTINUE ER: X SUBMAX MAX DISCONTINUE DISCONTINUE AAROM FF: X to 90 only to 135 TO TOL. TO TOL. ABD: X X to 120 TO TOL. TO TOL. IR: X X TO TOL. TO TOL. TO TOL. ER: X X to 30 TO TOL @ 0 TO TOL. begin 90/90 AROM FF: X X X TO TOL. ABD: X X X TO TOL. IR: X X X TO TOL. ER: X X X TO TOL. begin 90/90
    10. 10. WK 1-2 WK 3-4 WK 5-6 WK 7-8 WK 8-10 WK 10-12 ISOTONICS FF: X X TO TOL. TO TOL. TO TOL. TO TOL. ABD: X X TO TOL. TO TOL. TO TOL. TO TOL. IR: X X TO TOL. @0 TO TOL. @0 TO TOL. begin 90/90 ER: X X TO TOL. @0 TO TOL. @0 TO TOL. begin 90/90 SCAP STAB. X NO RESIST TO TOL.
    11. 11. WK 1-2 WK 3-4 WK 5-6 WK 7-8 WK 8-10 WK 10-12 SLING X X X PROM FF: 60 90 90 135 FULL FULL SCAPTION: 60 90 90 135 FULL FULL IR: X 0-15 [email_address] 45 @90/90 FULL @10wks FULL ER: 15-20 25-30 90 90 @90/90 FULL to functional (throwers) ABDUCTION: 45 60 135 FULL FULL FULL begin 90/90 ISOMETRICS FF: X SUBMAX MAX DISCONTINUE DISCONTINUE ABD: X SUBMAX MAX DISCONTINUE DISCONTINUE IR: X X MAX DISCONTINUE DISCONTINUE ER: X SUBMAX MAX DISCONTINUE DISCONTINUE AAROM FF: X to 90 only to 90 only TO TOL. TO TOL. ABD: X X to 90 only TO TOL. TO TOL. IR: X X X to 45 only TO TOL. ER: X X TO TOL TO TOL TO TOL. begin 90/90 AROM FF: X X X TO TOL. TO TOL. ABD: X X to 90 only TO TOL. TO TOL. IR: X X X TO 35. @0 TO TOL. ER: X X TO TOL TO TOL. TO TOL. ELBOW/WRIST TO TOL TO TOL TO TOL
    12. 12. WK 1-2 WK 3-4 WK 5-6 WK 7-8 WK 8-10 WK 10-12 ISOTONICS FF: X X X TO 90deg TO TOL. TO TOL. ABD: X X X TO 90deg TO TOL. TO TOL. IR: X X X X at 0 abd begin 90/90 ER: X X TO TOL. @0 TO TOL. TO TOL. begin 90/90 TRICEPS X X X no overhead TO TOL. BICEPS X X X TO TOL TO TOL. SCAP STAB. X NO RESIST NO RESIST TO TOL Notes: begin diagonals at 14-15 weeks Full A/PROM at 12 weeks 10 weeks, IR at 12 weeks avoid posterior glides for first 8 weeks may begin wall push ups at 8 weeks, progressive after 10 weeks
    13. 13. <ul><li>16 weeks Post-op/Post-injury </li></ul><ul><ul><li>Closed Kinetic Chain Exercises </li></ul></ul><ul><ul><li>Dynamic Rhythmic Stabilization </li></ul></ul><ul><ul><li>Increase Sets, Decrease Reps, Increase Resistance. </li></ul></ul><ul><ul><li>Maintain ROM </li></ul></ul><ul><ul><li>Return To Sports Training is a Sports Medicine Team Decision </li></ul></ul>
    14. 14. <ul><li>Year-round Training </li></ul><ul><ul><li>Including In-season Training program. </li></ul></ul><ul><li>Football, Ice Hockey, Lacrosse, Wrestling, Gymnastics, Swimming: You Have To Go All Out!!! </li></ul><ul><li>Train them Like Hell!!!! </li></ul><ul><li>But Be Smart About It!!! </li></ul><ul><li>Overhead Lifts?????? </li></ul>
    15. 16. <ul><li>Deep ROM Bench Presses </li></ul><ul><li>Dips </li></ul><ul><li>Heavy Overhead Lifts </li></ul><ul><li>Upright Rows </li></ul><ul><li>Snatch Cleans </li></ul><ul><li>Overhead Kettlebell Exs </li></ul><ul><li>Risk Outweighs Reward…. </li></ul>
    16. 17. <ul><li>[1] Dodson CC, Cordasco FA. Anterior Glenohumeral Joint Dislocations. Orthop Clin N Am 39 (2008): 507-518. </li></ul><ul><li>[2] Cox CL, Kuhn JE. Operative Versus Nonoperative Treatment of Acute Shoulder Dislocation in the Athlete. Current Sports Medicine Reports. Vol. 7(5), September/October (2008): 263-268. </li></ul><ul><li>[3] Kim SH, Ha KI, Jung MW, Lim MS, Kim YM, Park JH. Accelerated Rehabilitation After Arthroscopic Bankhart Repair for Selected Cases: A Prospective Randomized Clinical Study. Arthroscopy.(2003) Sep;19(7):722-31. </li></ul><ul><li>[4] Jakobsen BW, Johannsen HV, Suder P, Sojbjerg JO. Primary Repair Versus Conservative Treatment of First-Time Traumatic Anterior Dislocation of the Shoulder: A Randomized Study with 10-Year Follow-up. Arthroscopy. (2007) Feb;23(2):118-23. </li></ul><ul><li>[5] Gartsman GM, Roddey TS, Hammerman SM. Arthroscopic Treatment of Anterior-Inferior Glenohumeral Instability: Two to Five-Year Follow-up. The Journal of Bone and Joint Surgery. Vol. 82-A, no. 7, July (2000): 991-1003. </li></ul>

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