Post on 27-Dec-2015
transcript
ARTHROSCOPIC ACROMIOPLASTYAngela Whittington
DEFINITION Bursitis or tendonitis impingement Causes the tissues underneath the AC
joint to be pinched against the bone Produces irritation and pain
MOIRotator cuff muscles become stretched
laxityArm abducted > 90◦head drops & longhead biceps
tendon/supraspinatus becomes impinged
ACROMION PROCESS
Three types (shapes of acromion processes)
Type I: Flat Figure A
Type II: Gently curved Figure B
Type III: Sharply hooked Figure C
PATIENT HISTORY
Female 20 y/o Division I Collegiate Volleyball athlete S/S: pain with overhead activity Dec ROM Crepitus w/ GH motion
Pain w/ GH ABD & FLEXDecreased rotator cuff strength
Special Tests(+) Neer Impingement & Hawkins
Impingement
PATIENT HISTORY CONT.
Image FindingsRadiographs
confirm Type III Acromion Process
IMAGINGNormal Rotator Cuff Torn Rotator Cuff
Patient chose conservative treatments at firstRest IceNSAIDsRehabilitation
Conservative treatment failed to return her to preinjury levelSurgical intervention recommended
ARTHROSCOPIC ACROMIOPLASTY Ellman (1987) introduced
technique for subacromial decompression
Meant for pt’s who did not respond toSix mo. of conservative
treatmentNSAIDS, steroid
injectionsPhysical therapy
Three small skin portalsSpares deltoid muscle
& ↓ post-op movement restriction
SURGICAL INTERVENTION Goal is to smooth ANT acromial undersurface Subacromial space and bursa is debrided Acromioplasty performed Recommended anterior-inferior
acromioplasty Detaching deltoid muscle from ANT
subacromial process & AC joint Osteosome removes ANT & undersurface of
acromion process Portion of coracoacromial ligament removed to
decompress the space Arthroscopic acromioplasty preferred
PROCEDURE Orthosports - Orthopaedic
& Sports Medicine Physicians - Shoulder Impingement
REHABILITATION: PHASE 1
GoalsLimit PainRestore MotionReduce Swelling
TREATMENT RECOMMENDATIONS
IceSling (if necessary)E-Stim Joint Mobilization (grade 1 and 2)Rom (passive and active assisted
pain free)Pendulum Exercises
REHABILITATION: PHASE 2
GoalsEliminate PainRestore full active motionRestore good glenohumeral and
scapulohumeral rhythm4/5 strength or upper extremity
muscles
TREATMENT RECOMMENDATIONS
Continue modalities as needed
Start with active range of motion
Add isometrics below shoulder level
Flexibility of cervical, shoulder, and scapular muscles
PRECAUTIONSAll active and isometric exercises
should be muscle specificAll movements and activity
increasing symptoms should be eliminated
Isometrics are modified if patients symptoms are made worse
REHABILITATION: PHASE 3Attain full pain free ROMAchieve 5/5 strength in all shoulder
girdle musclesFull pain free resistive range of
motionNegative Neer SignNegative Hawkins SignSymmetrical scapulohumeral
rhythm
TREATMENT RECOMMENDATIONSContinue use of ice as necessaryContinue with previous exercisesProgress resistance to overhead and
above horizontalAdd resistance to scapular exercisesWork on quality of motion and not just
resistive trainingWork on balance of rotator cuff
muscles Start with sport/work specific exercisesWater resistive activities
PRECAUTIONSDo not neglect the rest of the body!
REHABILITATION: PHASE 4Goals
Full pain free ROM5/5 strength in all upper extremity
and scapular musclesNormal scapulohumeral rhythm w/
and w/o resistanceAble to complete throwing sport
specific or work tasks pain free, and w/o signs of instability or impingement
PRECAUTIONS It should be noted that time frames
for these phases overlap time frames for these phases can’t be given. It is based on exercise intensity, pain, underlying instability, healing time, and strength
Rehab should be progressive always achieving and then maintaining a pain free state
TREATMENT RECOMMENDATIONS
Continue use of ice as necessaryContinue with previous exercisesProgress resistance to overhead and
above horizontalAdd resistance to scapular exercisesWork on quality of motion and not
just resistive trainingWork on balance of rotator cuff
muscles
THINGS TO REMEMBER Core Strengthening Cardio Workouts Team involvement If athlete is sore after exercises, bring down
Do not progress or overwork!
FUNCTIONAL EXERCISE Dig & Roll
Practice defense and going to the floor after a dig.
Use groups of three or four.
Line starts at middle back position.
Coach hits a ball to the right.
Player must read coach's shoulders and dig ball.
After the dig the player must roll.
Coach alternates hits right and left.
Continue for a set number of digs for each player.
FUNCTIONAL EXERCISE Cross Court Digging
To practice digging balls a good distance away from the net and from different angles.
1.Hitters alternate hitting balls at the defenders.
2.The defenders dig the balls to the target.
3.After the defender digs the ball they alternate lines.
4.Repeat until a set number of digs is
FUNCTIONAL EXERCISE No Fear Defense Teach aggressiveness on defense.
Teach defenders to get under balls hit down
Coach stands on a box in the middle of the net, where they can hit the ball
down inside 10' line.
Coach continuously hits balls to the defenders.
After a set number of hits the defender can only exit the drill when they can pass a ball straight up and
catch it.