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Rehabilitation Guidelines for Anterior Shoulder ...

U W H E A LT H S P O R T S R E H A B I L I T A T I O N. Rehabilitation Guidelines for Anterior Shoulder Reconstruction with Arthroscopic Bankart Repair The anatomic configuration of the is abducted and externally rotated Humeral Shoulder joint (glenohumeral joint) (Figure 2) or the arm is stretched head is often compared to a golf ball straight out from the body, such on a tee (Figure 1). This analogy as falling on an outstretched hand. is used because the articular When the Shoulder dislocates surface of the round humeral anteriorly the capsule, ligaments and head (upper most part of the labrum are often torn.)

Shoulder dislocations can occur from trauma or from hyperlaxity (genetic or acquired looseness of the capsule and ligaments). Traumatic anterior shoulder dislocations (in which the humeral head is displaced towards the front) most often occur when significant force is placed on the hand or lower part of the arm when the shoulder

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Transcription of Rehabilitation Guidelines for Anterior Shoulder ...

1 U W H E A LT H S P O R T S R E H A B I L I T A T I O N. Rehabilitation Guidelines for Anterior Shoulder Reconstruction with Arthroscopic Bankart Repair The anatomic configuration of the is abducted and externally rotated Humeral Shoulder joint (glenohumeral joint) (Figure 2) or the arm is stretched head is often compared to a golf ball straight out from the body, such on a tee (Figure 1). This analogy as falling on an outstretched hand. is used because the articular When the Shoulder dislocates surface of the round humeral anteriorly the capsule, ligaments and head (upper most part of the labrum are often torn.)

2 The Anterior arm) is approximately four times inferior part of the labrum (located greater than that of the relatively between the 3 o'clock to 6 o'clock Glenoid flat Shoulder blade face (glenoid positions on the glenoid) is the area fossa fossa). The stability and movement torn with this type of injury (Figure of the Shoulder is controlled by 3). In more severe cases when the rotator cuff muscles, ligaments the labrum is torn a portion of the Figure 1 Anterior (looking from the front) bony and the capsulolabral complex glenoid may be fractured and this is anatomic Shoulder model. of the Shoulder .

3 The labrum is a referred to as bony Bankart lesion. Image property of Primal Pictures, Ltd., Use of this image without authorization from Primal Pictures, Ltd. is fibrocartilaginous ring which attaches prohibited. Studies have shown that traumatic to the bony rim of the glenoid fossa. Shoulder dislocations result in The labrum doubles the depth of recurrent instability. The degree of the glenoid fossa to help provide recurrent instability is related to the stability. An analogy would be a patient's age and sport or activity parked car on a hillside with a chop level. Younger patients are more block under the tire the round tire likely to have recurrent instability.

4 Being the humeral head, the road Studies report recurrence rates from being the glenoid fossa and the 65-95% for patients less than 20. chop block being the labrum. years of age. Simonet reviewed 128. The anatomy of the Shoulder allows patients who suffered a Shoulder for great mobility yet sacrifices dislocation and found that two stability. For this reason the Shoulder years after the initial dislocation , is one of the most commonly 66% of patients who were less than dislocated joints in the body. 20 years old suffered a second Shoulder dislocations can occur from dislocation while 40% of patients trauma or from hyperlaxity (genetic who were between 20 and 40 years or acquired looseness of the capsule old suffered a second dislocation .)

5 Figure 2 Abducted externally rotated and ligaments). None of the patients older than 40 position of the left Shoulder years old had suffered subsequent Traumatic Anterior Shoulder dislocations. Pevny studied 125. dislocations (in which the humeral It is likely the injury pattern for patients with Shoulder dislocation head is displaced towards the front) dislocation changes as people age. over the age of 40 and found that most often occur when significant while only 4% of these patients Simonet also compared recurrent force is placed on the hand or lower had recurrent instability, 35% of dislocations with athletes and part of the arm when the Shoulder the patients had a rotator cuff tear.

6 Nonathletes, with athletes having The world class health care team for the UW Badgers and proud sponsor of UW Athletics 621 SCIENCE DRIVE MADISON, WI 53711 4 6 0 2 E A S T PA R K B LV D . M A D I S O N , W I 5 3 7 1 8. Rehabilitation Guidelines for Anterior Shoulder Reconstruction with Arthroscopic Bankart Repair This is called a Bankart repair. This can be done surgically with an arthroscopic technique or an open technique. The arthroscopic technique involves making three small incisions and using a camera to see inside the Shoulder joint. The torn tissue is identified then suture anchors or bio-absorbably tacks are used to repair the torn tissue back to its anatomic locations.

7 (Figure 4). Arthroscopic Anterior stabilization has a similar rate of failure to open stabilization after two years. The proposed advantage of arthroscopic Figure 3 B. ankart tear ( Anterior labral tear) Figure 4 Fixation of the Bankart tear using repair include less surgical trauma to When looking at a right Shoulder it would three suture anchors in the boney glenoid and the adjacent tissue in the Shoulder normally extend from 3 o'clock to 6 o'clock if sutures approximating the labrum back to the and improved outcomes. imagining the glenoid as the face of a clock boney glenoid an 82% recurrence rate and non- Restoring the normal anatomy of the athletes having a 30% recurrence rate.

8 Shoulder is the most effective way of The athletic group also has different preventing recurrent instability and recurrent risk based on the type of improving function in the young and sport, with overhead and contact athletic population. Restoring the sports being more likely to have anatomy primarily means repairing recurrent dislocations. the torn labrum back to the rim of the glenoid. PHASE I (surgery to 6 weeks after surgery). Appointments Rehabilitation appointments begin 4-10 days after surgery Rehabilitation Goals Protect the post-surgical Shoulder Activate the stabilizing muscles of the gleno-humeral and scapula-thoracic joints Full active and passive range of motion (ROM) for Shoulder flexion, abduction, internal rotation (IR) and external rotation (ER) to neutral Precautions Sling immobilization required for soft tissue healing for 3-4 weeks.

9 Remove sling during the 4th week in safe environmentsHypersensitivity in axillary nerve distribution is a common occurrence No Shoulder ER with abduction for 6 weeks to protect repaired tissues 2 621 SCIENCE DRIVE MADISON, WI 53711 4 6 0 2 E A S T PA R K B LV D . M A D I S O N , W I 5 3 7 1 8. Rehabilitation Guidelines for Anterior Shoulder Reconstruction with Arthroscopic Bankart Suggested Therapeutic Exercise Begin week 3, sub-maximal Shoulder isometrics for IR and ER, flexion, extension, adduction and abduction. Take caution to start gradually especially with IR to protect the subscapularis repair Active assisted and passive ROM for Shoulder flexion, abduction and IR in pain- free ROM.

10 ER to neutral. Progress to active ROM at week 5. Hand gripping Elbow, forearm and wrist active ROM. Cervical spine and scapular active ROM. Desensitization techniques for axillary nerve distribution Postural exercises Cardiovascular Exercise Walking, stationary bike - sling on. No swimming or treadmill Avoid running and jumping due to the distractive forces that can occur at landing Progression Criteria Full active ROM in all cardinal planes 5/5 IR and ER strength at 0 of Shoulder abduction Negative apprehension and impingement signs PHASE II (begin after meeting Phase I criteria, usually 6 weeks after surgery).


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