under local anaesthetic as day surgery |
||||
, with minimal morbidity. 13 |
||||
The success rate of arthroscopic stabilisation |
||||
in experienced hands is more than 95 %. 13 Recurrent dislocation is the major complication; this is more common |
||||
if there is bone loss of the anterior |
||||
glenoid. Pain and osteoarthritis are |
||||
long-term sequelae of untreated recurrent |
||||
shoulder dislocations. |
||||
The management of multidirectional |
||||
instability has changed in |
||||
recent years, with surgery no longer |
||||
first-line management. A group of |
||||
physiotherapists in Melbourne has |
||||
shown that non-operative management |
||||
by dynamic stabilisation |
||||
physiotherapy is now the first-line |
||||
management of multidirectional |
||||
instability in young individuals. 14-16 It is usually a 3-6 month regimen |
||||
focusing on strengthening of the |
||||
dynamic stabilisers( rotator cuff and |
||||
periscapular musculature). |
||||
|
Rehabilitation protocol after arthroscopic shoulder stabilisation
After arthroscopic shoulder stabilisation
|
||||
, patients are advised to wear |
||||
a sling during the day for the first |
||||
six weeks for comfort. Patients can |
||||
perform grip strengthening, scapula |
||||
retraction / depression and pendulum |
||||
exercise three times per day |
||||
within comfort. |
||||
From day seven post-surgery |
||||
until six weeks, patients are advised |
||||
to perform passive forward flexion. |
||||
Between day 14 and until six weeks, |
||||
patients are advised to perform horizontal |
||||
flexion stretch and shoulder |
||||
extension as comfort allows. |
||||
Patients should avoid lifting any |
||||
weight for the first six weeks. From |
||||
six weeks to three months, patients |
||||
can stop wearing the sling. Stretching |
||||
and resistance band strengthening |
||||
exercises are recommended |
||||
during this period. |
||||
Three months post-surgery, |
||||
patients are advised to start lightweight |
||||
strengthening exercises |
||||
in addition to the resistance band strengthening. Start with no weight |
Henry Gray( 1918) Anatomy of the Human Body |
Figure 8. Cutaneous innervation of the upper limb. |
||
and progress by 0.5kg increments. |
||||
High-level athletes can often return |
dislocation occurred after a fall while |
John is diagnosed with recurrent |
shoulder pain and immobility. She |
in ED using the traction and counter- |
to contact sports at three months. |
skiing. He has now sustained his |
anterior shoulder dislocation sec- |
reports she fell down the steps out- |
traction technique. Post-reduction |
Patients can usually return to |
third dislocation, which was reduced |
ondary to an anterior Bankart lesion. |
side her house, landing on her right |
X-ray confirms good reduction. |
full work duties and sports after six |
in ED. |
The most appropriate management |
side. On examination, Sarah’ s right |
An ultrasound on her follow-up |
months, after clearance by the surgeon. |
Examination reveals a full range |
for him is arthroscopic anterior |
arm is abducted and externally |
visit to the specialist shows a rota- |
|
CASE STUDIES
Case study one
JOHN, a 26-year-old man, has recurrent
shoulder instability. His first
|
of movement of the shoulder but a positive apprehension and relocation test. His X-ray shows a Hill – Sachs lesion and a normal glenoid. An MRI shows an anterior Bankart lesion. |
Bankart repair.
Case study two
Sarah, a 60-year-old woman, presents
to ED with severe right
|
rotated. There is decreased sensation to touch over the lateral aspect of her right shoulder. X-rays reveal an anterior shoulder dislocation but no fractures. The dislocation is reduced |
tor cuff tear. Sarah is managed with arthroscopic rotator cuff repair.
Case study three
Sally, a 19-year-old woman,
|
Figure 9. The sulcus sign is significant when a 2cm gap is noted between the acromion and the humeral head. |
Figure 10. O’ Brien test for a SLAP tear. |
ER |
Supraspinatus |
Impingement |
Figure 11. Three tests for an intact rotator cuff.
Weakness in external rotation, supraspinatus weakness and a positive impingement sign. If all are negative, a rotator cuff tear can be ruled out.
|