Phase I: 0–6 weeks post operative: PROM Phase
Goals: Patient education (posture, joint protection, positioning and hygiene), controlling pain and inflammation, initiating ROM exercises. Allowing healing of the repaired rotator cuff tendon while minimizing stiffness and muscle atrophy are the primary goals of the phase I.
The first 6 weeks are considered Phase I, which only aloud to do PROM. Patient will be in the healing phase during this time. Until proximally to 6 weeks post op no AROM is permitted. The patient had a home exercise program from hospital up to 3 times per day. We continued and added some exercises to the program. He is using eis on his shoulder 3-4 times per day for up to 20 minutes. Also, keep his arm in sling, and removes
only for bathing and exercises. He is doing AROM of elbow curls (he did not have surgical work done to biceps), active exercises for wrist and hand, such as ball squeezing. He also doing pendulum, with no active movement of shoulder.
Many factors like patients age, symptoms, size of the tear, and nature of onset (traumatic or degenerative) are responsible for determining the prognosis of the physical therapy treatment 9. Since it’s a partial thickness tear of the rotator cuff, the non-operative treatment is reasonable unlike, a full thickness tear where surgery will be required to treat the patient 9. The patient shows symptoms of moderate irritability without significant functional deficit which makes him a good candidate for conservative treatment 10. The pain reported by the patient is 6/10 so the patient participates well in physical therapy exercise to increase shoulder strength, and flexibility. There was a study done from Finland which asserted that physical therapy alone can produce results which are equal to those produced by arthroscopic surgery and open surgical repair in cases of rotator cuff tears 11. In this case, with three weeks of physical therapy the patient has showed a decrease in pain and reported it as 4/10 on pain rating scale and showed improvements in abduction (140̊) and external rotation (65̊). The MMT for shoulder abduction was 4-/5 and external rotation is still same as
That's basically it. A surgery that baseball players and fans have grown to appreciate, and one of the more scientific breakthroughs in modern sports medicine. And after doing this report I’m fascinated by the modern science and how a tendon in your wrist can be used as a ligament.
Witvrouw, E., Mahieu, N., Roosen, P., & McNair, P. (2007). The role of stretching in tendon injuries. British journal of Sports Medicine , 224-226.
This case involved a 53 year old man who sustained a significant tear of his rotator cuff while playing baseball. He underwent surgical repair and was given a referral for physical therapy. The referral was to begin passive ROM 3 times per week for 2 weeks then initiate a supervised home program of active exercise for 2 weeks, and elastic resistance exercises for internal and external rotation every other day for a month. 2 weeks after surgery, he had his first PT visit in a sports medicine clinic that was managed by an athletic trainer (ATC).”
When comparing rotator cuff tears from the common people and athletes, they are much more common when a person is physically active in sports. An injury in the rotator ...
The four progressive resistive exercises I chose are, Thera-band tubing shoulder flexion, Thera-band shoulder diagonal, Thera-band shoulder Extension, and Thera-band shoulder external rotation at 90 degrees.
Graston instrument-assisted soft tissue mobilization (GITSM) is a tool used by therapists and chiropractors to help break up the scar tissue and replace it with fibroblast, allowing for faster recoveries (Black 2010). A series of heat, GISTM, strength and flexibility training are required (Black 2010). Numerous studies have been conducted, by certified therapists qualified in GISTM, to examine the styles and recovery periods after an injury. After going through the treatment, patients are measured by their range of motion (ROM) to see if the treatments were effective or not (Black 2010). ROM can vary depending on the region of the body that is being treated, but the overall goal of GISTM is to allow a person to get back to the regular routines they had before their injury.
An example of clinical application of this frame of reference can be seen when working with a baseball player who is need of a rotator cuff repair. Using the biomechanical frame of reference as the chosen model, an OT/ COTA practitioner can gradually improve positioning by using a sling.
Although joint movement is a very important source of physical stress on connective tissues, isometric muscle contractions can assist with applying therapeutic levels of stress to immobilized structures. Muscle tissue benefits from the force generated by an isometric contraction and may reduce the loss of proteins and muscle fiber diameter, and help maintain tension and power of fibers during immobilization. Isometric contractions across the wrist will help minimize the effects of immobilization. As noted in earlier sections, this can be achieved with making a fist, and with other gripping activities with objects of various size and density. Active muscle contractions are encouraged throughout the 6 week period of immobilization. Active range of motion and resistive exercises of the non-immobilized joints of the upper extremity will also be of great benefit. Use of resistance bands are a convenient way to progress resistance of upper extremity exercises while the arm is still in a cast. Pain from the bone fracture will be the likely guide in the progression of these exercises during the 6 weeks of
The solution to this problem is located in the lab. Researchers across the country are working day in and day out to come up with a solution to accelerate the healing of soft tissues. They have come up with many solutions, from vibration therapy, to personalized rehab plans, but none of these are yielding truly significant results. I believe the solution lies at the molecular level. I believe that we can observe the healing of these soft connective tissues and learn from it. Then we can design a method from the observations to accelerate the production of the fibrils and collagen that will go on to make up the soft connective tissue. I have begun to take the beginning steps in solving this problem through my mentorship with Dr. Weinhold. Our research goals go hand in hand, which has led us to beginning research on the release of an angiogenic growth factor through a gelatin that will coat sutures. In theory, this angiogenic growth factor, once released from the crosslinking with the gelatin will stimulate the development of blood vessels around the recently repaired collagenous tissue. This, in turn, will allow the tendon/ligament to have a better oxygen supply and allow for quicker
Rotator cuff tear – The muscles adjoining the shoulder joint are required for rotating the shoulder, amid other movements. The tendons of these muscles furthermore influence the structural strength of the shoulder joint. Harsh, rapid actions, for example in tennis and baseball, can result in tearing of one of these tendons. This then causes pain as well as a decline in range of motion. Surgery possibly will be necessary to repair a torn
Tendon disorders and injuries comprise 30% to 50% of all activity-related injuries; chronic degenerative tendon disorders (tendinopathy) occur frequently and are difficult to treat (Vos 144). What PRP does is release the growth factor into the degenerative tendons while intentionally inflaming your muscles and tendons, to encourage healing. In an experiment conducted by Doctor Vos and his colleagues, they examined whether a PRP injection would actually improve the outcome in chronic mid-portion Achilles tendinopathy. The control group was given a placebo while the others were given the PRP injections. At the conclusio...
Prom, when the joint is moved by an external force or therapist, is greatly recommended. PROM helps stiffening or weak muscles caused by non-use. When a resident’s muscles are not used on a regular basis, they become weak. As the person begins to exercise, the range of motion increases, improving the strength of the joint. Adding physical therapy would let the residents have the everyday activity they deserve to keep their health in the best possible condition.
The role of the nurse in the preoperative area is to determine the patient’s psychological status to help with the use of coping during the surgery process. Determine physiologic factors directly or indirectly related to the surgical procedure that may cause operative risk factors. Establish baseline data for comparison in the intraoperative and postoperative period. Participate in the identification and documentation of the surgical site and or side of body on which the procedure is to be performed. Identify prescription drugs, over the counter, and herbal supplements that are taken by the patient that may interact and affect the surgical outcome. Document the results of all preoperative laboratory and diagnostic tests in the patient’s record
Although students were not allowed in the recovery unit, I was able to talk to one of the recovery nurses. I learned that a nurse’s duty of care includes monitoring the patient’s vital signs and level of consciousness, and maintaining airway patency. Assessing pain and the effectiveness of pain management is also necessary. Once patients are transferred to the surgical ward, the goal is to assist in the recovery process, as well as providing referral details and education on care required when the patient returns home (Hamlin, 2010).