Post-Operative Instructions Shoulder Arthroscopy and SLAP Repair

Transcription

1 Laith M Jazrawi, MD Prfessr f Orthpedic Surgery Chief, Divisin f Sprts Medicine T Pst-Operative Instructins Shulder Arthrscpy and SLAP Repair Day f Surgery A. Relax. Diet as tlerated. B. Icing is imprtant fr the first 5-7 days pst-p. While the pst-p dressing is in place, icing shuld be dne cntinuusly. Once the dressing is remved n the first r secnd day, ice is applied fr 20-minute perids 3-4 times per day. Care must be taken with icing t avid frstbite. Alternatively, Crycuff r Game-ready ice cuff can be used as per instructins. Yu will be cntacted by East Cast Orthtics regarding an ice cmpressin unit t be used after surgery. This helps with pain and swelling but typically is nt cvered by insurance. The cst is $ fr a 2-week rental. Alternatively, ice gel packs with a shulder r knee sleeve can be prvided by the hspital fr a minimal charge. C. Pain medicatin as needed every 6 hurs (refer t pain medicatin sheet) First and Secnd Pst-Operative Day A. Cntinue Icing. B. Pain medicatins as needed Third Pst-Operative Day A. Yu may remve surgical bandage and shwer this evening. Apply regular bandages t these wunds prir t shwering and when shwering is cmplete apply fresh regular bandages. Yu will need t fllw this rutine fr 2 weeks after surgery. Physical Therapy A. Physical Therapy shuld begin at 4 weeks. Please call yur preferred facility t make an appintment. B. Pendulum exercises can be started n day 3. *Nte: Yur shulder will be very swllen. It may take a week r lnger fr this t g away. It is als cmmn t ntice burning arund the shulder as the swelling reslves. If excessive bleeding ccurs, please ntify Dr. Jazrawi. Call ur ptin 4, ptin 2 t cnfirm yur first pstperative visit, which is usually abut 1-2 weeks after surgery. If yu are experiencing any prblems, please call ur ffice r cntact us via the internet at NYU Langne Orthpedic Center 333 E 38th St, New Yrk, NY T F

2 Dr. Laith M. Jazrawi Chief, Divisin f Sprts Medicine Assciate Prfessr Department f Orthpaedic Surgery The anatmic cnfiguratin f the shulder jint (glenhumeral jint) is ften cmpared t a glf ball n a tee. This is because the articular surface f the rund humeral head is apprximately fur times greater than that f the relatively at shulder blade face (glenid fssa)1 (Figure 1). The stability and mvement f the shulder is cntrlled by the rtatr cuff muscles, as well as the shulder ligaments, the capsule f the shulder and the glenid labrum. The labrum is a fibrcartilagenus ring which attaches t the bny rim f the glenid fssa.1 The labrum dubles the depth f the glenid fssa t help prvide stability.2 An analgy wuld be a parked car n a hillside with a blck under the tire the rund tire being the humeral head, the rad being the glenid fssa and the blck being the labrum. The labrum als serves as the anchr fr the lng head f the biceps. A large prtin f the lng head f the biceps riginates frm the tp (superir) prtin f the labrum. Overhead sprts can create significant frces at this attachment site. This can ultimately lead t injury and tears f the biceps ff this attachment. This is called a SLAP lesin (Superir Labral Anterir t Psterir tear). These injuries can als ccur frm trauma, such as falling n yur arm, bracing yur arm in an accident, arm tackling in ftball r any large sudden frce applied t the arm. There are fur basic types f SLAP tears.3 A Type II SLAP tear is the mst cmmn type f SLAP tear requiring surgical recnstructin (Figure 2).3 In this type f tear the lng head f the biceps remains attached t the labrum but the labrum has been detached frm the th St. New Yrk, NY (646) newyrkrth.cm

3 bny glenid.4 This is repaired surgically by placing suture anchrs (Figure 3) in the glenid fssa, passing sutures thrugh the labrum and then tying special surgical knts t apprximate the labrum back t the bny glenid rim. Full return t thrwing and cntact sprts ccurs in 80-90% f athletes.4, 5 Successful return t sprt and activity is dependent n fllwing pstperative precautins and cmpleting a structured pstperative rehabilitatin prgram. Our rehabilitatin prgram is utlined belw. The rehabilitatin guidelines are presented in a criterin based prgressin. General time frames are given fr reference t the average, but individual patients will prgress at different rates depending n their age, assciated injuries, pre-injury health status, rehabilitatin cmpliance and injury severity. These factrs will als affect hw lng it takes each individual t meet the required criteria fr return t sprt and activity th St. New Yrk, NY (646) newyrkrth.cm

4 Phase I (Surgery t 4 weeks after surgery) Gals Prtectin f shulder after surgery Activate muscles that help stabilize yur glenhumeral and scapul-thracic jints Precautins Sling immbilizatin at all times except fr shwering and rehabilitatin under guidance f physical therapist Range f Mtin Active assistive range f mtin (AAROM) active range f mtin (AROM) Restrict mtin t 140 f Frward Flexin, 40 f External Rtatin and Internal Rtatin t stmach N Internal Rtatin up the back N External Rtatin behind the head Wrist/Hand Range f Mtin Grip Strengthening Ismetric Abductin, Internal/External Rtatin exercises with elbw at side N resisted Frward Flexin/Elbw Flexin (t avid stressing the biceps rigin) Other Suggestins Heat/Ice befre and after PT sessins Phase II (4 weeks t 6 weeks fllwing surgery) Gals Increased AROM Increased rtatr cuff strength in a neutral psitin Precautins Discntinue sling immbilizatin Range f Mtin Increase Frward Flexin, Internal/External Rtatin t full mtin as tlerated Advance ismetrics frm Phase I t use f a theraband within AROM limitatins Cntinue with Wrist/Hand Range f Mtin and Grip Strengthening Begin Prne Extensins and Scapular Stabilizing (traps/rhmbids/levatr scapula) Gentle jint mbilizatin Other Suggestins Mdalities per PT discretin th St. New Yrk, NY (646) newyrkrth.cm

5 Phase III (6 weeks t 12 weeks fllwing surgery) Gals Prgress t full AROM withut discmfrt Range f Mtin Active assistive range f mtin (AAROM) active range f mtin (AROM) Restrict mtin t 140 f Frward Flexin, 40 f External Rtatin and Internal Rtatin t stmach N Internal Rtatin up the back N External Rtatin behind the head Advance Theraband exercises t light weights (1-5 lbs) 8-12 repetitins/2-3 sets fr Rtatr Cuff, Deltid and Scapular Stabilizers Cntinue and prgress with Phase II exercises Begin UE ergmeter Other Suggestins Mdalities per PT discretin Phase IV (3 mnths t 6 mnths fllwing surgery) Gals Full range f mtin withut discmfrt Other Suggestins Mdalities per PT discretin Advance exercises in Phase III (strengthening 3x per week) Sprt/Wrk specific rehabilitatin Return t thrwing at 4.5 mnths Return t sprts at 6 mnths if apprved References th St. New Yrk, NY (646) newyrkrth.cm

6 Laith M Jazrawi, MD Prfessr f Orthpedic Surgery Chief, Divisin f Sprts Medicine T Rehabilitatin Prtcl: Arthrscpic SLAP Repair Name: Diagnsis: Date: Date f Surgery: Phase I (Weeks 0-4) Sling immbilizatin at all times except fr shwering and rehab under guidance f PT Range f Mtin AAROM à AROM as tlerated Restrict mtin t 140 f Frward Flexin, 40 f External Rtatin and Internal Rtatin t stmach N Internal Rtatin up the back/n External Rtatin behind the head Exercise Wrist/Hand Range f Mtin Grip Strengthening Ismetric Abductin, Internal/External Rtatin exercises with elbw at side N resisted Frward Flexin/Elbw Flexin (t avid stressing the biceps rigin) Heat/Ice befre and after PT sessins Phase II (Weeks 4-6) Discntinue sling immbilizatin Range f Mtin Increase Frward Flexin, Internal/External Rtatin t full mtin as tlerated Exercise Advance ismetrics frm Phase I t use f a theraband within AROM limitatins Cntinue with Wrist/Hand Range f Mtin and Grip Strengthening Begin Prne Extensins and Scapular Stabilizing (traps/rhmbids/levatr scapula) Gentle jint mbilizatin Mdalities per PT discretin Phase III (Weeks 6-12) Range f Mtin Prgress t full AROM withut discmfrt Exercise Advance theraband exercises t light weights (1-5 lbs) 8-12 repetitins/2-3 sets fr Rtatr Cuff, Deltid and Scapular Stabilizers Cntinue and prgress with Phase II exercises Begin UE ergmeter Mdalities per PT discretin Phase IV (Mnths 3-6) Range f Mtin Full withut discmfrt Exercise Advance exercises in Phase III (strengthening 3x per week) Sprt/Wrk specific rehabilitatin Return t thrwing at 4.5 mnths Return t sprts at 6 mnths if apprved Mdalities per PT discretin Cmments: Frequency: times per week Duratin: weeks Signature: Date: NYU Langne Orthpedic Center 333 E 38th St, New Yrk, NY T F