9200 Calumet Avenue Sincer Jacob, PA-C Munster, IN Jessica Morin, ATC Deanna Cozzi, ATC

Transcription

1 DISCHARGE INSTRUCTIONS & PHYSICAL THERAPY PROTOCOL: Subacrmial Decmpressin, Glenhumeral Debridement, Distal Clavicle Resectin Recvery after shulder arthrscpy entails cntrlling swelling and discmfrt, return f range-fmtin f the shulder jint, regaining strength in the muscles arund the shulder jint, and a gradual return t activities. The fllwing instructins are intended as a guide t help yu achieve these individual gals and recver as quickly as pssible after yur arthrscpic shulder surgery. COMFORT Cld Therapy If yu elected t receive the circulating cling device, this can be used cntinuusly fr the first 3 days, (while the initial pst-p dressing is n). After 3 days, the cling device shuld be applied 3 times a day fr minute intervals. If yu elected t receive the gel wrap, this may be applied fr 20 minutes n, 20 minutes ff as needed. Yu may apply this ver the pst-p dressing. Once the dressing is remved, be sure t place a barrier (shirt, twel, clth, etc.) between yur skin and the gel wrap. If yu elected t use regular ice, this may be applied fr 20 minutes n, 20 minutes ff as needed. Yu may apply this ver the pst-p dressing. Once the dressing is remved, be sure t place a barrier (shirt, twel, clth, etc.) between yur skin and the gel wrap. Medicatin Pain Medicatin- Take medicatins as prescribed, but nly as ften as necessary. Avid alchl and driving if yu are taking pain medicatin. Yu have been prvided a narctic prescriptin pstperatively. Use this medicatin sparingly fr mderate t severe pain. Yu are allwed tw (2) refills f yur narctic prescriptin if necessary. When refilling pain medicatin, weaning dwn t a lwer ptency r nnnarctic prescriptin is recmmended as sn as pssible. Extra strength Tylenl may be used fr mild pain. Over the cunter anti-inflammatries (Ibuprfen, Aleve, Mtrin, etc.) may be used as an alternative t yur narctic medicatin.

2 Anti-cagulatin medicatin: A medicatin t prevent pst-perative bld clts has been prescribed (Aspirin, Lvenx, etc.) This is the nly medicatin that MUST be taken as prescribed until directed t stp by Dr. Frsythe. Nausea Medicatin Zfran (Odansetrn) has been prescribed fr nausea. Yu may take this as needed per the prescriptin instructins. Cnstipatin Medicatin - Clace has been prescribed fr cnstipatin. Bth yur pain medicatin and the anesthesia can cause cnstipatin. Take this as needed. Driving Driving is NOT permitted as lng as the sling is necessary. ACTIVITIES Range-f-Mtin Exercises - Mve yur shulder, elbw and wrist thrugh a full range-fmtin as much as pssible t prevent stiffness. Sling Yu may use yur sling as needed fr cmfrt. It may be discntinued when yu are able. Daily Activities Use yur shulder and arm in activities f daily living as yur level f cmfrt permits. Physical Therapy If physical therapy is required, yur dctr will give yu a prescriptin. Yu may call the therapist f yur chice and begin therapy 1-3 days after yur surgery. Take the prescriptin t the therapist fr yur first appintment. Athletic Activities Athletic activities, such as thrwing, swimming, bicycling, jgging, running and stp-and-g sprts, shuld be avided until allwed by yur dctr after yur first fllw-up visit. WOUND CARE Bathing - Tub bathing, swimming, and saking f the shulder shuld be avided until allwed by yur dctr - Usually 2-3 weeks after yur surgery. Keep the dressing n, clean and dry fr the first 3 days after surgery. Yu may shwer 3 days after surgery with WATERPROOF band-aids n. Apply new band-aids after shwering.. Dressings - Remve the dressing 3 days after surgery. Yu may apply band-aids t the small incisins arund yur shulder EATING Yur first few meals, after surgery, shuld include light, easily digestible fds and plenty f liquids, since sme peple experience slight nausea as a temprary reactin t anesthesia

3 CALL YOUR PHYSICIAN IF: Pain in yur shulder persists r wrsens in the first few days after surgery. Excessive redness r drainage f cludy r bldy material frm the wunds (Clear red tinted fluid and sme mild drainage shuld be expected). Drainage f any kind 5 days after surgery shuld be reprted t the dctr. Yu have a temperature elevatin greater than 101 Yu have pain, swelling r redness in yur arm r hand. Yu have numbness r weakness in yur arm r hand. RETURN TO THE OFFICE Yur first return t ur ffice shuld be within the first 1-2 weeks after yur surgery. Yu can find yur appintment fr this first pst-perative visit in the pst p instructin flder.

4 REHABILITATION PROGRAM: Subacrmial Decmpressin, Glenhumeral Debridement, Distal Clavicle Resectin NOTE: The fllwing instructins are intended fr yur physical therapist and shuld be brught t yur first physical therapy visit. The purpse f the exercise prgram belw is t mre effectively treat patients after an arthrscpic subacrmial decmpressin prcedure. This pst-surgical rehabilitatin prgram addresses anatmical, bimechanical, and healing time cncerns. The treatment plan includes rest at the apprpriate time (relative rest) and the use f nn-steridal anti-inflammatries. The attainment f full range-f-mtin, prper training f the rtatr cuff muscles fr balance and t prvide gd scapulhumeral rhythm and cnditining f the rtatr cuff and scapular muscles is critical fr a successful utcme. This rehabilitatin prgram is designed in phases. Each phase has a list f gals t be attained during that phase and there are cncmitant precautins in each phase t avid the inability t achieve the gals set fr each phase. Alng with the gals and precautins are sme suggested exercises in rder t achieve the gals within the limits f the precautins. PHASE I ACUTE PHASE ( 1-6 weeks) Gals: Limit pain (relative rest avid pain prvking psitins and mvements) Reduce swelling Restre mtin Treatment Recmmendatins: Ice Sling (if necessary) E-Stim Gentle mbilizatin (Grade I, Grade II) Pendulum exercises ROM (passive, active assisted and active pain free) Nn-steridal anti-inflammatry medicatin Precautin: Relative rest is imprtant reduce inflammatin

5 PHASE II SUBACUTE PHASE ( 6-12 weeks) Gals: Eliminate pain Restre full active mtin Restre gd glenhumeral and scapulhumeral rhythm 4/5 strength f upper extremity muscles including scapular muscles Treatment Recmmendatins: Cntinue t use mdalities as needed Start with active range-f-mtin thrugh the available range Add ismetrics belw shulder level Flexibility f the cervical, shulder and scapular muscles Nn-invlved upper extremity and bilateral lwer extremity exercises Precautins: All active and ismetric exercises shuld be muscle specific All mvements and activity increasing symptms shuld be eliminated Ismetrics are t be mdified (psitin change) if patient s symptms are made wrse PHASE III STRENGTHENING PHASE ( >10 weeks) Gals: Attain full pain free range-f-mtin Achieve 5/5 strength in all shulder girdle muscles, including distal extremity muscles Full pain free resistive range-f-mtin Negative Neer sign Negative Hawkins sign Perfect symmetrical scapulhumeral rhythm Treatment Recmmendatins: Cntinue with the use f ice as necessary Cntinue with previus exercises Prgress resistance t verhead and abve hrizntal Add resistance t scapular exercises Wrk n quality f mtin, nt just resistive training Wrk n balance f the rtatr cuff muscles Start sprt specific/wrk specific exercises Weightbearing upper extremity Water resistive activities

6 Precautins: D nt frget entire bdy PHASE IV CRITERIA FOR RETURN TO WORK/SPORT ( >16 weeks) Gals: Full pain free range-f-mtin 5/5 strength in all upper extremity and scapular muscles Nrmal scapulhumeral rhythm with and withut resistance Gd trunk strength Gd lwer extremity strength Able t cmplete thrwing sprt specific r wrk tasks withut pain, signs f instability r impingement Precautins: It shuld be nted that time frames fr these phases and verlap time frames fr these phases cannt be given. It is based n exercise intensity, pain, underlying instability, acute vs. chrnic cnditins, healing time and strength. Rehabilitatin shuld be prgressive, always achieving a pain free state and always acutely aware f the patient safety.