anterior shoulder instability肩关节不稳定

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1、ANTERIORSHOULDERINSTABILITYSURGICALREPAIRPROTOCOLDr.DavidR.GuelichThisrehabilitationprotocolhasbeendevelopedforthepatientfollowinganarthroscopicACLR(anteriorcapsular-labralrepair)surgicalprocedure.Theprotocolisdividedintophases.Eachphaseisadaptablebasedont

2、heindividualandspecialcircumstances.FollowinganACLR,thepatientshouldavoidplacingstressontheanteriorjointcapsule.Earlypassiverangeofmotionishighlybeneficialtoenhancecirculationwithinthejointtopromotehealing.Theoverallgoalsofthesurgicalprocedureandrehabilita

3、tionareto:·Controlpainandinflammation·Regainnormalupperextremitystrengthandendurance·Regainnormalshoulderrangeofmotion·AchievetheleveloffunctionbasedontheorthopedicandpatientgoalsThephysicaltherapyshouldbeinitiatedwithinthe3to4weeksfollowingsurgery.Thesupe

4、rvisedrehabilitationistobesupplementedbyahomefitnessprogramwherethepatientperformsthegivenexercisesathomeoratagymfacility.Importantpost-operativesignstomonitorinclude:·Swellingoftheshoulderandsurroundingsofttissue·Abnormalpain,hypersensitive—anincreaseinni

5、ghtpain·Severerangeofmotionlimitations·WeaknessintheupperextremitymusculatureReturntoactivityrequiresbothtimeandclinicalevaluation.Tomostsafelyandefficientlyreturntonormalorhighlevelfunctionalactivity,thepatientrequiresadequatestrength,flexibility,andendur

6、ance.Functionalevaluationincludingstrengthandrangeofmotiontestingisonemethodofevaluatingapatient’sreadinesstoreturntoactivity.ReturntointenseactivitiesfollowinganarthroscopicACLRrequiresbothastrenuousstrengtheningandrangeofmotionprogramalongwithaperiodofti

7、metoallowfortissuehealing.Symptomssuchaspain,swelling,orinstabilityshouldbecloselymonitoredbythepatient.Dr.DavidR.GuelichPhase1:Week1-4AnteriorStabilizationProtocolWEEKEXERCISEGOAL1-4ROMGradualWillbeassessedatweek2postopIfincreasedstiffnesswillbegingentleR

8、OMgravityassistedrotation(CodmanExercises)Ifnotstiff,nomotionandcontinueslingimmobilizationexceptforADL’sSTRENGTHInitiatesubmaximal/painfreeisometrics-allplanesBRACESlingfor4weeksorasnotedbyDr.GuelichSlingrem