Slap lesions of the shoulder, standing for superior labrum tear from anterior to posterior, is a type of labral tear located on the superior glenoid rim. Keener completed an orthopaedic surgery residency at the university of iowa hospitals and clinics and fellowship training in shoulder and elbow reconstruction in the department of orthopaedic surgery at washington university school of medicine. Rotator cuff repairs, labral repairs, acromioplasty, distal clavicle resection and instability repairs are all done athroscopically. It is performed under local or general anesthesia to create more room for the rotator cuff tendons. Resection is started from anterior aspect working towards the posterior aspect of the joint. Indeed, most cases can be effectively treated with some combination of rest, regular icing, antiinflammatory medications, corticosteroid injections, and physical therapy. My subacromial decompression, distal clavicle resection and possible rotator cuff repair the part which i hope to avoid are scheduled for 8. Open reduction internal fixation orif is a surgery to fix severely broken bones. G8991, other physical or occupational primary functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting g8992, other physical or occupational primary functional limitation, discharge status, at discharge from therapy or to end reporting other ptot subsequent g. The boney removal has the potential to stimulate scarring and difficult restoration of range of motion. Brandon bryant who serves in fairfax, ashburn, manassas and. However, anyone recovering from an injury or surgery is free to use them.
While surgery is rarely needed, treatment can involve special therapy and exercises that extend to six months or more. Slucare sports medicine and shoulder surgery specialists developed the following physical therapy protocols for slucare clinicians to use when recommending treatment and rehab for slucare patients. Review therapy clinical amputation, upper extremity, in. Mumford procedure distal clavicle resection what is a mumford procedure.
Sports medicine physical therapy 6176439999 we use cookies and other tools to enhance your experience on our website and to analyze our web traffic. Distal clavicle excision san diego minimally invasive. Its only used for serious fractures that cant be treated with a cast or splint. Pain 10 weeks after distal clavicle and decompression shoulder surgery please help.
Dr black performs distal clavicle excision surgery in mckinney, frisco and dallas tx. Essential to the success of the surgical procedure is early normalization of passive and active range of motion. Murphy, md board certified orthopedic surgeon specializing in sports medicine and arthroscopy 10475 centurion pkwy. All active exercises should be carefully monitored to minimize substitution or compensation. Distal clavicle excision mckinney shoulder surgery dallas tx. Rehabilitation guidelines for proximal humerus fracture nonoperative instructions for postoperative physical therapy after. Shoulder, elbow, upper extremity specialists at university. Presenting over 100 rehabilitation protocols for the hand and upper extremity in an easytouse, stepbystep format, this practical reference provides surgeons and therapists alike with a goto source for the therapy technique or strategy appropriate for their patients. The intent of posting these standards of care and protocols is to provide clinicians and patients. Shoulder rehabilitation protocols shoulder surgery avon. Elbowwristhand rom, pendulums, wall stretch at home per instruction sheets. However, if after a course of conservative treatment, consisting of antiinflammatory medication and physical therapy, your symptoms do not improve. You should wear the sling at all times except for physical therapy. Home patientmedical professionals rehab protocols shoulder rehabilitation protocols shoulder rehabilitation protocols acromioclavicular ac joint reconstruction postoperative physical therapy protocol arthroscopic bankart repair arthroscopic labral repair and open capsular shift protocol.
Once the distal end of the clavicle is exposed, any infringing soft tissue will be removed following which resection of the distal clavicle is carried out using a bur. Sports medicine physical therapy rehabilitation protocols. Acromioclavicular joint ac arthritis may develop because of degenerative changes that occur as a part of the normal aging process. Advice for activity modification and specific training tips. Soft tissue mobilization to surrounding tissues, effleurage for edema. I perform these surgeries with the assistance of ashley book, pac. Most of you will require physical therapy to address your rotator cuff which is more than likely to be the main cause of pain. This protocol of treatment for the physical therapy management of the thoracic outlet syndrome was presented at the humera society meeting in bermuda on april 23. Arthroscopic resection an overview sciencedirect topics. Subacromial decompression with distal clavicle resection shoulder impingement shoulder home exercise program preop shoulder physical therapy visit preop slap lesion repair subacromial decompression subscapularis repair protocol swelling control tens electrode placement chart tens information handout total knee arthroplasty tsa with osteotomy. Restrictions rom 140 degrees of forward flexion 40 degrees of external rotation 60 degrees of abduction rom exercises begin with the arm comfortably at the patients side, progress to. The information contained in these standards of care or protocols is not intended in any way to be used as primary medical advice or to replace medical advice offered by physical, occupational, speech therapists or other health care professionals.
Although there will be some pain, it is important to maintain arm motion to prevent stiffness. Patients over 30 were at risk for subsequent acromioplasty and distal clavicle resection. If physical therapy is unsuccessful, a mumford procedure is often the best way to surgically modify this bony. Andrew green, md is the chief of the division of shoulder and elbow surgery and an professor of orthopaedic surgery in the department of orthopaedic surgery of the warren alpert medical school of brown university. The acromioclavicular joint is formed by the medial facet of the acromion and the distal end of the clavicle. Phase i phase ii phase iii phase iv phase v 02 weeks postop 2 weeks postop 26 weeks postop 6 weeks postop 12 weeks postop general information. Lifts, such as bench press, that put an extreme load on the ac joint will be some of the last exercises to be added and may take up to 4 months before resuming their previous level of performance. Shoulder arthroscopy rehab protocol the stone clinic. Microfracture treatment of articular cartilage defects tibiofemoral patellar tendon repair. Passive range of motion in all planes as tolerated.
Managing and recognizing complications after treatment of acromioclavicular joint repair or reconstruction. I no longer perform open surgery of the shoulder such as shoulder replacement due to the busy nature of my arthroscopic practice. Dc osteolysis usually responds favorably to more conservative treatments. Arthroscopic distal clavicle excision acromioclavicular. Arthroscopic subacromial decompressiondistal clavicle excision name. Green is a fellowship trained specialist in problems of. The two types of acromioplasty and decompression are open and arthroscopic. Pain 10 weeks after distal clavicle and decompression. Vonda wright, orthopedic surgeon, provides rehabilitation recommendations in the it band lengthening physical therapy protocol. Physical therapy will focus on pain management and restoration. His specialty is helping professional athletes recover from injury and return to peak performance. Arthroscopic subacromial decompression and debridement biceps tenodesis distal clavicle resection mumford procedure must wear sling for comfort, when out in public and while sleeping for 2 weeks come out of sling to move elbow, wrist, and hand 3 x daily physical therapy starts 23 days postoperative.
The sports physical therapy service is an integral part of the sports medicine center and the department of physical and occupational therapy. After arthroscopic subacromial decompression intact. My surgery consisted of a arthroscopic distal clavicle resection and arthroscopic shoulder decompression, both on my left shoulder. For example, they will advise you to move handgrip closer together on the barbells and to stop your bench press two inches above the chest also decreases the stress on the distal clavicle. After earning his bachelor of science in physical therapy and his medical degree from the west virginia university school of medicine, dr. Rehabilitation guidelines after surgery, sports medicine. Rehabilitation guidelines for patella orifnondisplaced nonoperative patella fracturequadricep or inferior patellar tendon repair. Distal radius fracture and repair rehab protocol may 2017. Winner of the best physical therapy blog award and top ranked podcast for multiple years. When an individual is identified as having this bony abnormality of the clavicle, physical therapy is sometimes the first treatment option to attempt to minimize the pinching. After a clavicle fracture, it is common to lose some shoulder and arm strength. Arthroscopic distal clavicle excision is a surgical technique used to treat arthritis of the ac joint. Arthroscopic subacromial decompression shoulder surgeon.
Managing and recognizing complications after treatment of. Physical therapy can delay the need for surgery in 2 out if of 3 patients. Vonda wright performs arthroscopic shoulder surgery to treat torn rotator cuff, impingement and shoulder instability. It band lengthening physical therapy protocol vonda wright. After the surgery i began physical therapy two days later. The purpose of this study was to examine the distal clavicle morphology by assessing the dimensions and the angles of the distal clavicle in relation to the design of a potential distal clavicle. Weaver and dunn published their description of distal clavicle resection and cc ligament reconstruction in 1972. During arthroscopy of the subacromial space, the ac joint is located and the distal end portion of the clavicle is resected to create a 12centimeter gap between the acromion and the clavicle.
Distal radius fracture and repair rehab protocol the surgeon must specify on the referral any specific recommendations or deviations outside this protocol. Physical and occupational therapists at university orthopedics play a significant role in the nonsurgical treatment of upper extremity injuries, as success with therapy eliminates the need for surgical intervention. Subacromial decompression sad distal clavicle resection dcr what is impingement. Repairing a slap tear without surgery caring medical. Distal clavicle excision new york shoulder surgery. Mike reinold physical therapy and sports performance blog. Rehabilitation protocol adopted from the massachusetts general hospital sports physical therapy program and the american academy of orthopedic surgeons for nonsurgical rehabilitation of clavicle fractures 7,15. Cole,md,mba range of motion sling exercises phase i 04 weeks prom as tolerated 02 weeks.
The open distal clavicle resection originally described by both mumford and gurd over six decades ago has been the gold standard for surgical treatment of acromioclavicular joint pathology. A mumford procedure is the removal of the farthest outer portion of the clavicle or collarbone which creates a more normal amount of space for shoulder movements. Distal clavicle resection therapy protocol page 3 of 3 weight room activities will be phases in at this time depending on patients tolerance. Arthroscopic distal clavicle excision is a surgical technique used to treat to arthritis of the ac joint that is nonresponsive to conservative treatments. Often, patients will begin doing exercises for elbow motion immediately after the injury. Physical therapy standards of care brigham and womens.
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