SLAP repair behandelprotocol
SLAP LESION REPAIR PROTOCOL
Inhoud
Auteur
- Dr. Walter R. Lowe
Inleiding
This rehabilitation protocol has been developed for the patient following a SLAP (Superior Labrum Anterior Posterior) repair. It is extremely important to protect the biceps/labral complex for 6 weeks post-operatively to allow appropriate healing. This protocol has been divided into phases. Each phase may vary slightly based on the individual patient and special circumstances.
Doel
The overall goals of the surgical procedure and rehabilitation are to:
- Control pain and inflammation
- Regain normal upper extremity strength and endurance
- Regain normal shoulder range of motion
- Achieve the level of function based on the orthopedic and patient goals
Early passive range of motion with noted limitations is highly beneficial to enhance circulation within the joint to promote healing. The physical therapy should be initiated within the first week following surgery. The supervised rehabilitation program is to be supplemented by a home fitness program where the patient performs the given exercises at home or at a gym facility.
Postoperatieve signalen
Important post-operative signs to monitor include:
- Swelling of the shoulder and surrounding soft tissue
- Abnormal pain response, hypersensitive-an increase in night pain
- Severe range of motion limitations
- Weakness in the upper extremity musculature
Return to activity requires both time and clinical evaluation. To safely and most efficiently return to normal or high level functional activity, the patient requires adequate strength, flexibility, and endurance. Functional evaluation including strength and range of motion testing is one method of evaluating a patient’s readiness to return to activity. Return to intense activities following a SLAP repair requires both a strenuous strengthening and range of motion program along with a period of time to allow for tissue healing. Symptoms such as pain, swelling, or instability should be closely monitored by the patient.
Fasering
Phase 1: Week 1-3
WEEK EXERCISE GOAL
- 1-3 ROM Gradual ↑
- Passive range of motion
- Flexion/Elevation 0-60° wk 1
- 0-75° wk 2
- 0-90° wk 3
Passive range of motion-scapular plane
- External Rotation 0-15° wk 1
- 0-30° wk 2-3
- Internal Rotation as tolerated
- Pendulum exercises
- Rope/Pulley (flex, abd, scaption)
- Wand exercises-all planes within limitations
- Posterior capsule stretch
- Manual stretching and Grade I-II joint mobs
STRENGTH
- Initiate submaximal isometrics-NO elbow flexion
- Initiate scapular stabilizer strengthening
- Initiate UBE without resistance
BRACE
- Brace for 3 weeks or as noted by surgeon
- Brace removed for exercises above
MODALITIES
- E-stim as needed
- Ice 15-20 minutes
GOALS OF PHASE:
- Promote healing of tissue
- Control pain and inflammation
- Gradual increase in ROM
- Independent in HEP
- Initiate muscle contraction
Phase 2: Week 3-6
WEEK EXERCISE GOAL
- 3-6 ROM Gradual ↑
- Passive range of motion
- Flexion/Elevation 0-145°
- Passive range of motion-scapular plane
- External Rotation 0-50° wk 6
- Internal Rotation Full ROM wk 6
- Pendulum exercise
- Posterior capsule stretch
- Rope/Pulley (flex, abd, scaption)
- Wand exercise-all planes within limitations
- Manual stretching and Grade II-III to reach goals
STRENGTH
- Continue isometric activities as in Phase 1
- Initiate supine rhythmic stabilization at 90° flexion
- Initiate IR/ER at neutral with tubing
- Initiate forward flexion, scaption, empty can
- Initiate sidelying ER and tricep strengthening
- Push-up progression
- Prone abduction with external rotation
- Shoulder shrugs with resistance
- Supine punches with resistance
- Shoulder retraction with resistance
- Initiate UBE for endurance
- Prone rows
- Initiate light biceps curls at week 3
MODALITIES
- Ice 15-20 minutes
GOALS OF PHASE:
- Control pain and inflammation
- Enhance upper extremity strength
- Gradual increase in ROM
Phase 3: Week 6-12
WEEK EXERCISE GOAL
- 6-12 ROM Full ROM
- Continue all ROM activities from Phase 2 10-12 wks
- Posterior capsule stretching
- Towel stretching
- Rope/Pulley activities
- Wand exercises
- Manual stretching and Grade III-IV mobs
STRENGTH
- Continue all strengthening from previous phases increasing resistance and repetition
- Initiate plyotoss chest pass
- Initiate PNF patterns with theraband
- Initiate IR/ER exercises at 90° abduction
- Initiate isokinetic IR/ER at neutral at wk 10-12
MODALITIES
- Ice 15-20 minutes
GOALS OF PHASE:
- Minimize pain and swelling
- Reach full ROM
- Improve upper extremity strength and endurance
- Enhance neuromuscular control
- Normalize arthrokinematics
Phase 4: Week 12-24
WEEK EXERCISE
- 12-24 ROM
- Continue with all ROM activities from previous phases
- Posterior capsule stretching
- Towel stretching
- Grade III-IV joint mobs as needed for full ROM
STRENGTH
- Progress strengthening program with increase in
- resistance and high speed repetition
- Progress with eccentric strengthening of posterior cuff
- and scapular musculature
- Initiate single arm plyotoss
- Progress rhythmic stabilization activities to include
- standing PNF patterns with tubing
- UBE for strength and endurance
- Initiate military press, bench press, lat pulldown
- Initiate sport specific drills and functional activities
- Initiate interval throwing program week 16
- Initiate light plyometric program week 12-16
- Progress isokinetics to 90° of abduction at high speeds
MODALITIES
- Ice 15-20 minutes
GOALS OF PHASE:
- Full ROM
- Maximize upper extremity strength and endurance
- Maximize neuromuscular control
- Initiate sports specific training/functional training
Zie ok:
- Schouder anatomie
- Schouderoefeningen
- Rotator_cuff_ruptuur,_fysiotherapie_of_operatie,_scriptie
- Schouder_Impingement
- Schouderklachten_als_beroepsziekte,_factsheet
- Schouderinstabiliteit;_vermindering_van_recidive_na_fysiotherapie_of_cirurgie?_scriptie
- Spierkrachttraining_van_de_rotator_cuff,_scriptie
- Impingement schouder
- Klinimetrie voor de schouder, ppt
Youtube
Fysieke klachten?
Raadpleeg uw fysiotherapeut, specialist in beweging [4]
Voor België [5]
