Page 27 - ISAKOS 2019 Newsletter Volume 1

CURRENT CONCEPTS
Box 3
Key Points of Rehabilitation Following Instability Repair
• Protect repair for 6 weeks on average (especially external rotation)
• Start passive motion/scapular exercises as soon as possible; avoid external rotation beyond neutral
• Progress to active-assisted and active motion, neuromuscular control
• Start strengthening after 12 weeks or after full range of motion is achieved
For maximum effectiveness, it is recommended that physical therapy should be combined with another intervention, such as steroid injections, capsular distention, mobilization, or capsular release. Preferably, physical therapy should be performed in the pain-free stage of the frozen phase. It should include scapular mobilization and retraining of scapular stabilizers. There is no difference between home- based and institutional programs in terms of effectiveness. If capsular release is indicated, therapy should start as soon as possible, both to continue improvement of range of motion and to avoid recurrent stiffness due to scarring after release.
Overview
Despite the lack of high-quality evidence regarding physical therapy after shoulder arthroscopic surgery, there is no significant difference between early and conservative therapy programs. All programs should include scapular neuromuscular stabilization and should take into account the healing times and phases of the different repaired tissues.
Future Directions
There is a clear need for high-quality, prospective, randomized controlled trials involving larger numbers of patients in order to determine the efficacy of rehabilitation strategies for each shoulder condition. It also will be necessary to establish consensus between surgeons and rehabilitation physicians/therapists in order to bridge the gap between specialties.
References
1. Mazuquin BF, Wright AC, Russell S, et al. Br J Sports Med 2018;52:111–121. 2. Thomson S, Jukes C, Lewis J. Rehabilitation following surgical repair of the rotator cuff: a systematic review. Physiotherapy. 2016 Mar;102(1):20-8. doi: 10.1016/j. physio.2015.08.003. Epub 2015 Sep 8 3. Gaunt BW, Shaffer MA, Sauers EL, et al. The American Society of Shoulder and Elbow Therapists’ consensus rehabilitation guideline for arthroscopic anterior capsulolabral repair of the shoulder. J Orthop Sports Phys Ther 2010;40:155–68. 4. Brand H, van der Linde JA, van Deurzen DFP, et al. Lacking evidence for rehabilitation following arthroscopic Bankart repair: a systematic review JISAKOS 2017;2:14–20 5. Itoi, Eiji et al. Shoulder Stiffness: Current Concepts and Concerns. Arthroscopy 2016;32(7):1402 – 1414
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ISAKOS NEWSLETTER 2019: VOLUME I 25