Anterior Stabilization Surgery

Chapter 42 Anterior Stabilization Surgery

Michael Levinson, PT, CSCS

The etiology of anterior shoulder instability can be either the result of a traumatic, acute episode resulting in a dislocation that may have to be reduced by a physician or a chronic condition. The recurrence rate for anterior dislocations is extremely high, especially in the younger, active population.

The mechanism of injury for a traumatic anterior instability is usually some combination of shoulder external rotation, abduction, and extension. Common mechanisms include falling on an outstretched hand or planting a ski pole and falling forward. Instability can also be chronic, resulting from repetitive activities that can cause excessive laxity of the shoulder capsule and/or tearing of the labrum or individual general systemic laxity. Often the result of anterior shoulder instability is a “Bankart lesion,” which is defined as an avulsion of the anteroinferior glenoid labrum. Labral pathology and shoulder instability can be treated conservatively but often requires surgical intervention. This chapter will discuss the Hospital for Special Surgery (HSS) guidelines to rehabilitation following anterior shoulder stabilization.

Surgical Overview

• The labrum is a fibrocartilaginous structure that is attached to the glenoid rim. There is a great deal of anatomical variation.

1 The glenohumeral ligaments attach to the labrum.

2 The labrum contributes to glenohumeral stability by increasing the surface contact area for the humeral head and provides resistance to humeral head translation.

• An anterior stabilization may be performed open or arthroscopically.

• Patients with extreme laxity or who have multidirectional instability may need an open procedure.

1 The most common open procedure performed is done by transecting a portion of the subscapularis muscle.

2 The torn labrum is then repaired, and the capsule is tightened by making a cut through it and overlapping the margins of the cut.

Rehabilitation Overview

• The rehabilitation program following an anterior stabilization generally begins 1 to 3 weeks postsurgery.

• The goals are to restore normal strength, ROM, flexibility, and proprioception because loss of proprioception has been demonstrated with shoulder instability.

• The patient constantly wears the immobilizer, except when performing exercises or bathing.

• The program emphasizes early, controlled motion to prevent contractures and avoid excessive passive stretching later in the program.

• External rotation and extension of the shoulder are progressed slowly to protect the repair of the labrum and avoid excessive stretching of the anterior capsule.

1 Historically, there have been significant failure rates among arthroscopic procedures.

2 ROM progression following the arthroscopic procedure is slower than the open procedure secondary to the lesser fixation.

• Throughout the program a full upper extremity strengthening program will be progressed functionally to prepare the patient for return to activity.

• The program is based on the patient returning to sport-specific activities no earlier than 3 months post-surgery.

• Overhead activities are progressed last.

• Patient education is critical to avoid reinjury. Patients should understand the precautions associated with this surgery.

Postoperative Phase I (Weeks 1 to 3)

Related

Stay updated, free articles. Join our Telegram channel

Tags: Handbook of Postsurgical Rehabilitation Guidelines

Jun 22, 2016 | Posted by admin in PHYSICAL MEDICINE & REHABILITATION | Comments Off

Full access? Get Clinical Tree

Get Clinical Tree app for offline access

Get Clinical Tree app for offline access