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. Kochhar t, jayadev c, smith j, griffiths e, seehra k. Arthroscopic distal clavicle resection for isolated atraumatic osteolysis in weight lifters. Maintain good upright shoulder girdle posture at all times and especially during sling use. Patients who present post colles fracture tend to guard the entire upper extremity as a means of protecting the wrist. Even for displaced fractures, the literature generally reports a high rate of good results with a low nonunion rate 15. Distal clavicle resection therapy protocol page 3 of 3 weight room activities will be phases in at this time depending on patients tolerance. Arthroscopic subacromial decompression andor ac joint. Oct 09, 2010 closed displaced midshaft clavicle fractures used to be treated nonoperatively, and many studies have reported that nonoperative treatment gave good results. You will be taught exercises to promote movement and restore muscle strength. Acromioclavicular ac joint dislocationseven moderatetosevere casesmay be bettertreated through nonsurgical approaches, according to a new study from canada that found better shortterm outcomes, faster returntowork rates, and fewer complications among. 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.
Due to an auto accident several years ago, i suffered a type 1 shoulder separation that was excruciatingly painful and refractory to 8 months of conservative therapy. Anterior shoulder dislocationsubluxation nonoperative. Arthroscopic distal clavicle resection rehabilitation please give to your physiotherapist 0 to 6 weeks after surgery see dr burrow in rooms at 2 weeks postop use arm for paperwork, computer, eating with armelbow out of sling. However, anyone recovering from an injury or surgery is free to use them. If any concerns or complications arise regarding the progress of any patient, physical therapy will contact the orthopedist. A mumford distal clavicle excision is a surgical procedure which involves. Physical therapy management of clavicle fractures morphopedics.
The aim of this trial is to compare the results of plate fixation with nonoperative management of dislocated midshaft fractures of the clavicle with respect to the incidence of nonunion, functional outcome, pain scores, quality of life, cosmetic. If physical therapy is unsuccessful, a mumford procedure is often the best way to surgically modify this bony abnormality. Prior to the clavicular resection, i was able to live independently, work as a researcher, and maintain an athome pt regimen as well as aquatherapy at least once a week. Mumford procedure distal clavicle resection physical therapy. The exercises may be suggested for a condition or for rehabilitation. Tuesday, october 27, 2015 physical therapy achieves faster outcomes than surgery for common type of shoulder dislocation. Physical therapy is necessary to strengthen your muscles and. It can help to decrease pain and increase shoulder function. Stress fracture following resection of distal end of clavicle. Since 1941, resection of the distal clavicle has been a proven treatment for symptomatic acromioclavicular ac joint pathology. After arthroscopic subacromial decompression intact. Elbowwristhand rom, pendulums, wall stretch at home per instruction sheets. It is essential for people who have experienced clavicle fracture to have plenty of rest.
Posttraumatic osteolysis of the distal clavicle is an uncommon condition that may result from acute trauma type i, chronic repetitive microtrauma type ii, or idiopathic trauma type iii. Distal clavicle resection generally occurs when conservative treatment for degenerative changes or osteoarthritis wear and tear type arthritis over the small joint. Sep 09, 2019 arthroscopic distal clavicle resection for isolated atraumatic osteolysis in weight lifters. This condition causes chronic pain in the ac joint. Mr pimpalnerkar physiotherapy protocol 1 shoulder sad november 2007 rebecca backhousemichelle suri the above information is intended as a guide only. In the treatment of clavicle fractures, the choice of procedure depends on the possibility of restoring the anatomical functional integrity of the shoulder. A clavicle fracture most frequently results from trauma. By introducing exercise for the entire limb, disuse. Nonoperative treatment of closed displaced midshaft. Distal clavicle resection mumford physical therapy protocol preoperative guidelines restore full shoulder arom strengthen in painfree rom, emphasize rotator cuffscapular stabilization musculature instruct in postop protocol educate patient on postop compliance to ensure best functional outcome. Study protocol open access displaced midshaft fractures.
Clavicle fractures are common fractures and the optimal treatment strategy remains debatable. However, more recent studies have reported poorer results following nonoperative treatment, whereas the results of operative treatment have improved considerably. Rehabilitation protocol for undisplaced colles fractures. Symptom improvement has been satisfactory in most reported series.
Nonoperative treatment of closed displaced midshaft clavicle. Maintenance prom to involved shoulder elevation, er90, and ir90 as tolerated. Arthroscopic resection of the distal clavicle with. Also i can hardly do any weight bearing exercises as the pain is too much and when the physical therapist has me doing like wall push ups or cable chest presses my shoulder becomes very tight and hurts a little at the full extension inside my shoulder, around the bone area. Physical therapy will focus on pain management and restoration. Resection of the distal clavicle, as described by mumford 2, is a reliable surgical option in acromioclavicular joint acj osteoarthritis and shoulder impingement syndrome.
When an individual is identified as having this bony abnormality of the clavicle, physical therapy is sometimes the first. Distal clavicle resection rehab protocol distal clavicle resection generally occurs when conservative treatment for degenerative changes or osteoarthritis wear and tear type arthritis over the small joint of the shoulder, otherwise known at the acromioclavicular joint, generally over the course of a lifetime, general progressive arthritis occurs. Arthroscopic distal clavicle excision acromioclavicular joint ac. Clavicle fracture broken collar bone physical therapy. I just had distal clavicle resection surgery ac joint. Therapeutic exercise o codmanspulleyscane o elbowwristhand range of motion o grip strengthening o no resistive exercises. We examined 71 patients 51 males and 20 females, mean age 38. In 2012 harris et al found that acj disease was present in 31% of individuals who presented with shoulder pain. The information on this site is for informational purposes only and should in no way replace a conventional visit to an actual live physical therapist or other healthcare professional. Im new to posting here and look forward to learning alot from you guys and girls. He has been left with weakness and associated loss of motion in his shoulder.
Here are some examples of exercises for you to try. Phase i is the first week post operative and consists mainly of rest, ice and restricted activity. Manual therapy for ac joint pain the student physical. Therapeutic doses of radiation can lead to weakened, devascularized, and fractured bones. 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. Distal clavicle resection therapy protocol page 2 of 3 exercises. If physical therapy is unsuccessful, a mumford procedure is often the best way to surgically modify this bony. Physical therapy will focus on pain management and restoration of passive and active range of motion. Physical therapy prescription clavicle fracture orif. After arthroscopic subacromial decompression intact rotator cuff distal clavicle resection rehabilitation protocol. If the mumford is an open procedure, restrict overhead activities and heavy lifting for 3 weeks. Mar 24, 2017 the largest case series of open clavicle resection for dco was performed by cahill.
Treatment for clavicle fracture depends on the type of fracture and the associated damage. On the other hand, recent studies have reported poorer functional outcomes with nonunion rates of up to 20% for displaced, comminuted midshaft fractures treated nonoperatively, whereas the. Mr examination demonstrated abnormally increased t2 signal in the distal clavicle in all nine cases and no other cause for ac joint pain. A clavicle fracture is also known as a broken collarbone.
Rehabilitation protocol adopted from the massachusetts. Subacromial decompression distal clavicle excision. Jan 14, 2019 operative outcome of displaced medialend clavicle fractures in adults. Six experienced refractory pain despite conservative therapy. Clavicle fracture fixation information sheet pdf shoulder specialist. Resection of the distal clavicle was performed in five of the six cases. The majority of clavicle fractures can heal without surgery. Clavicle orif rockwood pin hook plate inpatient confirm from op notes patient to follow protocol. Physical therapy achieves faster outcomes than surgery for. Treatment may be modified based on the extent of the injury, type of surgery performed, pain level and speed of recovery. Devinder garewal is an orthopaedic shoulder specialist. Check out our entire database and interactive tools to learn more about conditions, procedures, and gain insight into your health risks. Distal clavicle resection removes a piece of the clavicle to open the area and decrease the pressure on the soft tissue. Three patients responded to a course of conservative therapy.
Increased t2 signal intensity in the distal clavicle. I am a former amateur boxer not that great, record was 22. Demographic and clinical data and the site of the lesion were recorded for each partecipant. Distal clavicle resection therapy protocol page 1 of 3 bart eastwood d. The clavicle serves as an important connection from the upper arm appendicular skeleton to the trunk axial skeleton. Cole,md,mba range of motion sling exercises phase i 04 weeks prom as tolerated 02 weeks. 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. Limit arom to 90 degrees of flexion and abduction for 3 weeks. The diagnosis is suggested with a history of trauma and established on plain film radiographs. Arthroscopic subacromial decompressiondistal clavicle excision. Impact of clavicle fractures on return to play and performance ratings in nfl athletes. Surgical treatment of postradiotherapy nonunions of the clavicle. Only wear sling when walking or travelling, and if uncomfortable when sleeping. Clavicle fractures are very common injuries in adults 25% and children 1015% and represent the 4466% of all shoulder fractures.
The clavicle, known as the collarbone, is a long bone located at the top of the chest. Distal clavicle resection therapy protocol sideline orthopedics. Distal clavicle resection rehab protocol orthopedic specialists of. R adiation therapy is commonly used in the treatment of numerous malignant tumors. Devinder completed his medical qualifications from the university of melbourne and is a fellow of the royal australasian college of surgeons and the. Acromioclavicular joint acj injuries are quite prevalent throughout the general population and specifically in the athletic population. Subacromial decompression distal clavicle excision rehab atlanta. 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.
Pdf conservative treatment of fractures of the clavicle. He underwent a course of physical therapy and has been declared medically stable. The most common place for an adult to break this bone is in the shaft, or middle third, of the bone. Based on comfort patient can be progressed through these phases more quickly. Diagnosis and management of distal clavicle osteolysis. The clavicle contributes to the freedom of motion seen at the shoulder by acting as a movable strut to which the scapula and upper arm are suspended at a distance from the. A fall onto the lateral shoulder most frequently causes a clavicle fracture. Radiographs confirm the diagnosis and aid in further. Thoracic outlet syndrome tos is a condition caused by compression squeezing of nerves or blood vessels in the. Fractures and ligamentous injuries of the clavicle and its articulation. Harris 2012 the acj is a synovial joint which connects the distal clavicle to the acromion. You will be told when to start these exercises and which ones will work best for you. Ken alleyne the tip of the shoulder blade scapula that forms the roof of the shoulder joint is known as the acromion.
Clavicle fractures are a common orthopedic injury, especially among infants and young children. This is the area between the base of the neck and the armpit, including the front of the shoulders and chest. Where this bone meets the collarbone clavicle is known as the acromioclavicular or ac joint. Anterior shoulder dislocationsubluxation nonoperative treatment. Surgical treatment of postradiotherapy nonunions of the. Mumford distal clavicle excision detroit ac joint disorder royal. Historically, clavicle fractures used to be treated nonoperatively 1. If a mumford distal clavicle excision was performed, limit horizontal adduction for 8 weeks post operative phase i weeks 04 sling immobilization for comfort weeks 02 discontinue sling use at 2 weeks range of motion prom aarom arom as tolerated. Your doctor will refer you to a physical therapist. The largest case series of open clavicle resection for dco was performed by cahill. Initially, nonsurgical methods of treatment such as medications and physical therapy exercises will be. Distal clavicle resection is the removal of a piece of the clavicle bone at the top of the shoulder.
Suite 224a blacksburg, va 24060 54055273 the rehabilitation program following a distal clavicle resection is divided into three phases. Manual physical therapy for injection confirmed nonacute acromioclavicular joint pain. Distal clavicle resection with rotator cuff repair the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Distal clavicle excision resection physical therapy. Ice to prevent pain and swelling passive, active assisted andor active rom exercises are initiated depending on the patients tolerance. The rehabilitation program following a distal clavicle resection is divided into three phases. Immediately post operative the shoulder sling applied in surgery. The boney removal has the potential to stimulate scarring and difficult restoration of range of motion.
Essential to the success of the surgical procedure is early normalization of passive and active range of motion. On may 7, 2007 i had a distal clavicle resection on my right shoulder where my doc removed 12 mm of my ac joint. Conservative treatment of fractures of the clavicle bmc. Teach home exercises o pendulum movements o active assisted passive flexion and abduction to 90 degrees elevation. Rom exercises begin with the arm comfortably at the patients side, progress to. Exercises may be performed in all planes of motion. Listing a study does not mean it has been evaluated by the u. Rom shoulder impairment upper extremity figures 1640, 43, 43, 46. Only wear sling when walking or travelling, and if. Although arthroscopic techniques have been well developed, open distal clavicle resection remains the gold standard and in certain patients is the preferred technique for removal of the distal clavicle.
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