Rehabilitation after acromioplasty (of the shoulder)
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voici la traduction en anglais : Rehabilitation after acromioplasty of the shoulder.
· By Sébastien Ruiz
· September 12th 2006
Rehabilitation after simple acromioplasty of the shoulder.
Hospitalization lasts 2 to 5 days.
This is rehabilitation with no particular difficulty as no movements are prohibited.
Only the active work must be carried out in moderation at the beginning to avoid triggering tendonitis or reactive capsulitis.
An « elbow-to-body» type sling will be worn for 3 days to 3 weeks depending on the severity of surgery and the thus surgeon’s judgment.
At the surgery, the first sessions consist of recovering the fullest passive amplitude possible with minimum pain.
To make it easier to relax, the patient must be in the decubitus position (lying flat on his back) while the physiotherapist carries out passive mobilization.
The physiotherapist will gently slide and pull on the gleno-humeral joint in order to avoid conflicts between joints and therefore decrease the risk of pain.
The aim of passive amplitude varies from one patient to another (age, quality of movement before the intervention, motivation…to go back to work and take up physical and sports activities again), hand-to-forehead amplitude should be aimed at quickly, with the humerus in the axis of the scapula.
Physiotherapeutic means must be complementary to manual mobilization, Electrotherapy and ultrasound might be a good indication.
Electrotherapy helps combat pain with endorphinic programs, and the early contraction of the muscular fibers of the supra and infra-spinal deltoid can also be obtained, this contraction favors the sliding of the fascias and thus limits the formation of fibrosis.
When maximum amplitude has been achieved without pain in passive mobilization and auto-passive mobilization (the use of pulley-therapy with which one limb can be raised passively with the other upper limb active, or direct mobilization of one limb with the other limb), active work on the lowering muscles of the shoulder becomes primordial.
Work must be done on the corporal perception of the shoulder-lowering movement before raising the upper limp, and likewise the endurance and strength of the latissimus dorsi and pectoralis major muscles.
This muscle work may be carried out manually or with the help of a simple pulley-therapy system. You simply have to slow down the arm-lowering movement and thus at the same time do the active work helped by the elevation.
In, The stability of the shoulder will be worked on progressively in an open and closed chain by gradually increasing the intensity of destabilization.
Massage (a cream containing an active or neutral principle) must not be forgotten by the physiotherapist because it remains a precious aid, the contracted areas can be softened, and any eventual areas of skin adherence.
In case of persistent pain upon actively raising the upper limb, the patient will have to use the ways of raising his arm as taught by the physiotherapist in order to avoid the area where it blocks
In general, surgeons prefer prescribing a certain amount of physiotherapy before the surgical intervention in order to make the painful shoulder more supple and strengthen it a little.
With experience, we have noticed that those patients who have begun physiotherapy before their intervention recover better and faster than the others.
Sometimes even in the case of slight damage to bone tissues, the surgical intervention is cancelled or put off because the patient has learned to optimize the use of his shoulder…
Ruiz Sébastien, Physiotherapist, Osteopath, CHU Lapeyronie (orthopedic surgery, surgery of the hand and the upper limb) and freelance, Montpellier.
