4° congresso nazionale sif
TRANSCRIPT
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4° CONGRESSO NAZIONALE S.I.F.FIRENZE 25-26 MAGGIO 2014
RIABILITAZIONE POST-RICOSTRUZIONE CHIRURGICA DELLA CUFFIA DEI ROTATORI
Antonio Poser
Master in terapia manuale e riabilitazione muscolo-scheletrica Università di PadovaMaster in fisioterapia applicata allo sport Università di Siena
C.d.L. Fisioterapia San Raffaele Milano
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ANAMNESI
Donna 47 aa. destrimane, casalinga, nuotatrice
Trauma il 10/10/2013
Intervento il 26/11//2013: acromio-plastica,tenodesi capo lungo del bicipite, riparazione cuffia spalla sx
Tutore 30 gg., fkt solo passiva per 30gg. poi attiva e passiva
Anamnesi remota: fastidio da 2 anni nuotando a dorso alla spalla sx
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Rehabilitation following rotator cuff repair is a gradual process. The
timing of these is largely empirical
Evans R.O.,Hughes P.J.and Sonnabend D.H. “Rotator cuff” in: Repair and regeneration of ligaments, tendons, and joint capsule Ed.Walsh W.R. 2005
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PROTOCOLLI
Harris JD,Ravindra A,Jones GL et al Setting patient’s expectations for range of motion after arthroscopic rotator cuff repair. Orthopedics 2013
Tutore con o senza mobilizzazione
Mobilizzazione passivaAttiva –assistita Movimenti attivi
Rinforzo muscolarecon resistenza
Ghilarducci M,Maxey L. Rotator cuff repair and rehabilitation 2001
3 s 6s
12 s6s
FASE I FASE II FASE III
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Hatakemaya, Itoi, Rabindra e al. Effect of arm elevation and rotation on the strain in the repaired rotator cuff tendon. Am.J.Sports Med. 2001
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Healing of these defects, even after surgical repair, is believed to be complex, unpredictable, and
frequently incomplet
Evans R.O.,Hughes P.J.and Sonnabend D.H. “Rotator cuff” in: Repair and regeneration of ligaments, tendons, and joint capsule Ed.Walsh W.R. 2005
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MOBILIZZAZIONE vs IMMOBILIZZAZIONE
Parsons B.O.,Gruson K.I.,Chen D.D.et al. Does slower rehabilitation after arthroscopic rotator cuff repair lead to long-term stifness? J.Shoulder Elbow Surg.2010
Arndt J.Clavert P.Mielcarek P. et al Immediate passive motion versus immobilization after endoscopic suprspinatus tendo repair: a prospective randomized study. Orthop.Truam.Surg.Res. 2012
Kim YS,Chung SW,OkJh et al. Is early passive motion exercise necessary after arthroscopic rotator cuff repair? Am.J Sports Med 2012
Lee BG,Cho NS,Rhee YG. Effect of two rehabilitation protocols on range of motion and healing rates after arthroscopic rotator cuff repair: agressive versus limited early passive exercise. Arthroscopy 2012
Keener JD,Galatz LM,Stobbs-Cucchi et al. Rehabilitation follow arthroscopic rotator cuff repair: a prospective randomized trial of immobilization compared with early motion J.Bone Joint Surg.2014
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SF36
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ESAME OBIETTIVOSCALA DI VALUTAZIONE
SF 36
Buona escursione articolarePaziente vitale, motivato e
collaborante
Rigidità articolarePaziente depresso, ansioso e
Non collaborante
AUTOTRATTAMENTOSUPERVISIONATO
SEDUTE INDIVIDUALI
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FASE I
• OBIETTIVI
– Proteggere la riparazione chirurgica
– Controllo del dolore
– Evitare l’instaurarsi di rigidità articolari
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ESERCIZIO PENDOLARE DI CODMAN
Long JL,Ruberte Thiele RA,SkendzelJG et al. Activation of the shoulder musculature during pendulum exercises and light activities. J.Orthop.Sports Phys. Ther.2010
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MOBILIZZAZIONE PASSIVA AUTOASSISTITA
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Lastayo P.C., Wright T., Jaffe R.e al.”Continuous passive motion after repair of the rotator cuff: A prospective outcome study” J.Bone Joint Surg. 1998
Michael J.W.P.e al.” Effektivitat der postoperativen behandlung mittels motorisierter bewegungsschienen (CPM) bei patienten mit ruptur der rotatorenmanschette” Z.Orthop.2005
Raab M.G.,Rzeszutko D., O’Connor W. E al. Early results of continuos passive motion after rotator cuff repair: A prospective,randomized,blinded,controlled study. J.Bone Joint Surg. 1998
MOBILIZZAZIONE PASSIVA CONTINUA
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FASE II• OBIETTIVI
– Recupero articolare
– Riattivazione muscolare
– Controllo motorio
– Controllo del dolore
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ABILITA’
ABILITA’ COMPOSITEEQUILIBRIO,
COORDINAZIONE, ECC.
ABILITA’ SINERGICHE
ATTIVAZIONE RECIPROCA , CO-CONTRAZIONE
ABILITA’ PARAMETRICHEFORZA, VELOCITA’, LUNGHEZZA (ROM), RESISTENZA
Complessità motoria
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MODIFICAZIONI ADATTIVE DELLA CORTECCIA MOTORIA NELLA SINDROME DA CONFLITTO CRONICA E NELLE LESIONI DELLA
CUFFIA
Central neuromuscular dysfunction of the deltoid muscle in patients with chronic rotator cuff tears
Berth et al J.Orthop.Traum. 2009
Altered neuromuscular control of a hand in chronic rotator cuff tearsBerth et al.Arch.Orthop.Traum.Surg. 2010
Kinetic strategies of patients with shoulder impingement syndromeDoiron et al. J.Orthop.Res. 2010
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FASE III
• OBIETTIVI
– Migliorare la forza e la resistenza muscolare
– Migliorare il controllo motorio
– Recupero articolarità
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ESERCIZI ATTIVI
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ESERCIZI ATTIVI
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ESERCIZI ATTIVI
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ESERCIZI ATTIVI
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ESERCIZI ATTIVI
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RECUPERO FORZA MUSCOLARE
SEMBRA SIA NECESSARIO 1 ANNO DI RIABILITAZIONE
PER IL RECUPERO OTTIMALE DELLA FORZA MUSCOLARE
Rokito A.S., Zuckerman J.D.,Gallagher M.A.et al. Strength after surgical repair of the rotator cuff. J.Shoulder Elbow Surg. 1996
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RICOSTRUZIONE CUFFIA SPALLA SX
DIMISSIONI
ROTTURA SOVRASPINATO DX
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A R T I C O L A R I T A’
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F O R Z A M U S C O L A R E
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Shoulder Pain And Disability Index
29-gen-14
1-feb-14
4-feb-14
7-feb-14
10-feb-14
13-feb-14
16-feb-14
19-feb-14
22-feb-14
25-feb-14
28-feb-14
3-mar-
14
6-mar-
14
9-mar-
14
12-mar-
14
15-mar-
14
18-mar-
14
21-mar-
14
24-mar-
14
27-mar-
14
30-mar-
14
2-apr-1
4
5-apr-1
4
8-apr-1
4
11-apr-1
4
14-apr-1
4
17-apr-1
4
20-apr-1
4
23-apr-1
4
26-apr-1
4
29-apr-1
4
2-mag
-14
5-mag
-14
8-mag
-14
11-mag
-14
14-mag
-140
10
20
30
40
50
60
20
129
2 2 2 2
36
15
8
4 3 2 2
56
27
17
6 5 4 4
Chart Title
doloreSeries2funzionalitàSeries4totale
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SF 36
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CONSIDERAZIONI
Il percorso riabilitativo nella ricostruzione dicuffia è lungo ed impegnativo.E’ necessario utilizzare le risorse del paziente per coinvolgerlo nel processo riabilitativo e nell’aderenza al programma di esercizi domiciliari
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CONSIDERAZIONI
L’esercizio migliore è quello che genera la maggiore attività elettromiografica?
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GRAZIE