REHABILITATION PROTOCOL AFTER AN ANTERIOR SCREWED CORACOID BLOCK PROCEDURE
Department of Orthopaedic Surgery, Clinique Sainte Anne Lumière Lyon
From 3 to 45 Days Postoperatively : Restoration of a Functional Range of Motion
After the operation, the involved limb is kept at rest in a sling for 10 days. Then sutures are removed the patient gets rid of the sling and, up to 45 days postoperatively, passive exercises are performed under the supervision of the therapist for restoration of a passive range of motion. Function is gradually restored for activities of daily living : 150° of elevation, 30° of external (ER1) and internal rotation (L5th). Self-directed passive exercises are associated with hydrotherapy. The patient is encouraged to swim breast stroke, doing smooth and painless movements, and neither requested nor authorized to make any muscular effort.
From 45 to 90 Days Postoperatively : Resoration of Full Range of Motion
45 days after the operation, the pysiatrist examines the scar, evaluates range of motion, and checks for neuromuscular status. At this stage, the spontaneus active motion pattern has been restored and the patient is fit for activities of daily living. The therapist teaches the overhead triple locking (OTL) exercise that will have to be done at home, at first occasionally and then more and moreoften as stretching gets easier and more complete. Of course swimming is encouraged; activities of daily living require limited efforts. The patrient is not allowed to resume sports requiring use of the arms; he can still do basic exercices as long as these do not actively involve the shoulder muscles. The second and last visit is scheduled 90 days after surgery; anteroposterior views are taken with 3 rotations of the humerus ans a Bernageau's lateral view of the glenoid to assess incorporation of the bone block.
After 90 Days : Resumption of Athletic Activities
90 days after the operation, the control X-ray should confirm the complete incorporation of the bone block, and the patient should have recovered a full range of motion; strength is evaluated in elevation and external rotation against manual full resistance. It should be back to normal althouh no specific strengthening exercises have been done. This is the signal for the patient to resume athletic activities, knowing that it will take him one month of gradual efforts to return to the previous level of sport. No specific muscle strengthening is recommended, since there is no instability; resumption of the previous basic and specific training will suffice.
LIOTARD J-P, WALCH G. (2001) Rehabilitation of the unstable shoulder. In : PUDDU G, GIOMBINI A, SELVANETTI A Eds, Rehabilitation of sports injuries. Ist edn (Springer-Verlag : Berlin Heidelberg New-York) 61-72.