a rthroscopic a cromioplasty angela whittington. definition bursitis or tendonitis impingement...

ARTHROSCOPIC ACROMIOPLASTYAngela Whittington

DEFINITION Bursitis or tendonitis impingement Causes the tissues underneath the AC

joint to be pinched against the bone Produces irritation and pain

MOIRotator cuff muscles become stretched

laxityArm abducted > 90◦head drops & longhead biceps

tendon/supraspinatus becomes impinged

ACROMION PROCESS

Three types (shapes of acromion processes)

Type I: Flat Figure A

Type II: Gently curved Figure B

Type III: Sharply hooked Figure C

PATIENT HISTORY

Female 20 y/o Division I Collegiate Volleyball athlete S/S: pain with overhead activity Dec ROM Crepitus w/ GH motion

Pain w/ GH ABD & FLEXDecreased rotator cuff strength

Special Tests(+) Neer Impingement & Hawkins

Impingement

PATIENT HISTORY CONT.

Image FindingsRadiographs

confirm Type III Acromion Process

IMAGINGNormal Rotator Cuff Torn Rotator Cuff

Patient chose conservative treatments at firstRest IceNSAIDsRehabilitation

Conservative treatment failed to return her to preinjury levelSurgical intervention recommended

ARTHROSCOPIC ACROMIOPLASTY Ellman (1987) introduced

technique for subacromial decompression

Meant for pt’s who did not respond toSix mo. of conservative

treatmentNSAIDS, steroid

injectionsPhysical therapy

Three small skin portalsSpares deltoid muscle

& ↓ post-op movement restriction

SURGICAL INTERVENTION Goal is to smooth ANT acromial undersurface Subacromial space and bursa is debrided Acromioplasty performed Recommended anterior-inferior

acromioplasty Detaching deltoid muscle from ANT

subacromial process & AC joint Osteosome removes ANT & undersurface of

acromion process Portion of coracoacromial ligament removed to

decompress the space Arthroscopic acromioplasty preferred

PROCEDURE Orthosports - Orthopaedic

& Sports Medicine Physicians - Shoulder Impingement

REHABILITATION: PHASE 1

GoalsLimit PainRestore MotionReduce Swelling

TREATMENT RECOMMENDATIONS

IceSling (if necessary)E-Stim Joint Mobilization (grade 1 and 2)Rom (passive and active assisted

pain free)Pendulum Exercises

REHABILITATION: PHASE 2

GoalsEliminate PainRestore full active motionRestore good glenohumeral and

scapulohumeral rhythm4/5 strength or upper extremity

muscles

TREATMENT RECOMMENDATIONS

Continue modalities as needed

Start with active range of motion

Add isometrics below shoulder level

Flexibility of cervical, shoulder, and scapular muscles

PRECAUTIONSAll active and isometric exercises

should be muscle specificAll movements and activity

increasing symptoms should be eliminated

Isometrics are modified if patients symptoms are made worse

REHABILITATION: PHASE 3Attain full pain free ROMAchieve 5/5 strength in all shoulder

girdle musclesFull pain free resistive range of

motionNegative Neer SignNegative Hawkins SignSymmetrical scapulohumeral

rhythm

TREATMENT RECOMMENDATIONSContinue use of ice as necessaryContinue with previous exercisesProgress resistance to overhead and

above horizontalAdd resistance to scapular exercisesWork on quality of motion and not just

resistive trainingWork on balance of rotator cuff

muscles Start with sport/work specific exercisesWater resistive activities

PRECAUTIONSDo not neglect the rest of the body!

REHABILITATION: PHASE 4Goals

Full pain free ROM5/5 strength in all upper extremity

and scapular musclesNormal scapulohumeral rhythm w/

and w/o resistanceAble to complete throwing sport

specific or work tasks pain free, and w/o signs of instability or impingement

PRECAUTIONS It should be noted that time frames

for these phases overlap time frames for these phases can’t be given. It is based on exercise intensity, pain, underlying instability, healing time, and strength

Rehab should be progressive always achieving and then maintaining a pain free state

TREATMENT RECOMMENDATIONS

Continue use of ice as necessaryContinue with previous exercisesProgress resistance to overhead and

above horizontalAdd resistance to scapular exercisesWork on quality of motion and not

just resistive trainingWork on balance of rotator cuff

muscles

THINGS TO REMEMBER Core Strengthening Cardio Workouts Team involvement If athlete is sore after exercises, bring down

Do not progress or overwork!

FUNCTIONAL EXERCISE Dig & Roll

Practice defense and going to the floor after a dig.

Use groups of three or four.

Line starts at middle back position.

Coach hits a ball to the right.

Player must read coach's shoulders and dig ball.

After the dig the player must roll.

Coach alternates hits right and left.

Continue for a set number of digs for each player.

FUNCTIONAL EXERCISE Cross Court Digging

To practice digging balls a good distance away from the net and from different angles.

1.Hitters alternate hitting balls at the defenders.

2.The defenders dig the balls to the target.

3.After the defender digs the ball they alternate lines.

4.Repeat until a set number of digs is

FUNCTIONAL EXERCISE No Fear Defense Teach aggressiveness on defense.

Teach defenders to get under balls hit down

Coach stands on a box in the middle of the net, where they can hit the ball

down inside 10' line.

Coach continuously hits balls to the defenders.

After a set number of hits the defender can only exit the drill when they can pass a ball straight up and

catch it.