S/p cervical fusion

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S/p cervical fusion - September 4, 2008 7:12:19 AM

JSPT

Posts: 284
Joined: April 19, 2005
From: Michigan
Status: offline

I have a 60 y/o male s/p anterior cervical fusion about 2 weeks ago referred for L shoulder rehab. Findings are:

-2/5 shoulder strength for flexion, abduction, extension, ER, scaption; grip strength is 100# R and 40# L, pinch strength is 1/2 of R on L
-Numbness/tingling in L thumb only
-When patient attempts to reach straight forwards, his L UE deviates towards midline, and the hand ends up close to the R hip
-A second MRI about 1 week post-op has ruled out any surgical complications or other pathology in the neck or L shoulder

We're starting with pool therapy, AAROM, biceps and wrist strengthening, scapular stabilization, etc.

Any suggestions for NMES, or other treatment ideas?

Post #: 1

RE: S/p cervical fusion - September 4, 2008 11:22:29 AM

Shill

Posts: 1097
Joined: February 13, 2003
From: Madison WI USA
Status: offline

While he may not have any true pathology in the shoulder muscles, it sounds like his posterior cuff and delt. cant hold the arm and it drifts over. Could be related to the neural compression prior to the fusion. I am assuming it was a C4/5 or 5/6 fusion. Could be a plexopathy as well, also not likely to show up on MRI. I would likely throw in a fair amount of sitting with passive scapular elevation, to relieve the gravity induced strain on these neural structures, and work the shoulder with exercises in gravity eliminated planes for now. Beyond that, I think you are doing the right stuff.
Interesting case, keep us posted.

Steve

(in reply to JSPT)

Post #: 2

RE: S/p cervical fusion - September 11, 2008 6:37:51 AM

JSPT

Posts: 284
Joined: April 19, 2005
From: Michigan
Status: offline

After almost 2 weeks, the following is recored:

-sensation decreased to light touch around the L acromion and proximal 1/4 of the middle deltoid
-AROM in standing has improved by 20 degrees of flexion and 15 degrees of abduction without substitution
-Client remains unable to activley abduct without substitution and unable to ER without substitution
-Grip strength is 60# L and 100# R, pinch strength is not equal to uninvolved

I have tried Russian e-stim to the infraspinatus and supraspinatus with minimal results, and continue to work AAROM in the pool and on land.

Speaking with the surgeon's office, these are normal limitations for someone 1 month out of surgery; they don't feel an EMG or MRI of the L shoulder are warranted at this point.

For those of you who have seen this type of problem before, does the rate of recovery seem normal? Any thoughts on an axillary or suprascapular nerve lesion? Would post-op swelling affect the C5-6 level this dramatically?

(in reply to Shill)

Post #: 3

RE: S/p cervical fusion - September 15, 2008 6:42:55 PM

JSPT

Posts: 284
Joined: April 19, 2005
From: Michigan
Status: offline

This patient is making modest gains in function, but he continues to have no significant middle deltoid or external rotator function. He remains unable to ER the L arm while in R sidelying.

We continue to work on AAROM and strengthening in the pool, and I've added 10 minutes of Russian e-stim to the infraspinatus and middle deltoid, 10 sec on 10 sec off.

I called the neurosurgeon, and per his nurse, they feel that he is still in the time frame where he is healing from the cervical fusion on 8/8/08.

Has anyone had a patient with a similar presentation? I'm getting frustrated with the lack of progress, as is the patient, understandably.

(in reply to JSPT)

Post #: 4

RE: S/p cervical fusion - September 18, 2008 8:45:31 AM

buckeye

Posts: 175
Joined: May 24, 2007
Status: offline

I had a similar patient within the past few years. Progress was very slow. Visits were infrequent for re-assessment and modifying the home exercises based on current status. I think the overall duration of therapy was four to six months.

(in reply to JSPT)

Post #: 5