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Lack of ROM in ER/IR after Bankart repair/capsular shift.

 
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Lack of ROM in ER/IR after Bankart repair/capsular shift. - May 9, 2012 8:12:32 PM   
JohnFeil

 

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Joined: January 13, 2009
From: Long Island, NY
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I have a 28 y/o pt who had a bankart lesion and was repaired with an anterior capsular shift. He is about 14 weeks post op.

Full pain free flexion and abduction AROM
At 90* of abduction he has pain around 70* of ER.

I read that after this procedure there should be full AROM by this point.

Joint mobs to improve the motion during ER at the GH joint are painful.

His surgical UE is grossly 4/5 MMT w/ ER being about 4-/5

I have been doing a ot of dynamic stabilization and PNF excerises to inc cuff strength and stability.

Any other ideas?

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John Feil PT, DPT, OCS, MCMT, CSCS, CKTP
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RE: Lack of ROM in ER/IR after Bankart repair/capsular ... - May 10, 2012 12:06:32 PM   
honker23

 

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Is the surgeon concerned about his ER?  I would think this is fine, he had a capsular shift to stabilize the joint and protect the anterior labrum.  Unless he's trying to return to pitching, I wouldn't be too concerned.  I think cuff exercises with dynamic stabilization sounds perect.

(in reply to JohnFeil)
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RE: Lack of ROM in ER/IR after Bankart repair/capsular ... - May 10, 2012 3:32:42 PM   
JohnFeil

 

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Joined: January 13, 2009
From: Long Island, NY
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I placed a call to the doctor earlier this week , but no call back yet. The pt states the surgeon told him he was done with him and no more visits to him were necessary 2 weeks ago. The surgeon told him to cont PT 1x/week for the the 4 weeks.

The pt is a police officer and states the lack of ROM could possibly effect him if he had to apprehend someone. He also reports pain laying on that side when sleeping. He is also a very active and physical fit indivual, states most overhead workouts cause pain.

The pt did not have any tears of his bicep or RTC during the intial injury.

I hope I can talk to the surgeon , not sure if he will make the time to take a call though

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John Feil PT, DPT, OCS, MCMT, CSCS, CKTP

(in reply to honker23)
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RE: Lack of ROM in ER/IR after Bankart repair/capsular ... - May 11, 2012 8:31:35 PM   
SpokanePT

 

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From: http://www.accelerationdeerpark.com
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I always like to consider the scapulothoracic, upper thoracic and first few ribs in terms of mobility. Typically they are not moving well into extension/rotation to that side. That being said, some stiffness into ER after a Bankhart is fairly typical.

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Acceleration Physical Therapy in Spokane WA Acceleration Physical Therapy in Deer Park WA

(in reply to JohnFeil)
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RE: Lack of ROM in ER/IR after Bankart repair/capsular ... - May 14, 2012 2:31:21 PM   
treybien

 

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From: Milwaukee, WI
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It is not uncommon for surgeons to tighten the ER portion of this too tight. Becomes the tortoise side of the tortoise and hare and I have seen a few that have ended up with long term limitation or capsulatomy.

(in reply to SpokanePT)
Post #: 5
RE: Lack of ROM in ER/IR after Bankart repair/capsular ... - May 23, 2012 8:10:35 PM   
rwillcott

 

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Joined: March 21, 2006
From: Canada
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Tell him that the reduced ROM is normal at this stage. What you read doesn't apply to ALL patients that have this surgery. Tell him his surgeon is right and that he will be fine. He has full flexion and abduction which is great! He will be able to adapt and continue to be able to apprehend people. Think of all the MMA fighters with this injury that can still submit people.

(in reply to treybien)
Post #: 6
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