Fizioterapevtska obravnava pacienta po večkratnem izpahu ramenskega sklepa in artroskopski stabilizacije Perthesove lezije: poročilo primera : diplomsko delo

Zorko, Jon (avtor), Umek, Nejc (mentor), Kacin, Alan (recenzent)

Uvod: Večkratni sprednji izpah ramenskega sklepa povzroči bolezenske spremembe, ki vplivajo na funkcionalnost in stabilnost sklepa. Perthesova lezija je oblika Bankartove lezije, pri kateri pride do nepopolne avulzije sprednjega dela labruma brez njegovega premika, z medialno zavihano in nepoškodovano pokostnico. Privede lahko do ponavljajoče nestabilnosti in pogosto zahteva operativno zdravljenje, najpogosteje z artroskopsko stabilizacijo po Bankartu. Primerna fizioterapevtska obravnava je ključna za obnovitev funkcije ramenskega sklepa in varno vrnitev v športne aktivnosti, smernice optimalne obravnave pa v literaturi niso enotne. Namen: Namen diplomskega dela je predstaviti fizioterapevtsko obravnavo pacienta po artroskopski stabilizaciji Perthesove lezije zaradi večkratnega sprednjega izpaha ramenskega sklepa. Cilj je oceniti uspešnost obravnave s primerjavo rezultatov fizioterapevtskega pregleda pred in po obravnavi ter ovrednotiti pripravljenost pacienta za vrnitev v šport po zaključeni fizioterapiji. Metode dela: Diplomsko delo je poročilo o primeru pacienta, ki je v štirimesečnem obdobju opravil 20 obiskov. Pred začetkom obravnave smo izvedli fizioterapevtski pregled, ki je zajemal inspekcijo, palpacijo, goniometrične meritve gibljivosti, ročne dinamometrije mišic ramenskega sklepa, oceno intenzivnosti bolečine in oceno vpliva nestabilnosti na kakovost življenja pacienta. Pregled smo ponovili po fizioterapevtski obravnavi, ko smo izvedli tudi skupino testov za ocenjevanje pripravljenosti pacienta za vrnitev v šport. Rezultati: Po zaključeni fizioterapiji je aktivna in pasivna gibljivost ramenskega sklepa primerljiva z nasprotnim zgornjim udom. Maksimalna hotena sila izometrične kontrakcije vseh testiranih mišičnih skupin se je povečala za od 36 % do 95 %. Dosegli smo stanje brez bolečin v ramenskem sklepu, izboljšana funkcija zgornjega uda pa je izboljšala kakovost življenja pacienta. Rezultati skupine testov so pokazali, da je pacient s psihološkega vidika, z vidika dinamičnega ravnotežja in stabilnosti zgornjega uda, vzdržljivosti mišic in sposobnosti razvijanja sile pripravljen za postopno vrnitev v športne aktivnosti. Razprava in zaključek: Bili smo uspešni pri doseganju vseh zastavljenih ciljev fizioterapevtske obravnave. Pacient je na podlagi rezultatov skupine testov pripravljen za postopno vrnitev k športnim aktivnostim. Čeprav literatura glede protokola obravnave po artroskopski stabilizaciji sprednjega labruma ni soglasna, sestavljeni načrt fizioterapije, ki je privedel do uspešne rehabilitacije potrjuje pomembnost individualizacije programa in sprotnega prilagajanja fizioterapevtskih intervencij. Rezultati potrjujejo, da je bil fizioterapevtski program je bil strokovno utemeljen, učinkovit in dobro izveden.

• Jezik: Slovenski jezik
• Ključne besede: diplomska dela, fizioterapija, sprednji izpah ramenskega sklepa, Perthesova lezija, artroskopska stabilizacija, fizioterapevtska obravnava, vrnitev v šport
• Vrsta gradiva: Diplomsko delo/naloga
• Tipologija: 2.11 - Diplomsko delo
• Organizacija: ZF - Zdravstvena fakulteta
• Kraj izida: Ljubljana
• Založnik: [J. Zorko]
• Leto izida: 2025
• Št. strani: 39 str.
• PID: 20.500.12556/RUL-169214
• UDK: 615.8
• COBISS.SI-ID: 236270595
• Datum objave v RUL: 18.05.2025

Sekundarni jezik

• Jezik: Angleški jezik
• Naslov: Physiotherapy treatment of a patient following multiple anterior shoulder dislocations and arthroscopic stabilization of a Perthes lesion: a case report : diploma work

Izvleček

Introduction: Multiple anterior dislocations of the shoulder joint cause pathological changes that can affect the functionality and stability of the joint. A Perthes lesion is a form of a Bankart lesion in which there is an incomplete avulsion of the anterior labrum without its displacement, with a medially lifted and intact periosteum. It can lead to recurrent instability and often requires surgical treatment, most often with the Arthroscopic Bankart Repair. Appropriate physiotherapy treatment is essential for restoring shoulder joint function and a safe return to sporting activities. The guidelines for optimal management, however, are not consistent in the literature. Purpose: The purpose of this diploma work is to present the physiotherapy treatment of a patient following multiple anterior shoulder dislocations and an arthroscopic stabilisation of a Perthes lesion. The goal is to evaluate the effectiveness of the physiotherapy treatment by comparing the results of the physiotherapy assessment before and after the treatment and to assess the patient's readiness to return to sport after physiotherapy. Methods: The diploma work is a case report of a patient who underwent 20 therapy sessions over a four month period. Before the treatment began, a physiotherapy assessment was conducted, which included inspection, palpation, goniometric measurements of mobility, hand-held dynamomety of muscles of the shoulder joint, pain intensity assessment, and an evaluation of the impact of instability on the patient's quality of life. The assessment was repeated after physiotherapy, at which point a battery of tests was also performed to evaluate the patient's readiness to return to sports. Results: After completing the physiotherapy treatment, both active and passive shoulder joint mobility were comparable to the contralateral upper limb. The maximum voluntary isometric contraction of all tested muscle groups increased by 36% to 95%. We achieved a pain-free state in the shoulder joint and the improved function of the upper limb enhanced the patient's quality of life. The results of the battery of tests showed that the patient is ready for a gradual return to sports activities from a psychological perspective, in terms of dynamic balance and stability of the upper limb, muscle endurance and the ability to develop force. Discussion and conclusion: We were successful in achieving all the set goals of the physiotherapy treatment. Based on the results of the battery of tests, the patient is ready for a gradual return to sports activities. Although the literature on the post-arthroscopic anterior labrum stabilization protocol is not unanimous, the structured physiotherapy plan that led to successful rehabilitation confirms the importance of individualizing the program and continuously adapting physiotherapy interventions. The results confirm that the physiotherapy program was thoughtfully and correctly structured and effectively implemented.

• Ključne besede: diploma theses, physiotherapy, anterior shoulder dislocation, Perthes lesion, arthroscopic stabilization, physiotherapy treatment, return to sport