Fizioterapevtska obravnava pacienta po artroskopski stabilizaciji ramenskega sklepa po Bankartu : diplomsko delo

Bregar, Žan (author), Divjak, Mojca (mentor)

Uvod: Plitev RS omogoča obsežne obsege gibljivosti na račun njegove stabilnosti, zato ne čudi, da je RS najpogosteje dislociran sinovialni sklep. Namen: V diplomskem delu je prikazana fizioterapevtska obravnava pacienta v srednjem obdobju po artroskopski stabilizaciji RS po Bankartu. Metode dela: To je poročilo o primeru, ki zajema fizioterapevtsko obravnavo pacienta 10 tednov po artroskopski stabilizaciji RS po Bankartu. Metode zajemajo fizioterapevtsko oceno stanja pacienta po 10. tednih po operaciji, izpostavitev problemov, postavitev ciljev, izbor metod in tehnik fizioterapije ter rezultate izvedbe. Rezultati: Obseg aktivne in pasivne gibljivost se je izboljšal v vseh smereh, razen pasivno v smeri notranje rotacije. Aktivna gibljivost se je povečala v smeri abdukcije za 15°, zunanje rotacije za 20°, notranje rotacije za 10°, retrofleksije za 10°, elevacije skozi antefleksijo za 25°, elevacije skozi abdukcijo za 25°. Pasivna gibljivost se je povečala v smeri abdukcije za 10°, zunanje rotacije za 20°, retrofleksije za 10°, elevacije skozi antefleksijo za 25°, elevacije skozi abdukcijo za 40°. Artrokinematična gibljivost se je izboljšala v vseh omejenih smereh, vendar je kavdalno in dorzalno drsenje nadlahtnice, kljub izboljšanju, še vedno zmerno omejeno (iz 1 na 2) po zaključenih terapijah. Mišična zmogljivost vseh testiranih mišičnih skupin se je izboljšala. Mišična zmogljivost mišičnih skupin retrofleksorjev, notranjih rotatorjev desnega RS se je izboljšala in postala fiziološka (iz 4 na 5), prav tako je postala fiziološka mišična zmogljivost mišičnih skupin adduktorjev ter adduktorjev in notranjih rotatorjev desne lopatice (iz -4 na 5). Mišična zmogljivost mišičnih skupin antefleksorjev, abduktorjev desnega RS, depresorjev in adduktorjev ter abduktrojev in zunanjih rotatorjev lopatice se je izboljšala iz -4 na 4. Mišična zmogljivost mišične skupine zunanjih rotatorjev desnega RS se je izboljšala iz ocene 3 na 4. Bolečina se je po VAL-IB lestvici zmanjšala za 20 mm (iz 30 mm na začetku se je izboljšalo na 10 mm na koncu). Funkcionalna ocena s pomočjo DASH lestvice je pokazala izboljšanje iz začetnega rezultata 42,5 v rezultat 20 na koncu. Razprava in sklep: Rezultati so pokazali, da je bil uporabljen fizioterapevtski program primeren.

• Language: Slovenian
• Keywords: sprednji izpah ramenskega sklepa, Bankart, fizioterapevtska obravnava, rehabilitacija
• Work type: Bachelor thesis/paper
• Organization: ZF - Faculty of Health Sciences
• Year: 2018
• PID: 20.500.12556/RUL-102671
• COBISS.SI-ID: 5475435
• Publication date in RUL: 06.09.2018

Secondary language

• Language: English
• Title: Physiotherapy rehabilitation of a patient after arthroscopic Bankart stabilization treatment

Abstract

Introduction: Shallow shoulder joint enables extensive movement because of its stability therefore it is not a surprise that shoulder joint is the most commonly dislocated synovial joint. Purpose: This diploma thesis presents a physiotherapy treatment of a middle-aged patient after arthroscopic Bankart stabilization of a shoulder joint. Methods: This is a case report that includes physiotherapy treatment of a patient after 10 weeks of arthroscopic Bankart stabilization of a shoulder joint. Methods consist of physiotherapy evaluation of the patient's condition after 10 weeks of surgery, problem exposure, setting the goals, choice of methods, physiotherapy technics and the results of the treatment. Results: The range of active and passive movement has improved in all directions except for the passive one in the direction of internal rotation. Active movement has improved in abduction direction for 15°, external rotation for 20°, internal rotation for 10°, retroflexion for 10°, elevation through anteflexion for 25°, elevation through abduction for 25°. Passive movement has improved in the abduction direction for 10°, external rotation for 20°, retroflexion for 10°, elevation through anteflexion for 25°, elevation through abduction for 40°. Arthrokinematic movement has improved in all limited directions although caudal and dorsal sliding remains limited (from1 to 2) despite the improvement after final treatment. The muscle performance of all muscle groups has improved. The muscle performance of retroflexive muscle group, internal rotation of the right shoulder joint has improved and became physiological (from 4 to 5); physiological became also the muscle performance of adductor muscle groups, adductor and internal rotators of the right scapula (from -4 to 5). The muscle performance of anteflexive muscle groups, abductors of the right shoulder joint, depressors, adductors, and abductors and external rotators of the right scapula has improved from -4 to 4.The muscle performance of the external rotator muscle group of the right shoulder joint has improved from 3 to 4. The paint according to VAL-IB scale has reduced for 20 mm (from 30 at the beginning it has improved to 10 mm at the end. Functional evaluation at the end according to DASH scale has shown improvement from 42,5 to 20 at the end. Discussion and conclusion: The results have shown that the physiotherapy treatment, which was used, was suitable.

• Keywords: front shoulder joint dislocation, Bankart, physiotherapy treatment, rehabilitation