Fizioterapevtska obravnava pacienta pri subakromialnem burzitisu ramenskega sklepa : diplomsko delo

Dević, Alen (avtor), Divjak, Mojca (mentor), Naglič, Nada (komentor)

Uvod: V ramenskem sklepu pogosto prihaja do subakromialnega burzitisa, saj je rama kroglast sklep, ki je zaradi mehkih in obsklepnih struktur zelo gibljiv in posledično nestabilen. Namen: Namen diplomskega dela je prikazati, kakšno vlogo ima desetdnevna fizioterapevtska obravnava in kakšna je učinkovitost fizioterapevtskih metod pri odpravi težav, povezanih s preobremenitvijo ramenskega sklepa, in obravnavi subakromialnega burzitisa. Metode dela: Podatke o pacientki smo pridobili iz medicinske dokumentacije, s pomočjo opravljenega intervjuja s pacientko in fizioterapevtske ocene, ki smo jo izvedli prvi in zadnji dan obravnave. Z zbranimi podatki smo sestavili individualni program fizioterapevtske obravnave. Rezultati: Goniometrične meritve pasivne gibljivosti so podale naslednje rezultate pasivne gibljivosti: elevacija skozi antefleksijo je bila pred fizioterapevtsko obravnavo 150° in po njej 160°, retrofleksija je bila prej in potem 40°, elevacija je bila skozi abdukcijo najprej 115° in potem 120°, notranja rotacija je bila prej 30° in potem 40°, zunanja rotacija pa je bila prej in potem 30°. Pri oceni artrokinematike je bilo zelo omejeno translacijsko drsenje v smeri notranje in zunanje rotacije, omejeno pa v smeri abdukcije, antefleksije in retrofleksije, medtem ko je bilo po fizioterapevtski obravnavi translacijsko drsenje v vseh smereh omejeno. Z manualnim mišičnim testiranjem je bila ugotovljena zmanjšana mišična zmogljivost fleksorjev, ki je bila pred fizioterapevtsko obravnavo 2, po njej pa 3B, in abduktorjev, ki je bila pred fizioterapevtsko obravnavo –3 in po njej 4B. Atrofije in sprememb površinske senzorike pri preiskovanki nismo zaznali, je pa imela pacientka pred fizioterapevtsko obravnavo v desnem ramenskem sklepu bolečine, ki jih je po VAL ocenila z 8, po fizioterapevtski obravnavi pa s 6. Razprava in zaključek: Tudi kratkotrajna ciljno usmerjena in individualno prilagojena fizioterapevtska obravnava ima vidne učinke na izboljšanje zdravstvenega stanja pacienta ter vpliva na lajšanje simptomov subakromialnega burzitisa: povečali smo gibljivost ramenskega sklepa in zmanjšali bolečine, na povečanje mišične moči pa zaradi kratkotrajne fizioterapije nismo znatno vplivali – na podlagi opravljenih meritev in testiranj pacientke je mogoče sklepati, da bi lahko nanjo znatneje vplivali z dolgotrajnejšo fizioterapijo. Za pacientko bi bilo smiselno nadaljevati s fizioterapijo.

• Jezik: Slovenski jezik
• Ključne besede: subakromialni burzitis, ramenski sklep, fizioterapevtska obravnava, fizioterapija
• Vrsta gradiva: Diplomsko delo/naloga
• Organizacija: ZF - Zdravstvena fakulteta
• Leto izida: 2018
• PID: 20.500.12556/RUL-104005
• COBISS.SI-ID: 5498731
• Datum objave v RUL: 30.09.2018

Sekundarni jezik

• Jezik: Angleški jezik
• Naslov: Physiotherapeutic treatment of a patient with subacromial shoulder bursitis : diploma work

Izvleček

Introduction: Subacromial bursitis is a common occurrence in shoulder joints as the shoulder is a ball and socket joint. The joint is very flexible and consequently unstable due to soft tissues surrounding the joint. Purpose: The purpose of this thesis is to present the role of a ten-day physiotherapeutic treatment and the effectiveness of physiotherapeutic methods in reducing problems linked to overloading the shoulder joint as well as the treatment of subacromial bursitis with the help of a case study. Methods: The patient's information was gathered from medical documentation, patient assessment, and from the physiotherapeutic evaluation carried out on the first and the last day of treatment. We prepared an individualised physiotherapeutic treatment programme based on the gathered information. Results: The goniometric measurements of passive movements gave the results of passive joint mobility. Elevation through anteflexion was 150° before and 160° after the treatment, retroflexion was 40° before and after the treatment, elevation through abduction was 115° before and 120° after the treatment, inner rotation was 30° before and 40° after the treatment, while the outer rotation remained unchanged at 30° before and after treatment. Based on the arthrokinematics evaluation, the translational sliding of inner and outer rotation was very limited, and limited in the direction of abduction, anteflexion and retroflexion. After the treatment, translational sliding was limited in all directions. Through manual muscular testing, we discovered a reduced muscular performance of flexors, which was graded at 2 before and at 3B after the treatment, as well as abductors, which was at -3 before the treatment and at 4B afterwards. We did not find any atrophies or changes in surface sensory perception. The patient did, however, feel pain in the right shoulder joint which she rated with 8 on the VAS before the treatment and with 6 afterwards. Discussion and conclusion: Even short-term goal oriented and individually adjusted physiotherapeutic treatment offers visible results on patient’s health condition improvement and influences on easing the symptoms of subacromial bursitis. We also improved the shoulder’s flexibility, diminished the pain, but we did not significantly influence on improving muscular power due to short rehabilitation, and with this knowledge we come to a reasonable conclusion that we could influence patient’s condition significantly with a long-term rehabilitation, and we believe it is in our patient’s best interest to continue with the therapy.

• Ključne besede: subacromial bursitis, shoulder joint, physiotherapeutic treatment, physiotherapy