We examined 71 patients 51 males and 20 females, mean age 38. Distal clavicle resection generally occurs when conservative treatment for degenerative changes or osteoarthritis wear and tear type arthritis over the small joint. Suite 224a blacksburg, va 24060 54055273 the rehabilitation program following a distal clavicle resection is divided into three phases. Immediately post operative the shoulder sling applied in surgery. Thoracic outlet syndrome tos is a condition caused by compression squeezing of nerves or blood vessels in the. Where this bone meets the collarbone clavicle is known as the acromioclavicular or ac joint. Resection of the distal clavicle was performed in five of the six cases. The diagnosis is suggested with a history of trauma and established on plain film radiographs. Three patients responded to a course of conservative therapy. Distal clavicle resection rehab protocol distal clavicle resection generally occurs when conservative treatment for degenerative changes or osteoarthritis wear and tear type arthritis over the small joint of the shoulder, otherwise known at the acromioclavicular joint, generally over the course of a lifetime, general progressive arthritis occurs. Manual therapy for ac joint pain the student physical. Mumford distal clavicle excision detroit ac joint disorder royal. Subacromial decompression distal clavicle excision.
Lifts, such as bench press, that put an extreme load on the ac joint will be some of the last exercises to be added and may take up to 4 months before resuming their previous level of performance. Maintenance prom to involved shoulder elevation, er90, and ir90 as tolerated. Mumford procedure distal clavicle resection physical therapy. Ken alleyne the tip of the shoulder blade scapula that forms the roof of the shoulder joint is known as the acromion. Your doctor will refer you to a physical therapist. It can help to decrease pain and increase shoulder function. Teach home exercises o pendulum movements o active assisted passive flexion and abduction to 90 degrees elevation. Physical therapy achieves faster outcomes than surgery for. Distal clavicle resection rehab protocol orthopedic specialists of. Since 1941, resection of the distal clavicle has been a proven treatment for symptomatic acromioclavicular ac joint pathology. Mr examination demonstrated abnormally increased t2 signal in the distal clavicle in all nine cases and no other cause for ac joint pain.
Oct 09, 2010 closed displaced midshaft clavicle fractures used to be treated nonoperatively, and many studies have reported that nonoperative treatment gave good results. Phase i is the first week post operative and consists mainly of rest, ice and restricted activity. Ice to prevent pain and swelling passive, active assisted andor active rom exercises are initiated depending on the patients tolerance. Only wear sling when walking or travelling, and if uncomfortable when sleeping. Listing a study does not mean it has been evaluated by the u. Arthroscopic subacromial decompression andor ac joint. Anterior shoulder dislocationsubluxation nonoperative. Physical therapy prescription clavicle fracture orif. Treatment may be modified based on the extent of the injury, type of surgery performed, pain level and speed of recovery. Slucare sports medicine and shoulder surgery specialists developed the following physical therapy protocols for slucare clinicians to use when recommending treatment and rehab for slucare patients. Sep 09, 2019 arthroscopic distal clavicle resection for isolated atraumatic osteolysis in weight lifters. When an individual is identified as having this bony abnormality of the clavicle, physical therapy is sometimes the first. Rehabilitation protocol adopted from the massachusetts general hospital sports physical therapy program and the american academy of orthopedic surgeons for nonsurgical rehabilitation of clavicle fractures 7,15.
A clavicle fracture most frequently results from trauma. A clavicle fracture is also known as a broken collarbone. Surgical treatment of postradiotherapy nonunions of the. Rom shoulder impairment upper extremity figures 1640, 43, 43, 46. A fall onto the lateral shoulder most frequently causes a clavicle fracture. Also i can hardly do any weight bearing exercises as the pain is too much and when the physical therapist has me doing like wall push ups or cable chest presses my shoulder becomes very tight and hurts a little at the full extension inside my shoulder, around the bone area. Cole,md,mba range of motion sling exercises phase i 04 weeks prom as tolerated 02 weeks. The information on this site is for informational purposes only and should in no way replace a conventional visit to an actual live physical therapist or other healthcare professional. In 2012 harris et al found that acj disease was present in 31% of individuals who presented with shoulder pain. Arthroscopic subacromial decompressiondistal clavicle excision. After arthroscopic subacromial decompression intact rotator cuff distal clavicle resection rehabilitation protocol.
Mumford procedure distal clavicle resection rehabilitation protocol aaaprom increase ir rotation cuff and scapula stabilization program exercises, begin at 0 progress to 4590 as tolerated in pain free arc avoid cross chest adduction for first six weeks no sports or throwing for 1012 weeks. Distal clavicle resection therapy protocol page 1 of 3 bart eastwood d. However, anyone recovering from an injury or surgery is free to use them. The most common place for an adult to break this bone is in the shaft, or middle third, of the bone. Only wear sling when walking or travelling, and if. However, more recent studies have reported poorer results following nonoperative treatment, whereas the results of operative treatment have improved considerably. Acromioclavicular joint acj injuries are quite prevalent throughout the general population and specifically in the athletic population. Historically, clavicle fractures used to be treated nonoperatively 1. Symptom improvement has been satisfactory in most reported series.
Conservative treatment of fractures of the clavicle bmc. Elbowwristhand rom, pendulums, wall stretch at home per instruction sheets. Maintain good upright shoulder girdle posture at all times and especially during sling use. Arthroscopic distal clavicle excision acromioclavicular joint ac. Prior to the clavicular resection, i was able to live independently, work as a researcher, and maintain an athome pt regimen as well as aquatherapy at least once a week. The aim of this trial is to compare the results of plate fixation with nonoperative management of dislocated midshaft fractures of the clavicle with respect to the incidence of nonunion, functional outcome, pain scores, quality of life, cosmetic. Although arthroscopic techniques have been well developed, open distal clavicle resection remains the gold standard and in certain patients is the preferred technique for removal of the distal clavicle. Arthroscopic distal clavicle resection rehabilitation please give to your physiotherapist 0 to 6 weeks after surgery see dr burrow in rooms at 2 weeks postop use arm for paperwork, computer, eating with armelbow out of sling.
Jan 14, 2019 operative outcome of displaced medialend clavicle fractures in adults. When an individual is identified as having this bony abnormality of the clavicle, physical therapy is sometimes the first treatment option to attempt to minimize the pinching. Clavicle fractures are a common orthopedic injury, especially among infants and young children. Rehabilitation protocol for undisplaced colles fractures. Surgical treatment of postradiotherapy nonunions of the clavicle. Distal clavicle resection with rotator cuff repair the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Harris 2012 the acj is a synovial joint which connects the distal clavicle to the acromion. Arthroscopic distal clavicle resection for isolated atraumatic osteolysis in weight lifters. Six experienced refractory pain despite conservative therapy. The boney removal has the potential to stimulate scarring and difficult restoration of range of motion. Therapeutic doses of radiation can lead to weakened, devascularized, and fractured bones. Physical therapy will focus on pain management and restoration. Manual physical therapy for injection confirmed nonacute acromioclavicular joint pain.
Demographic and clinical data and the site of the lesion were recorded for each partecipant. If a mumford distal clavicle excision was performed, limit horizontal adduction for 8 weeks post operative phase i weeks 04 sling immobilization for comfort weeks 02 discontinue sling use at 2 weeks range of motion prom aarom arom as tolerated. Essential to the success of the surgical procedure is early normalization of passive and active range of motion. Im new to posting here and look forward to learning alot from you guys and girls. Nonoperative treatment of closed displaced midshaft. Fractures and ligamentous injuries of the clavicle and its articulation. Initially, nonsurgical methods of treatment such as medications and physical therapy exercises will be. The majority of clavicle fractures can heal without surgery. On the other hand, recent studies have reported poorer functional outcomes with nonunion rates of up to 20% for displaced, comminuted midshaft fractures treated nonoperatively, whereas the. Anterior shoulder dislocationsubluxation nonoperative treatment.
Clavicle fractures are very common injuries in adults 25% and children 1015% and represent the 4466% of all shoulder fractures. If any concerns or complications arise regarding the progress of any patient, physical therapy will contact the orthopedist. Rom exercises begin with the arm comfortably at the patients side, progress to. By introducing exercise for the entire limb, disuse. Mar 24, 2017 the largest case series of open clavicle resection for dco was performed by cahill. Distal clavicle resection therapy protocol sideline orthopedics. Clavicle fractures are common fractures and the optimal treatment strategy remains debatable.
Distal clavicle resection mumford physical therapy protocol preoperative guidelines restore full shoulder arom strengthen in painfree rom, emphasize rotator cuffscapular stabilization musculature instruct in postop protocol educate patient on postop compliance to ensure best functional outcome. Distal clavicle excision resection physical therapy. Diagnosis and management of distal clavicle osteolysis. This condition causes chronic pain in the ac joint. If physical therapy is unsuccessful, a mumford procedure is often the best way to surgically modify this bony. He underwent a course of physical therapy and has been declared medically stable. Nonoperative treatment of closed displaced midshaft clavicle. Stress fracture following resection of distal end of clavicle. R adiation therapy is commonly used in the treatment of numerous malignant tumors. Therapeutic exercise o codmanspulleyscane o elbowwristhand range of motion o grip strengthening o no resistive exercises.
Clavicle fracture broken collar bone physical therapy. Tuesday, october 27, 2015 physical therapy achieves faster outcomes than surgery for common type of shoulder dislocation. Board certified orthopedic surgeon specializing in sports medicine and arthroscopy 10475 centurion pkwy. Due to an auto accident several years ago, i suffered a type 1 shoulder separation that was excruciatingly painful and refractory to 8 months of conservative therapy. Check out our entire database and interactive tools to learn more about conditions, procedures, and gain insight into your health risks. Patients who present post colles fracture tend to guard the entire upper extremity as a means of protecting the wrist. Here are some examples of exercises for you to try.
Physical therapy will focus on pain management and restoration of passive and active range of motion. Even for displaced fractures, the literature generally reports a high rate of good results with a low nonunion rate 15. Distal clavicle resection with rotator cuff repair no. Limit arom to 90 degrees of flexion and abduction for 3 weeks. Subacromial decompression distal clavicle excision rehab atlanta. In the treatment of clavicle fractures, the choice of procedure depends on the possibility of restoring the anatomical functional integrity of the shoulder. After arthroscopic subacromial decompression intact. Distal clavicle resection removes a piece of the clavicle to open the area and decrease the pressure on the soft tissue. The largest case series of open clavicle resection for dco was performed by cahill. On may 7, 2007 i had a distal clavicle resection on my right shoulder where my doc removed 12 mm of my ac joint. This is the area between the base of the neck and the armpit, including the front of the shoulders and chest. Treatment for clavicle fracture depends on the type of fracture and the associated damage.
You will be taught exercises to promote movement and restore muscle strength. If the mumford is an open procedure, restrict overhead activities and heavy lifting for 3 weeks. Physical therapy is necessary to strengthen your muscles and. Based on comfort patient can be progressed through these phases more quickly. You will be told when to start these exercises and which ones will work best for you. Study protocol open access displaced midshaft fractures. Rehabilitation protocol adopted from the massachusetts.
I am a former amateur boxer not that great, record was 22. If physical therapy is unsuccessful, a mumford procedure is often the best way to surgically modify this bony abnormality. Devinder completed his medical qualifications from the university of melbourne and is a fellow of the royal australasian college of surgeons and the. Radiographs confirm the diagnosis and aid in further. It is essential for people who have experienced clavicle fracture to have plenty of rest. He has been left with weakness and associated loss of motion in his shoulder. Acromioclavicular ac joint dislocationseven moderatetosevere casesmay be bettertreated through nonsurgical approaches, according to a new study from canada that found better shortterm outcomes, faster returntowork rates, and fewer complications among. Arthroscopic resection of the distal clavicle with. Devinder garewal is an orthopaedic shoulder specialist. Impact of clavicle fractures on return to play and performance ratings in nfl athletes.
Resection of the distal clavicle, as described by mumford 2, is a reliable surgical option in acromioclavicular joint acj osteoarthritis and shoulder impingement syndrome. The rehabilitation program following a distal clavicle resection is divided into three phases. Distal clavicle resection therapy protocol page 3 of 3 weight room activities will be phases in at this time depending on patients tolerance. A mumford distal clavicle excision is a surgical procedure which involves. Distal clavicle resection is the removal of a piece of the clavicle bone at the top of the shoulder. The clavicle contributes to the freedom of motion seen at the shoulder by acting as a movable strut to which the scapula and upper arm are suspended at a distance from the. Clavicle fracture fixation information sheet pdf shoulder specialist. Clavicle orif rockwood pin hook plate inpatient confirm from op notes patient to follow protocol. Freedman ba, javernick ma, obrien fp, ross ae, doukas wc.
Distal clavicle resection therapy protocol page 2 of 3 exercises. Mr pimpalnerkar physiotherapy protocol 1 shoulder sad november 2007 rebecca backhousemichelle suri the above information is intended as a guide only. Physical therapy management of clavicle fractures morphopedics. Kochhar t, jayadev c, smith j, griffiths e, seehra k. The exercises may be suggested for a condition or for rehabilitation. I just had distal clavicle resection surgery ac joint. Pdf conservative treatment of fractures of the clavicle. Exercises may be performed in all planes of motion. Restrictions rom 140 degrees of forward flexion 40 degrees of external rotation 60 degrees of abduction rom exercises begin with the arm comfortably at the patients side, progress to.