Transcript Arthroscopic Acromioplasty Overview

ARTHROSCOPIC ACROMIOPLASTY
Angela Whittington
DEFINITION
 Bursitis
or tendonitis  impingement
 Causes the tissues underneath the AC
joint to be pinched against the bone
 Produces irritation and pain
 MOI
Rotator cuff muscles become stretched 
laxity
 Arm abducted > 90◦
 head drops & longhead biceps
tendon/supraspinatus becomes impinged

ACROMION PROCESS
 Three
types
(shapes of
acromion
processes)
 Type I: Flat Figure
A
 Type
II: Gently
curved Figure B
 Type III:
Sharply hooked
Figure C
PATIENT HISTORY
Female 20 y/o
 Division I Collegiate Volleyball athlete
 S/S: pain with overhead activity
 Dec ROM
 Crepitus w/ GH motion
 Pain w/ GH ABD & FLEX
 Decreased rotator cuff strength
 Special Tests
 (+) Neer Impingement & Hawkins
Impingement

PATIENT HISTORY CONT.
 Image
Findings
 Radiographs
confirm Type III
Acromion
Process
IMAGING
Normal Rotator Cuff
Torn Rotator Cuff
 Patient
chose conservative treatments at
first
Rest
 Ice
 NSAIDs
 Rehabilitation

 Conservative
treatment failed to return
her to preinjury level

Surgical intervention recommended
ARTHROSCOPIC ACROMIOPLASTY
Ellman (1987) introduced
technique for subacromial
decompression
 Meant for pt’s who did not
respond to
 Six mo. of conservative
treatment
 NSAIDS, steroid
injections
 Physical therapy
 Three small skin portals
 Spares deltoid muscle & ↓
post-op movement
restriction

SURGICAL INTERVENTION
Goal is to smooth ANT acromial undersurface
 Subacromial space and bursa is debrided
 Acromioplasty performed
 Recommended anterior-inferior acromioplasty
 Detaching deltoid muscle from ANT subacromial
process & AC joint

Osteosome removes ANT & undersurface of
acromion process
 Portion of coracoacromial ligament removed to
decompress the space


Arthroscopic acromioplasty preferred
PROCEDURE

Orthosports - Orthopaedic & Sports Medicine
Physicians - Shoulder Impingement
REHABILITATION: PHASE 1
 Goals
Limit Pain
 Restore Motion
 Reduce Swelling

TREATMENT
RECOMMENDATIONS
 Ice
 Sling
(if necessary)
 E-Stim
 Joint Mobilization (grade 1 and 2)
 Rom (passive and active assisted pain
free)
 Pendulum Exercises
REHABILITATION: PHASE 2
 Goals
Eliminate Pain
 Restore full active motion
 Restore good glenohumeral and
scapulohumeral rhythm
 4/5 strength or upper extremity muscles

TREATMENT
RECOMMENDATIONS
 Continue
modalities as
needed
 Start with active range
of motion
 Add isometrics below
shoulder level
 Flexibility of cervical,
shoulder, and scapular
muscles
PRECAUTIONS
 All
active and isometric exercises
should be muscle specific
 All movements and activity increasing
symptoms should be eliminated
 Isometrics are modified if patients
symptoms are made worse
REHABILITATION: PHASE 3
 Attain
full pain free ROM
 Achieve 5/5 strength in all shoulder
girdle muscles
 Full pain free resistive range of motion
 Negative Neer Sign
 Negative Hawkins Sign
 Symmetrical scapulohumeral rhythm
TREATMENT
RECOMMENDATIONS
 Continue
use of ice as necessary
 Continue with previous exercises
 Progress resistance to overhead and
above horizontal
 Add resistance to scapular exercises
 Work on quality of motion and not just
resistive training
 Work on balance of rotator cuff muscles
 Start with sport/work specific exercises
 Water resistive activities
PRECAUTIONS
 Do
not neglect the rest of the body!
REHABILITATION: PHASE 4
 Goals
Full pain free ROM
 5/5 strength in all upper extremity and
scapular muscles
 Normal scapulohumeral rhythm w/ and
w/o resistance
 Able to complete throwing sport specific
or work tasks pain free, and w/o signs of
instability or impingement

PRECAUTIONS
 It
should be noted that time frames for
these phases overlap time frames for
these phases can’t be given. It is based
on exercise intensity, pain, underlying
instability, healing time, and strength
 Rehab should be progressive always
achieving and then maintaining a pain
free state
TREATMENT
RECOMMENDATIONS
 Continue
use of ice as necessary
 Continue with previous exercises
 Progress resistance to overhead and
above horizontal
 Add resistance to scapular exercises
 Work on quality of motion and not just
resistive training
 Work on balance of rotator cuff muscles
THINGS TO REMEMBER
Core Strengthening
 Cardio Workouts
 Team involvement
 If athlete is sore after exercises, bring down


Do not progress or overwork!
FUNCTIONAL EXERCISE

Dig & Roll
Practice defense and going to the floor after a dig.
Use groups of three or four.
Line starts at middle back position.
Coach hits a ball to the right.
Player must read coach's shoulders and dig ball.
After the dig the player must roll.
Coach alternates hits right and left.
Continue for a set number of digs for each player.
FUNCTIONAL EXERCISE

Cross Court Digging
To practice digging balls a good
distance away from the net and
from different angles.
1.Hitters alternate hitting balls at
the defenders.
2.The defenders dig the balls to
the target.
3.After the defender digs the ball
they alternate lines.
4.Repeat until a set number of
digs is
FUNCTIONAL EXERCISE

No Fear Defense
Teach aggressiveness on defense.
Teach defenders to get under balls hit
down
Coach stands on a box in the middle of
the net, where they can hit the ball down
inside 10' line.
Coach continuously hits balls to
the defenders.
After a set number of hits the defender
can only exit the drill when they can pass
a ball straight up and catch it.