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EARLY ACTIVATION OR A MORE PROTECTIVE PHYSIOTHERAPY PROTOCOL AFTER ASD – A PROSPECTIVE RANDOMIZED PILOT-STUDY WITH A TWO-YEAR FOLLOW-UP

Authors: I Hultenheim Klintberg; AC Gunnarsson; U Svantesson; J Styf; J Karlsson

References: Presented at SECEC 2009

Purpose
To describe clinical changes with two protocols of physiotherapy following arthroscopic subacromial decompression (ASD) until two years.

Material and Methods
Thirty-four shoulders (13 women), mean age 46 (SD7) years with primary shoulder impingement, listed for ASD. The Traditional group (n = 20) started with active assisted range of motion exercises on the day of surgery, dynamic exercises for the rotator-cuff after six weeks and strengthening exercises after eight weeks. The Progressive group (n = 14) started active assisted range of motion and dynamic exercises for the rotator-cuff on the day of surgery. The specific activation of the rotator cuff was performed 5 to 7 times daily. Strengthening exercises started after six weeks. A clinical evaluation was made pre-operatively, six weeks, three, six, 12 and 24 months after surgery. Pain, patient satisfaction, range of motion and muscular strength were evaluated. Constant score and Functional Index of the Shoulder were also used.

Results
Both groups showed significant improvements in pain during activity and at rest, in range of motion in extension and abduction, in strength of external rotation and in function. Progressive group versus Traditional group at the 3 months follow up showed VAS in pain during activity 0/10 mm and active abduction in standing 180/160°. Most patients were pain-free from 6 months. At the 2 year follow up the groups attained, 160/150º in active flexion, 180/170º in active abduction and 90/75º in external rotation. Using Constant Score the groups attained 87/67 points.

Conclusion
After ASD, a more proactive and progressive physiotherapy protocol was associated with slightly faster recovery of shoulder function. Early activation using a comprehensive, well-defined and controlled physiotherapy protocol can safely be used after ASD.

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