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Bristow-Lataerjet Procedure for Anterior Shoulder Instability

Alyssa Stirling

Anatomy
Ball-and socket joint Rotator Cuff Muscles
Functions

Coracoid Process

Mechanism of Injury/ Rationale


Mechanism Anterior Dislocation Chronic Anterior Instability Rationale The Coracoid process is moved in order to make the diameter of glenoid fossa greater and act as a bone block

Procedure
http://www.youtube.com/watch?v=zQZLjRe5sU g

Post- Op
Ice Pain Killers Sling at all times

Physical Therapy

Define Functional
What are ADLs? What are return to work/play criteria? What activities are performed during work/sport?

DASH Form
Disabilities of the Arm, Shoulder and Hand Pt will rank difficulty of ADLs
1 being no difficulty 5 being unable

Examples
Open a tight jar Place an object on a shelf above your head Push open a heavy door Put on a sweater

Things to keep in mind


External Rotation Internal Rotation Greatest Strength Loss

Short -Term Goals


Week One- Four : Minimize Pain and inflammation Week Four Six: externally rotate 25 to 30 degrees, increase internal rotation to 45 degrees also with 30 degrees of abduction Week Nine Twelve: passive flexion to 80% of the uninvolved shoulder, passive external rotation within 10-15 degrees of uninvolved shoulder at 20 degrees of abduction.

Criteria to Move from each stage: Good Mechanics No compensations Pain-free movement

Long Term Goal: Have full ROM back by end of week twelve

Week One through Four


Protocol Sling except for: Pendulum exercises (3 times a day for 10 mins) May squeeze a softball Shoulder shrugs Active scapular retraction w arms at side of body

Week Four through Six


Protocol Gradually gain PROM Protect Anterior Capsule No over-stretching

Progression Through Week Six


Week Four Moist Heat with Swiss Ball Flexion Pulleys Behind the Back Pass w Towel Week Six Possible Additions Supine punches Isometric IR/ER UBE Prone Rows and Extensions

Progression Week Six through Nine


Theraband IR Add weight to Prone rows and extensions Added weight to supine punch Swiss ball flexion exercise can now be done with pulley

Progression Week Nine through Ten


Between week eight and ten biceps and triceps strength exercises begin
Bicep Curls Triceps pull down

Possible Additions: Slide lying External Rotation and Abduction Body Blade

Progression Week Ten through Twelve


Continue to add resistance as tolerable Possible Additions: Push ups: wallTable Quad Ped T, Y, I

ROM Six Months Post- op

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