Home | Register | Login | Inquiries | Alerts | Sitemap |  


Advanced Search
JKM > Volume 40(3); 2019 > Article
Geum, Baek, and Lee: A Rehabilitation protocol for Arthroscopic Bankart repair in Korean Medicine : A Case Report

Abstract

Objectives

The aim of this study was to report the clinical improvement of a patient who underwent arthroscopic Bankart repair using a rehabilitation protocol involving Korean medicine.

Methods

The patient was treated with acupuncture, cupping, Korean Medicine, Chuna therapy, and Doin exercise therapy during the admission period. To estimate the patient’s status, we used the Numeric Rating Scale (NRS), Pain Disability Index (PDI), assessments of the range of motion (ROM) and Muscle Manual Test (MMT) for the shoulder joint.

Results

After administering the abovementioned treatments, we found that the patient’s NRS, PDI, and ROM and MMT for the shoulder joint were improved.

Conclusions

The rehabilitation protocol involving Korean medicine can be applied to and produce good results for patients who undergo arthroscopic repair for Bankart lesions. The limitation of the study was that the number of cases we studied was insufficient to prove the effectiveness. Hence, further studies are needed for designing the rehabilitation protocol involving Korean medicine.

Fig. 1
[2018.02.06.] Shoulder AP ; Right shoulder dislocation
jkm-40-3-177f1.gif
Fig. 2
[2018.02.12.] Shoulder MRI ; Compatible with Bankart lesion(labral tear) in right shoulder d/t previous anteroinferior dislocation of shoulder joint.
jkm-40-3-177f2.gif
Table 1
Medicinal herbal formulas of target diseases
Phase I Phase II Phase III
Criteria for next phase Declared by physician to begin rehabilization
Shoulder AAROM*
Flex. ≥ 90°
Abduction ≥ 90°
Shoulder Full PROM (Except Ext.Rot.§,, Int.Rot.||)
Shoulder AAROM*
Flex. ≥ 120°
Abduction ≥ 120°
Ext.Rot.§ ≥ 55°
Int.Rot. || ≥ 55°
Guidelines & Goal Control pain & edema
Prevent inflammation
Protect surgical wound
Prevent Shoulder AROM exercise
Restore full PROM
Initiate Shoulder strengthening & AROM exercise
Restore full AROM**
Restore normal scapulothoracic motion
Restore muscular Strength and balance
Return to daily living and work
Start nonoverhead sport-specific activity
Patient education Ice & Sling keep Ice (as needed)
Sling (None)
None
ROM** PROM
Flex. ≥ 90°
Abduction ≥ 90°
Ext.Rot.§ ≥ 20–30°
Int.Rot.|| behind back
PROM
Full Ext.Rot.§, Int.Rot.||
AAROM*
Flex. ≥ 120°
Abduction ≥ 120°
Ext.Rot.§ ≥ 15°
Int. Rot.|| as tolerate
(Supine, Abduction to 60°)
Full ROM**
Acupuncture Remote acupoint needling Near & remote acupoint needling Continue Phase II
Cupping Therapy Dry cupping therapy Dry & venesection cupping therapy Continue Phase II
Herbal medicine Herbal medicine for reducing edema and pyrexia Herbal medicine for assisting strengthening Shoulder joints Continue Phase II
DET†† Hand, Wrist, Elbow, Cervical ROM** exercise
Squeeze ball
Supported pendulum (Foward/back, Side/side)
Scapular pinches
Continue Phase I
Wall slide
Cane exercises
- PROM Flex., Abduction, Scaption to 90°
Passive horizontal Adduction Shoulder pulley
Prone scapular retraction with light weight
Push-up progression
wall to table
Pool
Continue Phase II
Cane exercises
- PROM Flex., Abduction to 120° , Ext.Rot.§ to 15°
Large theraball on floor : circles clockwise/counterclockwise
Push-up progression table to chair
Shoulder Ext.Rot.§, Int.Rot.||, Extension
Isotoincs
Theraband
Scapular retraction
Lower trapezius work
Treadmill
CMT‡‡ CJMT§§ : Elbow, Wrist
FCT|||| : Cervical
Continue Phase I
MET¶¶: Shoulder
Continue Phase II

* AAROM: Active assistive range of motion,

† Flex.: Flexion,

‡ PROM: Passive range of motion,

§ Ext.Rot.: External rotation,

|| Int.Rot.: Internal Rotation,

¶ AROM: Active range of motion,

** ROM: Range of motion,

†† DET: Doing exercise therapy,

‡‡ CMT: Chuna manual therapy,

§§ CJMT: Chuna joint mobilization therapy,

|||| FCT: Fascia Chuna therapy,

¶¶ MET: Muscle energy technique

Table 2
The Change of NRS, PDI, P/Ex.* in Case
Case Evaluation time

2018.02.19. (Adm) 2018.03.23. (D/C)
Scale or score
 NRS 7 3
 PDI 53 26

ROM§
 Flexion 20°/180° 100°/180°
 Extension 5°/55° 45°/55°
 Abduction 10°/180° 75°/180°
 Adduction 5°/45° 30°/45°

MMT||
 Flexion 2−/5 3+/5
 Extension 2−/5 3+/5
 Abduction 2−/5 3+/5
 Adduction 2−/5 3+/5

Other symptoms
 Swelling −/+ −/−
 Pyrexia −/+ −/±
 Flare −/+ −/−

* P/Ex.: physical examination

† Adm: Admission,

‡ D/C: Discharge,

§ ROM: Range Of Motion,

|| MMT: Manual muscle test,

¶ ±: Intermittent symptom.

참고문헌

1. Jeong MS, Jeon JM, Tae SG, Oh JH. The shoulder Surgery. 1st ed.Seoul: Koonja Publishing Co;2010. 141:p. 288p. 292p. 295p. 297–8.


2. Adams JC. Recurrent Dislocation of the Shoulder. J Bone and Joint Surg. 1948; 30–B:26–38.
crossref

3. Choi CH, Kwun KW, Kim SK, Lee SW, Shin DK, Kim KM. Bankart suture repair for anterior instability of the shoulder: results of arthroscopic versus open repair. J Korean Shoulder Elbow Soc. 2002; 5:47–54.
crossref

4. Kim YS. Rehabilitation after Bankart and SLAP repair. Journal of Korean Arthroscopy Soc. 2008; 12:2. 75–81.


5. Noh HK, Park JW, Lee JI, Park JH. Result of early active range of motion exercise after bankart repair of traumatic anterior instability. Jourmal of the Korean Fracture society. 2007; 20:1. 53–7.
crossref

6. Lee JH, Ko MK, Yoon KS, Lee CW, Kim YI, Kim JH. Case report of acute traumatic rotator cuff tear treatment in traditional korean medicine. Jourmal of pharmacopuncture. 2011; 14:4. 53–8.
crossref

7. Yeom SR, Song JH. Calcific Tendinitis of the Shoulder by Oriental Medical Treatments : 4 Cases Report. J Oriental Rehab Med. 2010; 20:1. 209–17.


8. Song MY, Jo HG, Sul JU, Leem JT. Proposal of East-west Integrative Medicine manual for Rehabilitation after shoulder surgery. Journal of Korean Medicine Rehabilitation. 2018; 28:1. 109–20.
crossref

9. DeFroda Steven, Mehta Nabil, Owens Brett. Physical Therapy Protocols for Arthroscopic Bankart Repair. Sports health. 2018; 10
crossref pmid pmc

10. Lee KO, Kuk YB, Yun YG. Effects of Jakyakgamchotang extract on the Analgestic effect in Mice. Korean J Oriental Medical Prescription. 2003; 11:1. 161–70.
crossref

11. Kim BW. Anti-inflammatory effect of Jakyakgamcho-tang. Korean J Orient Int Med. 2010; 31:2. 365–71.


12. Korean Society of Chuna Manual medicine for Spine & Nerves. Chuna manual medicine. 2.5th EdSeoul: Korean Society of Chuna Manual medicine for Spine & Nerves;2017. p. 101p. 222–30. p. 262p. 282–4..


13. The Society of Korean Medicine Rehabilitation. Korean Rehabilitation Medicine. 4th ed. Seoul: Koonja Publishing Co;2015. 3:p. 100p. 404–5. p. 413–6.


14. Haerer AF. The neurologic examination. 5th ed. Philadelphia: JB’ Lippincott company;1992. p. 335–74.


15. Shim SY, Park HJ, Lee JM, Lee HS. An Overview of Pain Measurements. The Korean Journal of Meridian & Acupoint. 2007; 24:2. 81–2.


16. Pollard CA. Preliminary validity study of the pain disability index. Percept Mot Skills. 1984; 59:3. 974
crossref pmid

17. MacLaughlin HL. Recurrent Anterior Dislocation of the Shoulder. I. Morbid anatomy. Am J Surg. 1960; 99:628–32.
crossref

18. Reeves B. Acute Anterior Dislocation of the Shoulder. Ann R Coll SurgEngl. 1989; 43:225
pmid pmc

19. Rockood CA, Masten FA. The Shoulder. 1st Ed. Philadelphia: W.B. Saunder Co;1990. 1:p. 230–1.


20. Bankart ASB. The Pathology and treatment of recurrent dislocation of the Shoulder Joint. British JSurg. 1938; 26:23–9.
crossref

21. Steven CT, Matsen FA. An approch to the repair of avulsion of the glenohumeral ligament in the management of traumatic anterior glenohumeral instability. JBone and Joint Surg. 1989; 71–A:511


22. Manta JP, Organ S, Nirschl RP, Pettrone FA. Arthroscopic transglenoid suture capsulolabral repair. Am J Sports Med. 1997; 25:614–8.
crossref pmid

23. Morgan CD, Bodenstab AB. Arthroscopic bankart suture repair: technique and early results. Arthroscopy. 1987; 3:111–22.
crossref pmid

24. Walch G, Boileau P, Levigne C, Mandrino A, Neyret P, Donell S. Arthroscopic stabilization for recurrent anterior shoulder dislocation: result s of 59 cases. Arthroscopy. 1995; 11:173–9.
crossref

25. Owens BD, Hurwitz SR, Thompson TL, Wolf JM. Surgical trents in Bankart repair:an analysis of data from the American board of Orthopaedic surgery certification examination. Am J Sports Med. 2011; 39:1865–9.
crossref pmid

26. Kim MK, Shin CS. Results According to Arthroscopic Repair Methods of Bankart Lesion (Operative Methods According to Labral Tear). The Journal of the Korean Orthopaedic Association. 2001; 36:6. 525–30.
crossref

27. Michael J. Strobel Manual of Arthroscopic surgery. 1st ed. Seoul: Gabon Publishing Co;2006. p. 875–82.


28. St Mary’s hospital. Rehabilitation after Bankart and SLAP Repair. Journal of Korean Arthroscopy Soc. 2008; 12:2. 75


29. Rowe CR, Zarins B. Recurrent transient subluxation of the shoulder. J Bone Joint surg Am. 1981; 63:863–72.
crossref pmid

Editorial office contact information
3F, #26-27 Gayang-dong, Gangseo-gu Seoul, 157-200 Seoul, Korea
The Society of Korean Medicine
Tel : +82-2-2658-3627   Fax : +82-2-2658-3631   E-mail : skom1953@daum.net
About |  Browse Articles |  Current Issue |  For Authors and Reviewers
Developed in M2PI