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Abstract(s)
Introdução: A artroplastia total do ombro é largamente aceite como tratamento para uma
variedade de patologias do ombro com dor persistente e perda acentuada da
funcionalidade. Em termos globais, os resultados obtidos após a intervenção cirúrgica são
bastante bons, parecendo estar, no entanto, condicionados com a patologia subjacente e a
qualidade da coifa dos rotadores. Objectivo: Pretende-se com este trabalho descrever e
avaliar a eficácia de um plano de intervenção numa prótese total do ombro com integridade
da coifa dos rotadores. Metodologia: Paciente sexo feminino, 61 anos, reformada, com dor
acentuada no ombro esquerdo desde há três anos, submetida a uma cirurgia de colocação
de prótese total do ombro. Apresentava limitação da amplitude articular, diminuição da
força, alteração do ritmo escapulo-umeral e ligeira incapacidade funcional. Cinco semanas
após a cirurgia, iniciou sessões diárias de fisioterapia durante 12 semanas. A intervenção
incluiu a aplicação de modalidades anti-álgicas, mobilização articular, fortalecimento
muscular e reeducação neuromuscular. Foi avaliada em quatro momentos: antes da
intervenção (M1), 4 (M2), 7 (M3) e 12 (M4) semanas após. Resultados: A dor diminuiu
de 4 para 0 (END) no final de 7 semanas e as amplitudes articulares passivas
aproximaram-se dos valores definidos pelo protocolo com a flexão/elevação anterior a
evoluir de 90º para 130º; a abdução/elevação lateral de 80º para 110º e a rotação medial de
35º para 70º. A força muscular inicial era de 3 nos grupos musculares flexores, extensores
e rotadores do ombro atingindo no final grau 4. O ritmo escapulo-umeral demonstrou
assincronia durante a elevação do ombro na primeira avaliação, ficando quase normalizado
no final das sessões. Quanto à funcionalidade, antes da intervenção o score obtido foi de
30.8 atingindo um valor de 11.6 no final das sessões de tratamento. Conclusão: Após 12
semanas de tratamento, os objectivos delineados foram praticamente atingidos, uma vez
que a utente já não refere dor no ombro e apresenta uma boa capacidade funcional, apesar
de apresentar ligeiras diferenças nas amplitudes articulares e força muscular esperadas,
apontando para o sucesso do protocolo de tratamento aplicado.
Introduction: Total shoulder arthroplasty is a standard operative treatment for a variety of glenohumeral joint disorders with persistent pain and deep function lost. In general, the acomplished results after this surgery are pretty good, although influenced by the previous disorder and rotador cuff integrity. Objective: This study goal is to describe and report the efectiveness of a protocol treatment after total shoulder arthroplasty with rotator cuff integrity. Methods: 61-years-old retired female presenting left shoulder pain for three years, undergone total shoulder replacement. Revealed limitation of mobility and strenght weakness of shoulder muscles and poor control of scapular motion. The upper extremity presents small functional disability. 5 weeks after surgery, the patient started a daily treatment program of physical therapy during 12 weeks. This program consisted mainly of antalgic therapy, joint mobilization (passive/active) strength muscle work and neuromuscular reeducation. The clinical outcomes were analysed before intervention, 4,7, and 12 weeks later. Results: Pain relief from 4 to 0 after 7 weeks and the passive range of movement improved from 90º to 130º for anterior elevation, from 80º to 110º for lateral elevation and medial rotation from 35º to 70º at the end of protocol. Innitiatly, the muscles strengh was 3 for flexores/extensors and shoulder rotators ending with 4 in all groups. Before intervention there was a poor scapular rotation pattern with decreasing glenohumeral congruency and stability achieving a normal shoulder dynamic at the end of the program. DASH scores improved, decreasing from 30.8 to 11.6 at final follow-up. Conclusion: After 12 weeks treatment, the objectives were almost achived because patient no longer refers shoulder pain and presents good function, despite some range of motion and strenght limitations compared to those expected. The treatment protocol was sucessfully applied.
Introduction: Total shoulder arthroplasty is a standard operative treatment for a variety of glenohumeral joint disorders with persistent pain and deep function lost. In general, the acomplished results after this surgery are pretty good, although influenced by the previous disorder and rotador cuff integrity. Objective: This study goal is to describe and report the efectiveness of a protocol treatment after total shoulder arthroplasty with rotator cuff integrity. Methods: 61-years-old retired female presenting left shoulder pain for three years, undergone total shoulder replacement. Revealed limitation of mobility and strenght weakness of shoulder muscles and poor control of scapular motion. The upper extremity presents small functional disability. 5 weeks after surgery, the patient started a daily treatment program of physical therapy during 12 weeks. This program consisted mainly of antalgic therapy, joint mobilization (passive/active) strength muscle work and neuromuscular reeducation. The clinical outcomes were analysed before intervention, 4,7, and 12 weeks later. Results: Pain relief from 4 to 0 after 7 weeks and the passive range of movement improved from 90º to 130º for anterior elevation, from 80º to 110º for lateral elevation and medial rotation from 35º to 70º at the end of protocol. Innitiatly, the muscles strengh was 3 for flexores/extensors and shoulder rotators ending with 4 in all groups. Before intervention there was a poor scapular rotation pattern with decreasing glenohumeral congruency and stability achieving a normal shoulder dynamic at the end of the program. DASH scores improved, decreasing from 30.8 to 11.6 at final follow-up. Conclusion: After 12 weeks treatment, the objectives were almost achived because patient no longer refers shoulder pain and presents good function, despite some range of motion and strenght limitations compared to those expected. The treatment protocol was sucessfully applied.
Description
Keywords
Prótese total do ombro Fisioterapia Funcionalidade Dor Protocolos de tratamento Total shoulder protesis Physical therapy Function Pain Protocols
Citation
Publisher
Instituto Politécnico do Porto. Escola Superior de Tecnologia da Saúde do Porto