Rehabilitation Following SLAP Repair in the Overhead Athlete: A Case Report
Ashley Pearsall, SPT; Bill Andrews, PT, MS, EdD, NCS
Elon University – Elon, NC
Objectives: The purpose of this case report is to outline the treatment course prescribed to a collegiate tennis player following arthroscopic repair of a superior labral anterior posterior (SLAP) lesion.
Background and Methods: The incidence of SLAP tears has been rising in overhead athletes. Conservative management was historically the treatment-of-choice, but recent evidence suggesting poorer outcomes in overhead athletes compared to their non-overhead athlete counterparts has led to an increased frequency of arthroscopic SLAP repairs. However, there is currently no standard treatment protocol guiding the rehabilitation of such athletes following surgery. In this study, the efficacy of a post-surgical program prescribed to a 21-year-old female collegiate tennis player who presented to physical therapy ten days status/post right shoulder SLAP repair was analyzed. Initial examination of the patient revealed limited right shoulder active and passive range of motion (ROM). The patient also presented with shoulder pain and disability measured via the Numeric Pain Rating Scale and QuickDASH outcome survey, respectively. As ROM restrictions were lifted during recovery, further examination revealed significant strength deficits in scapular stabilizing and rotator cuff musculature. To address these deficits, the patient’s interventions focused on regaining right shoulder mobility and strength via therapeutic exercise, manual therapy, the Thrower’s Ten home program, and pain management modalities to promote the athlete’s return to sport.
Outcomes: Following intervention, the patient presented with improved right shoulder active and passive ROM, 5/5 gross strength in all right shoulder musculature, and decreased pain and disability. At discharge, the patient was restricted until six months post-operatively from a full return to competitive tennis, but she could compete in partial range hitting and throwing. At follow-up 3.5 years later, the patient reported competing in recreational tennis play, though she experienced pain after matches and did not feel she could achieve prior levels of serving velocity. Otherwise, the patient performed non-overhead sports and activities of daily living symptom-free.
Conclusion: Due to the favorable outcomes observed in this patient, employing a post-surgical program with staged ROM and strengthening goals warrants consideration in the rehabilitation of SLAP repairs in overhead athletes.
Manual Physical Therapy and Exercise for Neck Pain and Cervicogenic Headache: A Case Report
Jaclyn Christofilos, SPT
Governors State University - University Park, IL
Background: Neck pain is very common among the general population and is associated with increased disability, poor self-perceived health, and high recurrence rates. Patients with neck pain may be experiencing an accompanying cerviogenic headache. Neck pain and cervicogenic headache is often treated with manual therapy and therapeutic exercise; however, limited research exists on the effectiveness of intervention variety.
Case Description: The patient was a 71-year-old male experiencing neck pain and cervicogenic headache symptoms. Limitations included but were not limited to pain with ADLs, driving, cervical mobility and reduced activity tolerance. Treatment focused on manual therapy consisting of cervical and thoracic thrust and nonthrust mobilization/manipulation techniques and instrument assisted soft tissue massage. Therapeutic exercise was also implemented into the treatment program for a combination approach.
Outcomes: The patient had reductions in disability evidenced by a lower score on the NDI and no pain according to the NPRS at the end of treatment. Results also showed improvements in cervical AROM, deep cervical neck flexor strength/endurance, and postural awareness. Patient reports indicated increased activity tolerance resulting in return to prior level of function.
Conclusion: A multimodal approach combining manual therapy and therapeutic exercise to target cervical musculoskeletal impairments resulted in beneficial outcomes. Further research can help determine the optimal approach for certain patient subtypes as well as long-term effectiveness of treatment to help prevent recurrence.
Effects of Dynamic Balance Training and Progressive Ambulation on Functional Mobility in an Individual with Vaccine-Associated Guillain-Barre Syndrome: A Case Report.
Sarah Rodgers, PT, DPT, A. Williams Andrews, PT, MS, EdD, NCS
Physical Therapist, Carolinas Healthcare System Northeast, email@example.com
Introduction: Guillain-Barré Syndrome (GBS) is an immune-mediated neurological condition characterized by rapidly ascending motor paralysis and sensory deficit. This case report provides an example of the functional mobility gains following outpatient physical therapy with a patient diagnosed with GBS.
Case Description: Patient was a 52-year-old male diagnosed with GBS following an episode of pneumonia, who received an influenza vaccine during his hospital admission. With intensive inpatient physical therapy, home health services, and outpatient physical therapy, the patient returned to being independent in ambulation and activities of daily living.
Outcomes: Patient participated in progressive gait and balance training with one hour sessions three-times per week. After 12 weeks of outpatient physical therapy, the patient significantly improved scores on the Dynamic Gait Index (DGI) and Timed-Up-And-Go (TUG), all of which coincided with improvements in fall risk and level of ambulation.
Discussion: Physical therapy was beneficial in improving this patient’s functional mobility and is an important factor in returning a patient to their previous level of function. Continued research is needed to further provide evidence supporting outpatient physical therapy in this patient population.