Professional Documents
Culture Documents
0-1 week
Àp Gauze and dressing removed in PT; replace ace or use Jobst stocking
Àp odalities including electrical stimulation for 20 minutes, biofeedback, and cryoboot
Àp ?yotherapy with ice, polar care, or cryocuff
Àp Patellar glides/mobilization
Àp T with brace locked in extension and crutches
Yp ay unlock brace for passive RO
Yp ?losed chain RO
Yp Goal 0-90 degrees
Àp utraight leg raises in all 4 planes progressing with ankle weights
Yp ork on isolated control of quad if no extensor lag with u R
Àp Prone extension stretch; goal extension symmetric to opposite side
Àp utart stationary bike; half revolutions forward and backward with progression to full
revolutions
Àp ?an start light exercises such as mini-dips, wall sits, step-ups, toe raises, 4 way tubing,
stork stands, etc
Àp utart treadmill for gait training if good control of quads without crutches
eek 1-2
Àp uuture removal [1oth day] and wound check; continue ace wrap for residualswelling;
may shower
Àp Open brace as flexion allows; extension should befull; should be T
Àp ?ontinue previous weeks exercises, bicycling, and treadmill (forward and backward)
Àp dd Total Gym, hamstring curls, leg press, lunges (knee not to pass foot), stool walk,
stork stands, stairmaster, elliptical machine, row machine, TKE (closed chain)
Àp Dome exercises: u R¶s, calf pumps, 4-way tubing, calf and hamstring stretches,
cryotherapy
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Àp Relative rest
Àp lternate activities (non-impact, symptom-free activities, cycling, swimming, Oordic Track)
Àp utretching and strengthening as above
Àp ce massage or ice wrap
Àp OuV¶s
Retr to Activit
Àp hen patient can tolerate alternate activites and rehabilitation for 4- weeks
Àp irst, alternate running with non-weight bearing exercise for 2-3 weeks
Àp Gradually increase mileage and intensity. Rule of too¶s
Yp Von¶t run too much, too soon or too fast and make sure your shoes are not too old
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Àp ull weightbearing
Àp odalities
Àp ?ontinue manual resistive exercises with inversion/eversion added
Àp unctional exercise
Yp Vouble toe raises, double-legged hopping, single toe raises, and single-legged hopping
Àp Progressive sport-specific drills
Àp Proprioceptive exercises
Àp alk, jog, run, cutting, explosive maneuvers
Àp P/taping for return*
*thlete may return to activity when able to complete 1 single-legged hop off toes, has passes
functional testing, and is mentally ready to return
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Àp Patient is immobilized in an abduction splint at 0-90 degrees internal rotation for 3 weeks.
Àp The abduction splint may be removed to allow the shoulder to adduct and for gentle passive
abduction, flexion, and external rotation exercises; 2 sets of 10 repetitions 2 times per day (Vo
not force external rotation).
Àp sometric abduction, horizontal adduction and external rotation.
Àp ctive elbow flexion and extension strengthening exercises.
Àp ay squeeze a soft ball for hand/forearm muscle strengthening.
Àp ?ontinue progressing weights with emphasis on eccentric exercises. ay begin isokinetic
strength training for flexion and abduction. ay add training at the lower speeds with continued
emphasis on the higher speeds.
Àp Perform first isokinetic test evaluating strength and endurance in the following movement
patterns: internal and external rotation, flexion and extension, abduction and adduction. Each
movement pattern is tested on a different day (3 day period).
Àp f the isokinetic test indicates adequate strength and endurance (0 or above as compared to
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Àp Patient is immobilized in an abduction splint at 0-90 degrees internal rotation for 3 weeks.
Àp The abduction splint may be removed to allow the shoulder to adduct and for gentle passive
abduction, flexion, and external rotation exercises; 2 sets of 10 repetitions 2 times per day (Vo
not force external rotation).
Àp sometric abduction, horizontal adduction and external rotation.
Àp ctive elbow flexion and extension strengthening exercises.
Àp ay squeeze a soft ball for hand/forearm muscle strengthening.
Àp ?ontinue progressing weights with emphasis on eccentric exercises. ay begin isokinetic
strength training for flexion and abduction. ay add training at the lower speeds with continued
emphasis on the higher speeds.
Àp Perform first isokinetic test evaluating strength and endurance in the following movement
patterns: internal and external rotation, flexion and extension, abduction and adduction. Each
movement pattern is tested on a different day (3 day period).
Àp f the isokinetic test indicates adequate strength and endurance (0 or above as compared to
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Àp ?odman exercises, PRO 0-90 degrees flexion and abduction; external rotationin adduction to
neutral; avoid extension of arm behind body for 4 weeks
Àp Oo external rotation in abduction because of peel-back mechanism
Àp uling immobilization when not doing PRO regimen
Àp Viscontinue sling and start progressive PRO to full as tolerated in all planes
Àp egin passive posterior capsular and internal rotation stretching
Àp egin passive and manual scapulothoracic mobility program
Àp egin external rotation in abduction
Àp llow use of operative extremity for light activities of daily living
Àp ?ontinue all stretching and flexibility programs as above; RO should be full
Àp egin progressive strengthening of rotator cuff, scapular stabilizers, and deltoid
Àp t 10-12 weeks, biceps resistance and sports/work specific exercises instituted with goal of
normal function at 4 months
Phase 6 (6 moths)
Phase 7 (7 moths)
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The physical therapy rehabilitation for rotator cuff repair will vary in length depending on degree of
instability, acute versus chronic condition, strength/RO status, and activity demands.
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Àp uling up to 10 days; encourage use of involved joints and use ice QV
Àp Pendulum exercises; start post-operative day 1 in sling
Àp Gentle pain-free isometrics post-operative day 2 (avoid stressed abduction)
Àp Post-operative day 3 start passive RO; mobilization as needed, supine wand exercises,
humeral glides
Àp uecond week start active assistive RO against gravity (wand, wall climb, pulley, etc)
Yp utart into flexion and progress to abduction
Àp Progress to active RO against gravity (avoid impingement)
Àp Progressive mobilization and shoulder girdle flexibility exercises leading to full RO
Yp Goal full RO at weeks
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À?ylinder cast
ÀTouch down weight bearing to partial weight bearing with crutches
Àsometric quadriceps strengthening
Geeral Istrctios
Àp pply ice covered with a towel to knee for 2-3 days (1-20 minutes at a time).
Àp uwelling and bruising is normal. You may loosen dressing if needed.
Àp ow grade fevers (less than 101 degrees) are common after surgery. Veep breathing will help
with this. f your fever persists for more than a few days, or the wound gets more red, call my
office.
Àp The pain medication given to you can cause constipation, nausea and itching. You may switch to
Tyelenol or otrin when more comfortable.
- ercises
Àp Elevate your leg above the level of your heart for 2-3 days after surgery to decrease swelling.
Àp You may place as much weight on operative leg as tolerated, unlessspecifically told not to.
Viscontinue crutches when you feel comfortable without them.
Àp hile sitting, start flexing and extending knee and ankle as comfort allows.
Àp utart straight leg raises 20-40 times, 3 times a day
Àp utart physical therapy within 2-3 days.
ada es
Àp Your dressing may show blood stains after surgery. This is expected. f the blood is still wet
after the first day, call my office.
Àp Remove all dressings and cover wounds with band-aids after three days.
Àp You may shower after 3 days.
Àp Vo not swim or submerge incisions in water for 2 weeks.
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Importat
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Geeral Istrctios
Àp pply ice covered with a towel to ankle for 2-3 days (1-20 minutes at a time).
Àp uwelling and bruising is normal. Elevate ankle above the level of your heart to decrease this.
You may loosen dressing if needed.
Àp ow-grade fevers (less than 101 degrees) are common after surgery. Veep breathing will help
with this. f your fever persists for more than a few days, or the wound has increased redness,
call my office.
Àp The pain medication given to you can cause constipation, nausea and itching. You may switch to
Tyelenol or otrin when more comfortable.
- ercises
Àp You may place as much weight as you can tolerate on your leg unless specifically instructed not
to. You may discontinue crutches when you feel comfortable without them
Àp hile sitting, start moving your knee, ankle, and toes as comfort allows.
Àp utart physical therapy within 2-3 days.
ada es
Àp Your dressing may show blood stains after surgery. This is expected. f the blood isstill wet
after the first day, call my office.
Àp Remove all dressings and cover wounds with band-aids after three days.
Àp You may shower after days.
Àp Vo not swim or submerge incisions in water for 2 weeks.
Àp åse your ace wrap for compression when walking for 2 weeks.
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Importat
Àp Report any complications to my office immediately. This includes excessive bleeding, wound
breakdown, increasing redness or pain, prolonged fever over 101 degrees, or increasing calf
pain.
Àp ?all office for follow-up appointment 10-14 days after surgery (if not scheduled).
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Geeral Istrctios
Àp pply ice covered with a towel to elbow for 2-3 days (1-20 minutes at a time).
Àp uwelling and bruising is normal. You may loosen dressing if needed.
Àp ow grade fevers (less than 101 degrees) are common after surgery. Veep breathing wi ll help
with this. f your fever persists for more than a few days, or the wound gets more red, call my
office.
Àp The pain medication given to you can cause constipation, nausea and itching. You may switch to
Tyelenol or otrin when more comfortable.
- ercises
Àp Elevate your hand/elbow above the level of your heart for 2-3 days after surgery to decrease
swelling.
Àp f you were given a sling, this is for comfort only. Try to discontinue use of sling as soon as
possible to avoid stiffness.
Àp utart to flex/extend the elbow as pain allows, unless immobilized in splint. utart squeezing a
tennis ball for grip strength.
Àp utart physical therapy within 2-3 days.
ada es
Àp Your dressing may show blood stains after surgery. This is expected. f the blood is still wet
after the first day, call my office.
Àp Remove all dressings and cover wounds with band-aids after three days.
Àp You may shower after 3 days.
Àp Vo not swim or submerge incisions in water for 2 weeks.
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Importat
Àp Report any complications to my office immediately. This includes excessive bleeding, wound
breakdown, increasing redness or pain, prolonged numbness or tingling, prolong ed fever over
101 degrees, or increasing calf pain.
Àp ?all office for follow-up appointment 10-14 days after surgery (if not scheduled).
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Oo-operative treatmet
The physical therapy rehabilitation for an posterior shoulder dislocation/subluxation will vary in length
depending on factors such as degree of instability, acute versus chronic condition, length of time
immobilized, strength and range of motion status, and performance/activity demands.
This program is in three phases and phases can overlap. n all exercises during phase 1 and 2, caution
must be applied in placing undue stress on the posterior joint capsule as dynamic joint stability is
restored. n isokinetic strength and endurance test is scheduled during the latter part of phase 2. The
focus of phase 3 is on progressive isotonic and isokinetic exercises in preparation for returning to the
prior activity level.
Phase 1
(p Prone: Perform the combined movements of horizontal abduction followed by external rotation
to protect posterior joint capsule.
)p uidelying: imit the degrees of internal rotation to protect theposterior capsule.
Àdd active internal rotation performed from full external rotation to 0 degrees rotation using rubber
tubing. imiting the degrees of internal rotation is necessary to avoid excessive stress to the posterior
capsule. f there is pain with active movements, strength can be maintatined by performing an
isometric contraction. The shoulder position may be adjusted to allow a pain free muscle contraction to
occur.
Àdd supraspinatus exercise, if adequate range of motion available (0-90 degrees). uhoulder is
positioned in the scapular plane about 20-30 degrees forward of the coronal plane.
Àctive shoulder flexion exercise through available range of motion.
Àctive shoulder abduction exercise to 90 degrees.
Àuhoulder shrug exercise-avoid traction in the glenohumeral joint between repetitions by not allowing
the arms to drop completely. This will avoid an excessive inferior glide of the humeral head.
Àctive horizontal abduction exercise (posterior deltoid) in prone lying position. void excessive stress
to the posterior capsule by limiting movement from 4 degrees of horizontal adduction to full
horizontal abduction.
Àdd forearm strengthening exercises (elbow and wrist).
Phase 2
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Àp Vressing removed in therapy; gunslinger brace all times for three weeks
Àp rist and elbow RO as tolerated, ball squeezes
Àp utart gentle passive RO with shoulder flexion, abduction, external rotation
Yp Progress with internal rotation as needed
Yp dd active-assist (wand exercises) and shoulder shrugs
Yp Progress with isometric internal and external rotation with arm at side and elbow flexed
at 90 degrees (pain free contraction)
Yp s strength improves, add active external rotation with tubing (pain free)
Àp ?ontinue passive and active-assist RO exercises; may add wall climbs
Àp Progress to free weights for external rotation in prone lying position with arm abducted to 90
degrees or sidelying with arm at the side
Yp Perform combined movements of horizontal abduction followed by external rotation to
protect posterior capsule
Yp f sidelying, limit degrees of internal rotation to protect capsule
Yp dd supraspinatus exercise if pain free and RO 0-90 degrees
Yp uhoulder positioned in scapular plane in 20-30 degrees forward of coronal plane
Yp dd active shoulder flexion through available RO and active abduction to 90 degrees
Phase (4 months)
Phase ( months)
Àp sokinetic test
Àp ?ontinue to progress isotonic and isokinetic exercises (can add flexion/extension and
abduction/adduction)
Àp dd military press with weight directly over or behind head
Àp Total body conditioning and flexibility addressed
Phae 7 ( months)
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Àp ånlock brace to prescribed angles for range-of-motion exercises only on 1 and 2 post-op weeks
Àp eave unlocked at weeks post-op: extension stop 10 degrees and flexion stop 0 degrees
Àp uhower without brace on at weeks post-op
Àp uleep without brace on at 10 weeks post-op
Àp åse functional brace at 1 weeks post-op for ambulation and exercise until 2 weeks post-op;
then exercise only
Àp Vonjoy 4 point P? brace or orthotist made brace
Àp egin passive range of motion 1 week post-op from 0 degrees extension to 40 degrees flexion;
increase 0 degrees extension and 10 degrees flexion per week beginning weeks post -op for 2
weeks only, then lock at 10 degrees for 4 weeks
Àp ay increase PRO prn
Àp egin active range of motion 1 week post-op from 0 degrees extension to 40 degrees flexion;
increase 0 degrees extension and 10 degrees flexion per week beginning weeks post -op
Àp ay increase RO prn
Àp egin weightbearing 12 weeks post-op; start with 2 body weight and increase 2 per
week-then continue on one crutch (7 body weight) until notified.
Yp wean from crutches as tolerated-total 1 weeks on crutches
Phase 4-Isometrics
Àp eg press PRE
Yp ncrease prn from 0 degrees extension to 70 degrees flexion after weeks post
-op, then
advance prn
Yp Oo limits on weight from 0 degrees extension to 40 degrees flexion
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General nstructions
Àp pply ice covered with a towel to shoulder for 2-3 days (1-20 minutes at a time).
Àp uwelling and bruising is normal. You may loosen dressing if needed.
Àp ow grade fevers (less than 101 degrees) are common after surgery. Veep breathing will help
with this. f your fever persists for more than a few days, or the wound gets more red, call my
office.
Àp Your sling is for comfort only.
Àp The pain medication given to you can cause constipation, nausea and itching. You may switch to
Tyelenol or otrin when more comfortable.
- ercises
Àp ove and use your elbow and wrist as comfort; start squeezing a tennis ball.
Àp Oo lifting, pushing, and pulling for 1 week.
Àp utart ³pendulum´ exercises with arm in front of body.
Àp utart physical therapy within 2-3 days.
ada es
Àp Your dressing may show blood stains after surgery. This is expected. f the blood is still wet
after the first day, call my office.
Àp Remove all dressings and cover wounds with band-aids after three days.
Àp You may shower after 3 days.
Àp Vo not swim or submerge incisions in water for 2 weeks.
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Importat
Àp Report any complications to my office immediately. This includes excessive bleeding, wound
breakdown, increasing redness or pain, prolonged fever over 101 degrees, or increasing calf
pain.
Àp ?all office for follow-up appointment 10-14 days after surgery (if not scheduled).
Rationale: The number of patellofemoral problems is increasing. Oo single cure exists for the treatment
of this problem. This suggested exercise program is divided into three goal-oriented phases. Paying
attention to the precautions and good education is paramount to success.
Goals:
Àp Education
Àp Vecrease pain, swelling, palpable tenderness
Àp mprove gait deviations
Àp Restore normal mechanics
u ested treatmet:
Precatios
Goals:
u ested treatmet
Àp Exercises include quad sets, straight leg raises, wall squats, mini-squats, closed chain
strengthening (eg. ulow motion walking, leg press, step ups, resistive bends in weight-bearing,
be innovative with weight-bearing activities)
Àp ?ontinue stretching tight muscles
Àp Patellar mobilizations (medial glides and lateral tilts)
Àp Electrical stimulation to VO
Àp Orthotics to balance the foot
Àp Pain free biking (high seat with low resistance)
Àp Overall conditioning program (avoid open chain knee extension exercises )
Precatios
Goals
Àp Pain free functional closed chain activities (steps, jogging, running, and sport specific activities)
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The pain you have on the inside of your elbow is due microtearingof the tendons coming off the
epicondyle (bone). This results in the formation of scar tissue with resultant pain. ?ontinued stress can
lead to a viscous cycle of pain and weakness. This is not a serious injury, but the pain can greatly
affect your capability to perform sports activities.
Exercises
Throwing orkout
Àp fter throwing, ice and compression wrap for 1 minutes with elbow extended
Àp utart iontophoresis (10 Dydrocortisone cream) continuous fashion 1. to 2/?2 every other
day over a course of 10 days
Once you no longer have pain on the outside of your knee when you press on it, you will be able to do
everything except routine running for the next two weeks. Vuring these two weeks, you will participate
daily in the following regimen:
Take the medication and use ice until your season is completed
You may also need to augment your program with formal physical therapy
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The pain you have on the outside of your elbow is due microtearing of the tendons coming off the
epicondyle (bone).This results in the formation of scar tissue with resultant pain. ?ontinued stress can
lead to a viscous cycle of pain and weakness. This is not a serious injury, but the pain can greatly
affect your capability to perform sports activities. e can keep you in training if you follow this
treatment regimen: cute (1-3 weeks from onset of symptoms)
Rehabilitation
Yp Exercise: flexibility (alphabet tracing), strength (isometric) program for wrist extensors,
endurance (when pain-free, begin isokinetic program).
Yp Return to full activities when grip strength is normal and pain is absent
n isometric strengthening program for forearm extensors can begin with the use of lightly resistive
therapeutic putty. s the patient grips the putty, the wrist extensors isometrically contract to stabilize
the wrist. sometric exercises allow strengthening of the muscle with less stress than occurs with
isotonic and isokinetic exercises.
s the patient¶s level of pain decreases, generally within 3- weeks of initiation of treatmen, a
progressive resistive exercise program is started, with the goal of strengthening the wrist extensors,
forearm flexors, supinators, and pronators. sotonic and isokinetic exercises can also be used.
sotonic exercise occurs when the muscle works against resistance through available range -of-motion.
ree weights or exercise rubber bands can be used. ith isokinetic exercises, the speed of muscle
lengthening and contraction is controlled and resistance is varied.
#
#
0- weeks
weeks
12 weeks
Àp Progressive strengthening
9-12 months
Àp ?ontact sports
10 days to 2 weeks
Àp
sometrics and external rotation to 10 degrees, forward elevation 90 degrees
2-4 weeks
4- weeks
weeks
Àp
External rotation to 0 degrees, forward elevation 10 degrees with resistance exercises
3 months
4-12 months
#
*
+
Oo-operative treatmet
mpingement of the rotator cuff can be both anatomical and kinesiological in nature. t is best treated
when any kinesiological disturbances are treated first. This is usually accomplished by muscle
balancing and specific muscle training. This includes rest at the appropriate time and the use of non-
steroidal anti-inflammatories (OuV¶s). Proper training of the rotator cuff muscles for balance to
provide good scapulohumeral rhythm and conditioning of the rotator cuff and scapular muscles is
critical. n anatomic limitation to this program may be an underlying instability. This must be
considered when following this program.
Goals:
Jreatmet recommedatios:
Precatios:
Goals:
Jreatmet recommedatios:
Precatios:
Goals:
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,
The pain on the outside of your knee is due to inflammation (tendonitis) of the iliotibialband tendon.
This tendonitis is not a serious injury, but the pain can greatly affect your capability to perform sports
activities. You will experience pain on the outside of your knee when you run, go up and down stairs,
and when pivoting.
Once you no longer have pain on the outside of your knee when you press on it, you will be able to do
everything except routine running for the next two weeks. Vuring these two weeks, you will participate
daily in the following specific regimen:
Take the medication and use ice until your season is completed.
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Oo-operative treatmet
Àp Elevation
Àp ce compression
Àp OuV¶s
Àp ?rutches (2-3 days)
Phase 2-obilization
Àp Vorsiflexion
Àp Plantar flexion
Àp nversion/eversion
%
Pre-op phase
Perioperative phase
Àp 20-2 straight leg raises in brace; no more than 40-0 three times a day
Àp Passively flexing 0-4 degrees
Àp Damstring setting and stretching
Àp Dip exercises in splint abduction, extension and adduction
eeks 1-3
eeks 3-12
Àp eights (low weights/high reps), bicycling (keep seat high) and functional activities
Àp Jogging or running is the last thing allowed
Àp Patient must be able to run without a limp; if limp occurs, stop running and continue weights
until swelling subsides
Àp Progressive running program
Yp 1st day: ¼ mile/run 100 yards/walk 100 yards
âp routine continued over time until patient can run ¼ mile
Yp 2nd week: ½ mile run (slow) three times per week
Yp 3rd week: ¾ mile run (slow) three times per week
Yp 4th week: 1 mile run (slow) three times per week
Yp th week: begin sprints 40 yard dash (1/2 speed) then ¾ speed and progress to full
speed
Yp th week: agility drills
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Goals:
Jreatmet Recommedatios:
Precatio:
Goals:p
Jreatmet Recommedatios:
Àp odalities as needed
Àp utart with active RO through available range
Àp dd isometrics below shoulder level
Àp lexibility of the cervical, shoulder and scapular muscles
Àp Oon-involved upper extremity and bilateral lower extremity exercises
Precatios:
Goals:p
Jreatmet Recommedatios:
Precatios:
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Goals
Phase 4 (6 weeks)
Àp Dome program
Phase 6 (4 moths)
Phase 7 (6 moths)
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hat is arthritis?
rthritis is the gradual breakdown and damage to cartilage that function as "shock absorbers" at the
end off your bones. There are many forms, but osteoarthritis is the most common and occurs with
aging. Osteoarthritis is a disease of joint cartilage, mediated by inflammation, breakdown, and
eventual loss of this cartilage.
The most common symptom is pain, usually worse at the end of the day. There may be swelling,
warmth, popping or grinding of the affected joints. Pain and stiffness may also occur afterlong periods
of inactivity, for example, sitting in a theater. Pain at rest or pain with decreased range of motion is
common with severe osteoarthritis. uymptoms can be intermittent, but are usually progressive.
Osteoarthritis is usually diagnosed from the history, physical, and radiographs. There is currently no
blood test for this diagnosis. lood tests may be helpful to exclude other arthritic conditions that can
mimic osteoarthritis. The most common radiographic findings of osteoarthritis are narrowingof the
joint "space" between adjacent bones, bony spur formation, and cyst formation.
lthough we do not have a cure for osteoarthritis, there are modalities that may be employed to
improve symptoms. The goal of treatment is to reduce stress, pain and inflammation, while improving
and maintaining function and mobility. The program outlined below may be helpful to improving
symptoms of osteoarthritis.
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Oo-operative treatmet
The physical therapy rehabilitation for an anterior shoulder dislocation/subluxationwill vary in length
depending on factors such as degree of instability, acute versus chronic condition, length of time
immobilized, strength and range of motion status, and performance/activity demands.
This program is in three phases and phases can overlap. n all exercises during phase 1 and 2, caution
must be applied in placing undue stress on the anterior joint capsule as dynamic joint stability is
restored. n isokinetic strength and endurance test is scheduled during the latter part of phase 2. The
focus of phase 3 is on progressive isotonic and isokinetic exercises in preparation for returning to the
prior activity level.
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