<![CDATA[Journal of Orthopaedic & Sports Physical Therapy - Linda E. Arslanian, PT, DPT, MS]]> http://www.jospt.org/lindaearslanian Wed, 30 Apr 2008 09:05:25 EST 0 Management of a Patient With an Isolated Greater Tuberosity Fracture and Rotator Cuff Tear http://www.jospt.org/issues/articleID.701/article_detail.asp Reg B. Wilcox III, Linda E. Arslanian, Peter J. Millett

Study Design: Case report. Background: Patients with hyperflexion/hyperabduction injury to the glenohumeral joint are at risk for isolated greater tuberosity fractures, which are often undiagnosed or misdiagnosed. In this case report, we describe the clinical decision-making process that led to the diagnosis of an isolated greater tuberosity fracture and subsequent rotator cuff tear. Case Description: The patient was a 45-year-old male who sustained a shoulder injury as the result of a fall while skiing. After the initiation of physical therapy, he was diagnosed with an isolated greater tuberosity fracture. Little is known regarding the optimal management and overall prognosis of this type of fracture. Conservative nonoperative management and postoperative physical therapy management are discussed. Outcomes: With conservative nonoperative management, the patient was unable to regain high-level functional shoulder use. Suspicion of continued pathology of the greater tuberosity dictated further diagnostic imaging, which led to surgical intervention. Upon completion of postoperative rehabilitation, he was able to resume full recreational activities. Discussion: It is recommended that sound clinical decision-making dictate the management and ongoing evaluation of traumatic shoulder injuries, especially when managing a patient with an injury for which optimal treatment and prognosis is not well established.

J Orthop Sports Phys Ther. 2005;35(8):521-530. doi:10.2519/jospt.2005.1723

Key Words: diagnostic imaging, physical therapy, shoulder rehabilitation

]]> http://www.jospt.org/issues/articleID.701/article_detail.asp Rehabilitation Following Total Shoulder Arthroplasty http://www.jospt.org/issues/articleID.823/article_detail.asp Reg B. Wilcox III, Linda E. Arslanian, Peter J. Millett
Total shoulder arthroplasty (TSA) is a standard operative treatment for a variety of disorders of the glenohumeral joint. Patients, who have continued shoulder pain and loss of function in the presence of advanced joint pathology, despite conservative management, are often managed by undergoing a TSA. The overall outcomes that are reported after surgical intervention are quite good and appear to be primarily determined by the underlying pathology and the tissue quality of the rotator cuff. The current Neer protocol for postoperative TSA rehabilitation is widely used and based on tradition and the basic science of soft tissue and bone healing.

The purpose of this paper is to review the indications for TSA, focusing on the underlying pathologies, and to describe the variables that impact the rehabilitation program of individuals who have had a TSA. A postoperative TSA rehabilitation protocol and algorithm, founded on basic science principles and tailored toward the specific clinical condition, are presented.

J Orthop Sports Phys Ther. 2005;35(12):821-836. doi:10.2519/jospt.2005.2000

Key Words: physical therapy, protocols, shoulder rehabilitation

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