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Rivista di Medicina Fisica e Riabilitativa dopo Eventi Patologici
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Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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European Journal of Physical and Rehabilitation Medicine 2016 Nov 10
Post-operative physical therapy program for latissimus dorsi and teres major tendons transfer to rotator cuff in children with obstetrical brachial plexus injury
Yasser A. SAFOURY 1, Mohamed T. ELDESOKY 2, Enas E. ABUTALEB 2, Mohamed RAAFAT 3, Ahmed M. GABER 4
1 Orthopedic Department, Kasr EL Aini Hospital, Cairo University, Cairo, Egypt.; 2 Department of Basic Science, Faculty of Physical Therapy, Cairo University, Cairo, Egypt; 3 Department of Physical Therapy, Faculty of Applied Medical Science, Hail University, Hail, Kingdom of Saudi Arabia; 4 Department of Pediatric, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
BACKGROUND: The transfer latissimus dorsi and teres major tendons to rotator cuff have been developed to rebalance the muscular dysfunction and improve shoulder range of motion in children with obstetrical brachial plexus palsy (OBPP). No previous study reported the ideal postoperative physical therapy program for these cases.
AIM: The aim of the present study was to design appropriate postoperative physical therapy (PT) program after latissimus dorsi and teres major tendons transfer to rotator cuff in OBPP to improve upper limb function.
DESIGN: Time series design.
POPULATION: Forty seven OBPP infants (4.64±1.21 years with a range of 2.5 to 7 years, 21male and26 female) were allocated to one group. The patients were recruited from outpatient clinic of Kasr EL Aini Hospital, Cairo, Egypt. All patients had functional limitation in the involved arm due to muscle paralysis and contracture. 25patients had C5-C6 nerve root lesions while 22 had C5-C6-C7 nerve root lesions.
METHODS: The children underwent the surgical procedures of the transfer of latissimus dorsi and teres major tendons to rotator cuff. After the surgery the children participate in a designed physical therapy program for 6 months. Active shoulder abduction, flexion and external rotation range of motion (ROM) were assessed by electrogoniometer, and functional assessments were measured using the modified Mallet scale. All measurements were taken preoperative, 6 weeks, 3 months, and 6 months post- operatively after the application of the designed PT program.
RESULTS: Repeated measure analysis of variance (ANOVA) followed by Bonferroni post hoc test were used to show the improvement in all measured variables. Analysis revealed that shoulder abduction, flexion and external rotation ROM and shoulder function measured by modified Mallet scale were significantly improved (P˂0.0001) after the designed postoperative PT program.
CONCLUSION: It can be concluded that the combination treatment of surgical procedure and the postoperative physical therapy program seems to be effective in improving shoulder and arm functions in children with OBPP.
CLINICAL REHABILITATION IMPACT: This study describes a detailed physical therapy program after latissimus dorsi and teres major tendons transfer to rotator cuff in OBPP.