Article
Rehabilitation after reverse Sauvè-Kapandji procedures for the treatment of posttraumatic elbow: a case report
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Authors
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Isabella Monnanni
- Hand Rehabilitation Center, Florence, Italy
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Giulia Guidi
- Hand Rehabilitation Center, Florence, Italy
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Massimo Ceruso
- Hand Reconstructive unit Careggi Florence, Florence, Italy
| Published: | February 6, 2020 |
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Outline
Text
Clinical issue/s: We report the case of a 49 years old women, with high limitation of elbow prono-supination range of motion after a trauma which occurred 28 years ago. The patient presented elbow, shoulder, neck pain and motor impairment, frequent headache not solved after physical therapy. She was treated surgically by reverse Sauvè-Kapandji procedures followed by physiotherapy.
Clinical reasoning: We evaluated the differences in elbow range of motion (ROM), disability and pain (with DASH scale, PRWE score, VAS scale at rest and at movement) before surgery and at 6 months of follow up.
The rehabilitation treatment started 3 weeks after surgery. It was realized a Muenster splint and the active-assisted mobilisation of the elbow was allowed. Active mobilisation of fingers and shoulder was permitted from the start.
Manual therapy and exercises were purposed to restore the passive and active elbow movement. The patient presented a very significant difficulty to move the elbow actively in rotational directions and the arm motor pattern was altered. Mirror therapy, stabilization exercises and a static wrist splint were used to restore the right wrist motor control and to distribute the pronosupination movement between wrist and elbow. A wrist brace was used to control the wrist pain and ulnar head functional instability. Shoulder and neck impairments were treated with upper quadrant manual therapy and exercises.
Innovative, analytical or new approach: The evaluation revealed differences in range of motion of prono-supination, before surgery (0°-15°), and at 6 months of follow-up (70°-50°).
At FU the patient reported improvement in all the outcome measures. (DASH 51,97 vs 11,8, PRWE 39 vs 5, VAS at rest 1 vs 0, VAS at movement 5 vs 0).
Contribution to advancing HT practice: The physical therapy after reverse Sauvè-Kapandji procedures was useful to stabilize the improved elbow range of motion and the diminished pain. The focus was the restoration of the entire upper limb functional motor pattern including manual therapy and motor control exercises of all the upper quadrant joints.
