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NONOPERATIVE REHABILITATION FOLLOWING TRAUMATIC ANTERIOR GLENOHUMERAL INSTABILITY IN A PROFESSIONAL BASEBALL PLAYER. Reinold MM, Wilk KE, Andrews JR; Healthsouth Sports Medicine & Rehabilitation Center, American Sports Medicine Institute, Birmingham, AL. michael.reinold@healthsouth.com. PURPOSE: Controversy exists regarding the optimal rehabilitation program following traumatic nonoperative anterior instability in the overhead athletic population. Specific guidelines involving the amount of time of immobilization and restrictions from activities vary. The overhead athlete requires a great degree of external rotation to perform at competitive levels, thus making lengthy immobilization disadvantageous due to the risk of motion complications, particularly external rotation. FOUNDATION: A period of brief restricted range of motion, without immobilization, followed by gradual restoration of passive range of motion, muscle strength, proprioception, dynamic stability, and neuromuscular control may be used to return the professional athlete to competition following traumatic instability. DESCRIPTION: The patient sustained a traumatic anterior dislocation during a head-first slide while colliding shoulder-first into another player on 3/31/03. The patient exhibited an anterior Bankart lesion with posterior Hill-Sachs lesion on magnetic resonance imaging. Initial presentation included passive flexion of 90° and external rotation at 45° abduction of 45° both with spasm end-feels. The patient was placed in a sling for comfort although immediate pain-free passive range of motion was performed for shoulder flexion, external rotation at 45° abduction, and internal rotation at 45° abduction as tolerated. External and internal rotation range of motion were progressed to 90° abduction at week 4-5. Isometric exercises and manual rhythmic stabilizations for the shoulder musculature were performed immediately following injury, progressing to include isotonic exercises for the glenohumeral and scapulothoracic musculature with emphasis on external rotation strength at week 2. Emphasis was placed on restoring baseline proprioception and dynamic stability initially, progressing to advanced neuromuscular control drills including manual perturbations and plyometrics by week 4. The patient began an interval throwing program at week 5 consisting of a gradual long-toss program and position specific drills. OBSERVATIONS: The patient progressed rapidly restoring full pain-free passive range of motion (180° degrees of flexion, 130° of external rotation and 65° of internal rotation at 90° abduction) at week 3 and gradually returned to unrestricted athletic activities at a premorbid level at 6 weeks (5/13/03 - 43 days) post-dislocation. The patient continued to play unrestricted for the remaining 4 months of the season. CONCLUSIONS: The discussed nonoperative guidelines, emphasizing immediate restricted range of motion, proprioceptive exercises, and neuromuscular training, may be used to restore function and return the overhead athlete to competition, while minimizing long term motion restrictions and recurrent instability following an acute traumatic instability of the glenohumeral joint. FUNDING SOURCE: None.
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