A Rehabilitation protocol for Arthroscopic Bankart repair in Korean Medicine : A Case Report

Ji-Hye Geum; Dong-gi Baek; Jung-Han Lee; Geum, Ji-Hye; Baek, Dong-gi; Lee, Jung-Han

doi:10.13048/jkm.19033

JKM > Volume 40(3); 2019 > Article

Geum, Baek, and Lee: A Rehabilitation protocol for Arthroscopic Bankart repair in Korean Medicine : A Case Report

Case Report

The Journal of Korean Medicine 2019; 40(3): 177-187.

Published online: September 30, 2019

DOI: https://doi.org/10.13048/jkm.19033

A Rehabilitation protocol for Arthroscopic Bankart repair in Korean Medicine : A Case Report

Ji-Hye Geum¹

, Dong-gi Baek²

, Jung-Han Lee¹^{, 3}^{, *}

¹Department of Rehabilitation Medicine of Korean Medicine, College of Korean Medicine, Won-Kwang University

²Department of Internal Medicine of Korean Medicine, College of Korean medicine, Won-Kwang University

³Traditional Korean Medicine Institute, Won-Kwang University

Correspondence to: Jung-Han Lee, Department of Rehabilitation Medicine of Korean Medicine, College of Korean Medicine, Won-Kwang University 895, Muwang-ro, Iksan-si, Jeollabuk-do, 54538, Rep. of Korea Tel: +82-63-859-2807, Fax: +82-63-841-0033, E-mail: milpaso@wku.ac.kr

Received July 23, 2019 Revised August 13, 2019 Accepted August 16, 2019

Abstract

Objectives

The aim of this study was to report the clinical improvement of a patient who underwent arthroscopic Bankart repair using a rehabilitation protocol involving Korean medicine.

Methods

The patient was treated with acupuncture, cupping, Korean Medicine, Chuna therapy, and Doin exercise therapy during the admission period. To estimate the patient’s status, we used the Numeric Rating Scale (NRS), Pain Disability Index (PDI), assessments of the range of motion (ROM) and Muscle Manual Test (MMT) for the shoulder joint.

Results

After administering the abovementioned treatments, we found that the patient’s NRS, PDI, and ROM and MMT for the shoulder joint were improved.

Conclusions

The rehabilitation protocol involving Korean medicine can be applied to and produce good results for patients who undergo arthroscopic repair for Bankart lesions. The limitation of the study was that the number of cases we studied was insufficient to prove the effectiveness. Hence, further studies are needed for designing the rehabilitation protocol involving Korean medicine.

Keywords: Bankart lesion, Arthroscopy, Rehabilitation, Protocol, Korean Medicine, Postoperative period

Fig. 1

[2018.02.06.] Shoulder AP ; Right shoulder dislocation

Fig. 2

[2018.02.12.] Shoulder MRI ; Compatible with Bankart lesion(labral tear) in right shoulder d/t previous anteroinferior dislocation of shoulder joint.

Table 1

Medicinal herbal formulas of target diseases

	Phase I	Phase II	Phase III
Criteria for next phase	Declared by physician to begin rehabilization Shoulder AAROM* Flex.† ≥ 90° Abduction ≥ 90°	Shoulder Full PROM‡ (Except Ext.Rot.§,, Int.Rot.\|\|) Shoulder AAROM* Flex.† ≥ 120° Abduction ≥ 120° Ext.Rot.§ ≥ 55° Int.Rot. \|\| ≥ 55°
Guidelines & Goal	Control pain & edema Prevent inflammation Protect surgical wound Prevent Shoulder AROM¶ exercise	Restore full PROM‡ Initiate Shoulder strengthening & AROM¶ exercise	Restore full AROM** Restore normal scapulothoracic motion Restore muscular Strength and balance Return to daily living and work Start nonoverhead sport-specific activity
Patient education	Ice & Sling keep	Ice (as needed) Sling (None)	None
ROM**	PROM‡ Flex.† ≥ 90° Abduction ≥ 90° Ext.Rot.§ ≥ 20–30° Int.Rot.\|\| behind back	PROM‡ Full Ext.Rot.§, Int.Rot.\|\| AAROM* Flex.† ≥ 120° Abduction ≥ 120° Ext.Rot.§ ≥ 15° Int. Rot.\|\| as tolerate (Supine, Abduction to 60°)	Full ROM**
Acupuncture	Remote acupoint needling	Near & remote acupoint needling	Continue Phase II
Cupping Therapy	Dry cupping therapy	Dry & venesection cupping therapy	Continue Phase II
Herbal medicine	Herbal medicine for reducing edema and pyrexia	Herbal medicine for assisting strengthening Shoulder joints	Continue Phase II
DET††	Hand, Wrist, Elbow, Cervical ROM** exercise Squeeze ball Supported pendulum (Foward/back, Side/side) Scapular pinches	Continue Phase I Wall slide Cane exercises - PROM‡ Flex.†, Abduction, Scaption to 90° Passive horizontal Adduction Shoulder pulley Prone scapular retraction with light weight Push-up progression wall to table Pool	Continue Phase II Cane exercises - PROM‡ Flex.†, Abduction to 120° , Ext.Rot.§ to 15° Large theraball on floor : circles clockwise/counterclockwise Push-up progression table to chair Shoulder Ext.Rot.§, Int.Rot.\|\|, Extension Isotoincs Theraband Scapular retraction Lower trapezius work Treadmill
CMT‡‡	CJMT§§ : Elbow, Wrist FCT\|\|\|\| : Cervical	Continue Phase I MET¶¶: Shoulder	Continue Phase II

* AAROM: Active assistive range of motion,

† Flex.: Flexion,

‡ PROM: Passive range of motion,

§ Ext.Rot.: External rotation,

|| Int.Rot.: Internal Rotation,

¶ AROM: Active range of motion,

** ROM: Range of motion,

†† DET: Doing exercise therapy,

‡‡ CMT: Chuna manual therapy,

§§ CJMT: Chuna joint mobilization therapy,

|||| FCT: Fascia Chuna therapy,

¶¶ MET: Muscle energy technique

Table 2

The Change of NRS, PDI, P/Ex.* in Case

Case	Evaluation time

	2018.02.19. (Adm†)	2018.03.23. (D/C‡)
Scale or score
NRS	7	3
PDI	53	26

ROM§
Flexion	20°/180°	100°/180°
Extension	5°/55°	45°/55°
Abduction	10°/180°	75°/180°
Adduction	5°/45°	30°/45°

MMT\|\|
Flexion	2−/5	3+/5
Extension	2−/5	3+/5
Abduction	2−/5	3+/5
Adduction	2−/5	3+/5

Other symptoms
Swelling	−/+	−/−
Pyrexia	−/+	−/±¶
Flare	−/+	−/−

* P/Ex.: physical examination

† Adm: Admission,

‡ D/C: Discharge,

§ ROM: Range Of Motion,

|| MMT: Manual muscle test,

¶ ±: Intermittent symptom.

참고문헌

1. Jeong MS, Jeon JM, Tae SG, Oh JH. The shoulder Surgery. 1st ed.Seoul: Koonja Publishing Co;2010. 141:p. 288p. 292p. 295p. 297–8.

2. Adams JC. Recurrent Dislocation of the Shoulder. J Bone and Joint Surg. 1948; 30–B:26–38.

3. Choi CH, Kwun KW, Kim SK, Lee SW, Shin DK, Kim KM. Bankart suture repair for anterior instability of the shoulder: results of arthroscopic versus open repair. J Korean Shoulder Elbow Soc. 2002; 5:47–54.

4. Kim YS. Rehabilitation after Bankart and SLAP repair. Journal of Korean Arthroscopy Soc. 2008; 12:2. 75–81.

5. Noh HK, Park JW, Lee JI, Park JH. Result of early active range of motion exercise after bankart repair of traumatic anterior instability. Jourmal of the Korean Fracture society. 2007; 20:1. 53–7.

6. Lee JH, Ko MK, Yoon KS, Lee CW, Kim YI, Kim JH. Case report of acute traumatic rotator cuff tear treatment in traditional korean medicine. Jourmal of pharmacopuncture. 2011; 14:4. 53–8.

7. Yeom SR, Song JH. Calcific Tendinitis of the Shoulder by Oriental Medical Treatments : 4 Cases Report. J Oriental Rehab Med. 2010; 20:1. 209–17.

8. Song MY, Jo HG, Sul JU, Leem JT. Proposal of East-west Integrative Medicine manual for Rehabilitation after shoulder surgery. Journal of Korean Medicine Rehabilitation. 2018; 28:1. 109–20.

9. DeFroda Steven, Mehta Nabil, Owens Brett. Physical Therapy Protocols for Arthroscopic Bankart Repair. Sports health. 2018; 10

10. Lee KO, Kuk YB, Yun YG. Effects of Jakyakgamchotang extract on the Analgestic effect in Mice. Korean J Oriental Medical Prescription. 2003; 11:1. 161–70.

11. Kim BW. Anti-inflammatory effect of Jakyakgamcho-tang. Korean J Orient Int Med. 2010; 31:2. 365–71.

12. Korean Society of Chuna Manual medicine for Spine & Nerves. Chuna manual medicine. 2.5th EdSeoul: Korean Society of Chuna Manual medicine for Spine & Nerves;2017. p. 101p. 222–30. p. 262p. 282–4..

13. The Society of Korean Medicine Rehabilitation. Korean Rehabilitation Medicine. 4th ed. Seoul: Koonja Publishing Co;2015. 3:p. 100p. 404–5. p. 413–6.

14. Haerer AF. The neurologic examination. 5th ed. Philadelphia: JB’ Lippincott company;1992. p. 335–74.

15. Shim SY, Park HJ, Lee JM, Lee HS. An Overview of Pain Measurements. The Korean Journal of Meridian & Acupoint. 2007; 24:2. 81–2.

16. Pollard CA. Preliminary validity study of the pain disability index. Percept Mot Skills. 1984; 59:3. 974

17. MacLaughlin HL. Recurrent Anterior Dislocation of the Shoulder. I. Morbid anatomy. Am J Surg. 1960; 99:628–32.

18. Reeves B. Acute Anterior Dislocation of the Shoulder. Ann R Coll SurgEngl. 1989; 43:225

19. Rockood CA, Masten FA. The Shoulder. 1st Ed. Philadelphia: W.B. Saunder Co;1990. 1:p. 230–1.

20. Bankart ASB. The Pathology and treatment of recurrent dislocation of the Shoulder Joint. British JSurg. 1938; 26:23–9.

21. Steven CT, Matsen FA. An approch to the repair of avulsion of the glenohumeral ligament in the management of traumatic anterior glenohumeral instability. JBone and Joint Surg. 1989; 71–A:511

22. Manta JP, Organ S, Nirschl RP, Pettrone FA. Arthroscopic transglenoid suture capsulolabral repair. Am J Sports Med. 1997; 25:614–8.

23. Morgan CD, Bodenstab AB. Arthroscopic bankart suture repair: technique and early results. Arthroscopy. 1987; 3:111–22.

24. Walch G, Boileau P, Levigne C, Mandrino A, Neyret P, Donell S. Arthroscopic stabilization for recurrent anterior shoulder dislocation: result s of 59 cases. Arthroscopy. 1995; 11:173–9.

25. Owens BD, Hurwitz SR, Thompson TL, Wolf JM. Surgical trents in Bankart repair:an analysis of data from the American board of Orthopaedic surgery certification examination. Am J Sports Med. 2011; 39:1865–9.

26. Kim MK, Shin CS. Results According to Arthroscopic Repair Methods of Bankart Lesion (Operative Methods According to Labral Tear). The Journal of the Korean Orthopaedic Association. 2001; 36:6. 525–30.

27. Michael J. Strobel Manual of Arthroscopic surgery. 1st ed. Seoul: Gabon Publishing Co;2006. p. 875–82.

28. St Mary’s hospital. Rehabilitation after Bankart and SLAP Repair. Journal of Korean Arthroscopy Soc. 2008; 12:2. 75

29. Rowe CR, Zarins B. Recurrent transient subluxation of the shoulder. J Bone Joint surg Am. 1981; 63:863–72.