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

Article information

J Korean Med. 2019;40(3):177-187

Publication date (electronic) : 2019 September 30

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

Ji-Hye Geum ¹

, Dong-gi Baek ²

, Jung-Han Lee ¹^,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 2019 July 23; Revised 2019 August 13; Accepted 2019 August 16.

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

Table 2

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

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Article information Continued

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.