Physical therapists ofttimes stric...

Physical therapists ofttimes strictly limit inpatients' upper extremity motion (UEM) following median sternotomy (MS) Typical sternal precautions usually limit shoulder flexion (= 90?°) scapular adduction, weight-bearing end the upper extremity and lifting more than ten impounds However, such practice is suspect since early mobilization is typically indicated following-other surgical conducts wherein bony segments are re-approximated. With an estimated 400000 M acts performed annually, we felt the rationale for M precautions warranted further investigation. The plan of this literature review is to: 1) examine the design of published research specific to UEM and M and, 2) determine if published research supports UEM limitation. The authors reviewed 94 articles searching according to various combinations of "median sternotomy", "exercise", "sternal dehiscence", "wound healing", and related descriptors. No inpatient studies and merely one outpatient abstract specific to UEM and M were plant The remaining published research addressed cardiothoracic deeds using MS (57), sternal dehiscence (9) brachial plexus injury (9) rib trauma (5) musculoskeletal and postoperative non-surgical complications (13) The single application of mind addressing both UEM and M was retrospective and involved 77 patients following participation in outpatient cardiac rehabilitation. A variety of upper extremity modalities were applyed including arm ergometers and rowing machines. Pain status and tolerance to range of motion (ROM) challenge regulateed progression. No sternal nonunions secondary to UEM were reported. Given the at hand review, it appears the rationale for limiting UEM immediately following M is not onward based objective evidence. Further, although sternal precautions are cautious we hypothesize that strict UEM limitations may yield negative sequelae (eg. frozen shoulder). of the like kind sequelae might be ameliorated via progressive restoration of normal UEM starting at the inpatient level

M Ferez D Shaw. Physical Therapy Department, Southwest Texas State University, San Marcos, TX

Copyright Cardiopulmonary Physical Therapy Journal Dec 2003

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