肩旋轉肌袖斷裂術後復健護理

Rehabilitation Nursing Care after a Rotator Cuff Tear Repair

10.6530/YYN/2018.5.3

曲幗敏(Kuo-Min Chu)；許秀珠(Hsin-Chu Hsu)；林麗華(Li-Hwa Lin)；顧振玲(Chen-Ling Ku)

肩旋轉肌袖斷裂 ； 肩旋轉肌袖修補術 ； 術後復健 ； 護理 ； rotator cuff tear ； rotator cuff repair ； rehabilitation ； nursing

源遠護理

12卷1期（2018 / 03 / 01）

17 - 25

繁體中文

肩旋轉肌袖是一種常見導致肩膀疼痛與失能的疾病，其影響的人口群從年輕人到年長者都有，但在年長者較為常見，也是中老年人肩關節功能失調最常見的疾病之一，主要症狀為疼痛與手臂上舉困難，治療方法有保守治療與手術治療，當保守治療無效時醫師會建議病患接受手術治療。術後復健是治療成功與否的關鍵因素，復健運動的目的為減緩疼痛與恢復肩部功能，運動需恰當，過與不及都會影響治療成效，運動過多容易導致肌腱再度斷裂，不足則會產生沾黏情形。復健運動共分為四個階段，術後早期階段、保護和保護性主動運動階段、早期加強階段以及增強階段。接受復健的時機與運動型態除了須考量肌腱癒合之生物機轉外，也須考量肌腱斷裂大小、肌腱本身的條件、肌腱修復與術前肩膀僵硬狀況，每個人的狀況不同，因此臨床上需依據病人的個別性擬定復健計畫，並需與病人充分溝通以確保運動安全。

Rotator cuff tears (RCT) are the most common causes of shoulder pain and disability. RCT occur both in the young and in the elderly, but they are significantly more common in the elderly population. It is one of the most common causes of shoulder disability in the elderly. The most common symptoms of RCT include pain and difficulty with overhead activities. RCT treatment includes conservative and operative methods. Conservative treatment is the appropriate initial plan of care for RCT. Surgery is also considered for patients who have attempted conservative treatment and regardless continue have difficulty with their shoulder. If conservative treatments fail to relieve pain or the patient continues to have difficulty with activities of daily living or occupational duties, surgical referral is recommended. The postoperative rehabilitation program is critical for the success of surgical treatment of RCT. The goals of rehabilitation are to relieve pain and restore shoulder function. The rehabilitation exercises should be appropriate; if attempting to do too much will lead to a retear, doing too less may cause stiffness. A rotator cuff rehabilitation program is broken down into four stages: immediate postoperative stage, protection and protected active stage, early strengthening, advanced strengthening stage. In order to ensure a successful rehabilitation protocol, understanding the biomechanical factors of the repaired Rotator Cuff tendon is an essential component. It is also necessary to considerate the size of the RCT, the condition of the tendon itself, the condition of the tendon repair, and shoulder stiffness before surgery. Individual exercise programs should be designed according to the patient's condition, and it is necessary to communicate to the patient why these exercise are needed and how they should be performed, in order to ensure the safety of the exercise.

1. 王嘉琪(2017)。旋轉肌袖撕裂。臨床醫學月刊，80(4)，593-600。
   連結：
2. Cuccurullo, S. J.,Cuccurullo, S.(2014).Physical medicine and rehabilitation board review.New York, United States:Demos Medical Publishing.
3. Fermont, A. J.,Wolterbeek, N.,Wessel, R. N.,Baeyens, J. P.,De Bie, R. A.(2014).Prognostic factors for successful recovery after arthroscopic rotator cuff repair: A systematic literature review.Journal of Orthopaedic & Sports Physical Therapy,44(3),153-163.
4. Frontera, W. R.,Silver, J. K.,Rizzo, T. D.(2015).Essentials of physical medicine and rehabilitation.Philadelphia, PA:Elsevier Saunders.
5. Gaunt, B. W.,McCluskey, G. M.,Uhl, T. L.(2010).An electromyographic evaluation of subdividing active-assistive shoulder elevation exercises.Sports Health,2(5),424-432.
6. Giangarra, C. E.,Manske, R. C.(2017).Clinical orthopaedic rehabilitation: A team approach e-book.Elsevier Health Sciences.
7. Gordon, N. M.,Maxson, S.,Hoffman, J. K.(2012).Biologically enhanced healing of the rotator cuff.Orthopedics (Online),35(6),498-504.
8. Haering, D.,Blache,Y,Raisonc, M.,Begon, M(2015).Mechanical risk of rotator cuff repair failure during passive movements: A simulation-based study.Clinical Biomechanics,30,1181-1188.
9. Koo, S. S.,Burkhart, S. S.(2010).Rehabilitation following arthroscopic rotator cuff repair.Clinics in Sports Medicine,29(2),203-211.
10. Lee, D. H.,Neviaser, R. J.(2011).Shoulder and Elbow Surgery.Philadelphia:Elsevier/Saunders.
11. Lotke, P. A.,Abboud, J. A.,Ende, J.(2013).Lip- pincott s primary care orthopaedics.United States:Wolters Kluwer.
12. MacDermid, J. C.,Holtby, R.,Razmjou, H.,Bryant, D.,Canada, J.(2006).All-arthroscopic versus mini-open repair of small or moderate-sized rotator cuff tears: A protocol for a randomized trial.BMC Musculoskeletal Disorders,7(25),1-11.
13. McCormick, F.,Wilcox III, R. B.,Alqueza, A.(2015).Postoperative rotator cuff repair rehabilitation and complication management.Operative Techniques in Orthopaedics,25(1),76-82.
14. Nikolaidou, O.,Migkou, S.,Karampalis, C.(2017).Rehabilitation after Rotator Cuff Repair.The Open Orthopaedics Journal,11,154-162.
15. Osborne, J. D.,Gowda, A. L.,Wiater, B.,Wiater, J. M.(2016).Rotator cuff rehabilitation: Current theories and practice.The Physician and Sports-medicine,44(1),85-92.
16. Ross, D.,Maerz, T.,Lynch, J.,Norris, S.,Baker, K.,Anderson, K.(2014).Rehabilitation following arthroscopic rotator cuff repair: A review of current literature.The Journal of the American Academy of Orthopaedic Surgeons,22(1),1-9.
17. Savin, D.,Meadows, M.,Verma, N.,Cole, B.(2017).Rotator cuff healing: improving biology.Operative Techniques in Sports Medicine,25(1),34-40.
18. Smith, M. A.,Smith, W. T.(2010).Rotator cuff tears an overview.Orthopaedic Nursing,29(5),319-322.
19. Thigpen, C. A.,Shaffer, M. A.,Kissenberth, M. J.(2015).Knowing the speed limit weighing the benefits and risks of rehabilitation progression after arthroscopic rotator cuff repair.Clinics in Sports Medicine,34(2),233-246.
20. Yi, A.,Villacis, D.,Yalamanchili, R.,Hatch, G. F., 3rd.(2015).A Comparison of Rehabilitation Methods After Arthroscopic Rotator Cuff Repair: A Systematic Review.Sports Health,7(4),326-334.
21. 李東煌(2015).中醫傷骨科學：結構醫學.台北:五南圖書出版股份有限公司.
22. 周正亮,程遠揚,陳慶駿,張佳琳,黃東富,鄭舜平,劉作仁(2006)。中老年人肩旋轉肌破損之復健。台灣復健醫誌，34(3)，141-148。

1. 曾韻珊,陳恊聰,林春珍(2020)。照護一位因運動傷害導致肩關節肩盂唇撕裂病人之手術全期護理。志為護理-慈濟護理雜誌，19(6)，125-136。
2. 鄭巧佩,潘雪幸,林佳慧,林玉雪(2022)。照顧一位行肩關節鏡手術後病人噁心嘔吐之護理經驗。源遠護理，16(增訂刊)，5-12。