Pontillo Marisa, Sennett Brian J, Bellm Eric
Penn Sports Medicine Center, University of Pennsylvania Health System, Philadelphia, PA, USA.
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Int J Sports Phys Ther. 2020 Dec;15(6):1141-1150. doi: 10.26603/ijspt20201141.
BACKGROUND/PURPOSE: Return to play decision making for upper extremity injuries is challenging due to a lack of evidence-based protocols and testing. Current guidelines utilize tests and measures with minimal evidence on re-injury risks and prediction. The purpose of this case series is to highlight a functional testing algorithm for upper extremities injuries and the outcomes for the patients that followed it.
Case series.
Six subjects (18 - 21 years old) who underwent shoulder capsulolabral repair secondary to recurrent instability and/or unyielding pain are included. All subjects underwent a criterion-based rehabilitation program before being assessed with the authors' upper extremity functional testing algorithm. The upper extremity functional testing algorithm consists of measures of active range of motion (AROM), passive range of motion (PROM), peak isometric force, a fatigue testing battery, and the closed kinetic chain upper extremity stability test (CKCUEST) to assess readiness for return to sport.
All athletes achieved > 90% symmetry on at least two out of three tests during a fatigue testing protocol and at least 25 touches on the CKCUEST. All of the athletes returned to unrestricted football the season following surgical intervention. None of the athletes sustained an additional glenohumeral subluxation, dislocation, or upper extremity injury requiring surgical intervention for the remainder of their athletic careers (six years).
The presented cases help to illustrate the effectiveness of the upper extremity functional testing algorithm to assess return to sport readiness for male collegiate football athletes. The algorithm included testing of AROM/PROM and strength that is typically used, but also included the CKCUEST and fatigue testing to further challenge and assess the upper extremity prior to returning to sports.
背景/目的：由于缺乏循证方案和测试，上肢损伤后恢复运动的决策具有挑战性。当前指南所采用的测试和测量方法，在再损伤风险和预测方面的证据极少。本病例系列的目的是突出一种针对上肢损伤的功能测试算法以及遵循该算法的患者的治疗结果。
病例系列。
纳入6名（年龄在18 - 21岁之间）因复发性不稳定和/或顽固性疼痛而接受肩盂唇修复术的受试者。所有受试者在接受作者的上肢功能测试算法评估之前，均接受了基于标准的康复计划。上肢功能测试算法包括主动活动范围（AROM）、被动活动范围（PROM）、等长肌力峰值、疲劳测试组以及闭链上肢稳定性测试（CKCUEST），以评估恢复运动的准备情况。
在疲劳测试方案中，所有运动员在三项测试中的至少两项上实现了> 90%的对称性，并且在CKCUEST中至少完成了25次触摸。所有运动员在手术干预后的那个赛季都恢复了无限制的橄榄球运动。在其运动生涯的剩余时间（六年）里，没有运动员发生额外的盂肱半脱位、脱位或需要手术干预的上肢损伤。
所呈现的病例有助于说明上肢功能测试算法在评估男性大学橄榄球运动员恢复运动准备情况方面的有效性。该算法包括了通常使用的AROM/PROM和力量测试，但还包括CKCUEST和疲劳测试，以便在恢复运动之前进一步挑战和评估上肢。
4级。
