Role of Early Physiotherapy to Enhance Functional Ability in a Patient with Bipolar Latissimus Dorsi Myocutaneous Flap Transfer at the Elbow:A Case Report
Background – Elbow flexion is often lacking in patients with neuro- vascular injuries post trauma to the arm. Option for functional reconstruction is often limited in such patients due to delayed presentation and unavailability of suitable nerves and blood vessels. Many a times the only available option is regional (Latissimus dorsi) or Free (gracilis) functional muscle transfer. Physiotherapy in the form of exercises and electrical stimulation, muscle re-education form an important part of post-operative protocol which helps in regaining the functional ability after bipolar latissimus dorsi transfer.
Case Description – A 17 year old male met with a road traffic accident which led to injury to his right arm because of which his radial, ulnar, median and musculocutaneous nerve got injured. Patient was unable to flex the elbow because of this injury. Surgeons performed bipolar latissimus dorsi myocutaneous flap transfer at the elbow and after the surgery patient was referred for the postoperative rehabilitation. Method – A case of post-bipolar latissimus dorsi transfer with reduced strength and range of motion has been presented.
Intervention – Pulsed short wave diathermy at the axilla for 15 minutes. Electrical stimulation over the transferred latissimus dorsi, lumbricals, flexor carpi radialis, flexor carpi ulnaris, flexor digitorum profundus and superficialis for 10 minutes each. Tapping was done over the transferred latissimus dorsi muscle with range of motion exercises. The subject was treated 1 hour per day, 3 days a week for 3 months.
Outcome Measures – Right shoulder/elbow/wrist muscular strength measured by manual muscle test, Right shoulder/elbow/wrist active and passive range of motion, Functional ability measured by Disabilities of arm, shoulder and hand scale.
Results – Physiotherapy can effectively improve the range and strength of the elbow muscles thus improving the functional capacity.
Conclusion – Elbow and arm function post operatively can significantly improve through various physiotherapeutic interventions.
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