RU2847722C1 - Rehabilitation method for oncological endoprosthetics of the elbow joint - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to methods of therapeutic physical training and can be used in the rehabilitation of patients after oncological endoprosthetics of the elbow joint. In the preoperative period, psychological preparation, training in verticalisation techniques using immobilisation devices, as well as training in correct deep chest and diaphragmatic breathing during respiratory gymnastics and a set of physical exercises aimed at strengthening the muscles of the upper limb girdle are carried out. On the 7th day after elbow joint replacement, a set of exercises is performed, including flexion, extension, pronation, supination of the upper limb, as well as raising the arm and its internal and external rotation, performed in a state of pre-tension within the pain threshold.

EFFECT: improved functional results and reduced pain syndrome in patients undergoing oncological elbow joint replacement.

1 cl, 4 dwg, 2 ex

Description

The invention relates to the field of medicine, in particular to methods of therapeutic exercise, and can be used in the rehabilitation of patients after oncological elbow arthroplasty.

Today, with the expansion of indications for organ-preserving surgeries, the use of new reconstruction techniques, and the advancement of metal structures, it has become possible to improve the quality of life of cancer patients after surgery. The development of rehabilitation methods plays an equally important role.

Elbow arthroplasty is only the first step on the road to recovery. The next, no less important, step is rehabilitation, which plays a key role in restoring functional status, improving quality of life, and, most importantly, enhancing the effectiveness of oncological outcomes.

Existing rehabilitation programs after elbow arthroplasty are designed for trauma patients. In orthopedic oncology, rehabilitation methods for elbow arthroplasty following distal humeral (proximal ulnar) resection are sporadic and primarily tailored to the individual patient.

The closest analogue (prototype) is the method for rehabilitation of patients with elbow joint contractures (RU 2286085 C2). Before physiotherapy, plexus anesthesia of the brachial plexus is performed by administering 45.0 ml of 0.5% lidocaine and 0.3 ml of 1% adrenaline to the affected side 2-3 times every 5-6 days during the physiotherapy course. Therapeutic exercise begins 1.5-2 hours after anesthesia.

A drawback of the known prototype is that the method is not aimed at rehabilitation after oncological elbow arthroplasty, which is extremely important given the en-block muscle resection during surgery. This method also addresses existing limitations of passive elbow motion, indicating a delayed postoperative period. Additional anesthetic support, specialized knowledge, and potential trauma to the shoulder joint, brachial plexus, and plexitis due to frequent drug administration are also required.

Rehabilitation tactics for cancer patients differ significantly from existing standards in traumatology and orthopedics. This is due to the need to adhere to the fundamental principles of surgical interventions in oncological orthopedics, such as sheathing, ablasticity, and radicality, performing adequate muscle grafting, and covering the endoprosthesis with soft tissue to reduce the risk of infection.

The objective of the invention is to improve the functional status after surgical treatment of tumor lesions of the elbow joint with endoprosthetics.

This problem is solved by the fact that, as in the known method, the patient is psychologically prepared, taught verticalization techniques and the use of immobilization means together with a rehabilitation physician, taught correct deep chest and diaphragmatic breathing during breathing exercises, and a set of physical exercises aimed at strengthening the muscles of the upper limb girdle.

A special feature of this invention is that on the 7th day after elbow joint endoprosthetics, a set of exercises is performed that include flexion, extension, pronation, supination of the upper limb, as well as raising the arm and its internal and external rotation, performed in a state of pre-tension within the pain threshold according to the following scheme:

- first week:

Exercise I: the patient sits on a chair and performs pronation/supination of the forearm, the hand lies on the couch, the elbow joint is fixed in a 90-degree position, with the edge of the palm down, at a pace of 2 minutes per exercise 4-6 times a day with an amplitude of 10 degrees, while the hyperextension of the wrist is 0 degrees;

Exercise II: the patient sits on a chair, the operated arm is in a hanging position, the elbow joint is in a fixed position of 90 degrees and, with the help of a doctor-instructor, flexion is performed at the elbow joint, while the arm is turned towards the patient's chest with an attempt to raise the elbow to the shoulder for 2-3 minutes and alternate flexion and extension movements are performed at the elbow joint 3-4 times a day;

Exercise III: the patient stands on the floor, extending the operated arm forward and holding an object weighing up to 0.5 kg in his hand and “draws” the letters of the alphabet in the air for 2 minutes 4-6 times a day;

- second week:

Exercise I: the patient stands on the floor, the arm is relaxed and lies on the surface of the table, the elbow joint is in a fixed position at 90 degrees, with the edge of the palm down, and pronates/supinates the forearm with an amplitude of 10-15 degrees 3-4 times a day for 2-3 minutes;

Exercise II: the patient sits on a chair and pronates/supinates the forearm, the arm lies on the couch, the elbow joint is fixed in a 90-degree position, with the edge of the palm facing down, for 2 minutes 4-6 times a day with an amplitude of 10 to 15 degrees, while the hyperextension of the wrist is 0 degrees;

Exercise III: the patient sits on a chair, the operated arm is in a hanging position, the elbow joint is in a fixed position of 90 degrees and, with the help of a doctor-instructor, bends are performed at the elbow joint, while the arm is turned towards the patient's chest and an attempt is made to raise the elbow to the shoulder for 4-5 minutes, alternately flexion and extension movements are performed at the elbow joint 4-5 times a day;

Exercise IV: the patient stands on the floor, extending the operated arm forward and holding an object weighing up to 0.5 kg in his hand and “draws” letters in the air one by one for 2 minutes 6-8 times a day;

- third week:

Exercise I: the patient stands on the floor, the arm is relaxed and lies on the surface of the table, the elbow joint is in a fixed position at 90 degrees, with the edge of the palm down, and performs pronation/supination of the elbow joint with an amplitude of 15 to 20 degrees 3-5 times a day for 3-4 minutes;

Exercise II: the patient performs forearm pronation/supination while sitting on a chair, the arm lies on the couch, the elbow joint is fixed in a 90-degree position, with the edge of the palm facing down, for 2 minutes 6-8 times a day with an amplitude of 10 to 15 degrees, while the wrist hyperextension is 0 degrees;

Exercise III: the patient sits on a chair, the operated arm is in a hanging position, the elbow joint is in a fixed position of 90 degrees and independently performs flexion at the elbow joint, while turning the arm towards the chest and trying to raise the elbow to the shoulder for 2-3 minutes and performs alternate flexion and extension movements at the elbow joint 3-4 times a day;

Exercise IV: the patient stands on the floor, extending the operated arm forward and holding an object weighing from 0.5 to 1 kg in his hand and “draws” in the air the letters of the alphabet and numbers one by one for 2 minutes 6-8 times a day;

- fourth week:

Exercise I: the patient stands on the floor, the arm is relaxed and lies on the surface of the table, the elbow joint is in a fixed position at 90 degrees, with the edge of the palm down, pronation/supination of the forearm is performed with an amplitude of 20 degrees 5 times a day for 5 minutes;

Exercise II: the patient performs pronation/supination of the forearm while sitting on a chair, the arm lies on the couch, the elbow joint is in a fixed position at 90 degrees, with the edge of the palm down, for 2 minutes 8-10 times a day with an amplitude of 20 degrees, while the hyperextension of the wrist is 0 degrees;

Exercise III: the patient sits on a chair, the operated arm is in a hanging position, the elbow joint is in a fixed position of 90 degrees and independently performs flexion at the elbow joint, while turning the arm towards the chest with raising the elbow to the shoulder for 4-5 minutes, alternately performing flexion and extension movements in the elbow joint 4-5 times a day;

Exercise IV: the patient stands on the floor, extending the operated arm forward and holding an object weighing from 1 kg to 3.5 kg in his hand and “draws” in the air the letters of the alphabet and numbers one by one for 2 minutes, 8-10 times a day.

The rehabilitation method for oncological elbow arthroplasty is explained with a description, examples of practical use, and illustrations depicting:

Fig. 1 – photo illustration of performing pronation/supination of the forearm in a standing position.

Fig. 2 - photo illustrations when performing pronation/supination of the forearm in a sitting position: a) the palm is turned down; b) the palm is turned up.

Fig. 3 - photo illustrations of flexion and extension of the elbow joint: a) flexion of the elbow joint; b) extension of the elbow joint.

Fig. 4 - photo illustration of the execution of active arm movements using a load.

The method is carried out as follows.

In the preoperative period, rehabilitation includes: psychological preparation of the patient, training in verticalization techniques and the use of immobilization devices in conjunction with a rehabilitation physician, training in correct deep chest and diaphragmatic breathing during breathing exercises, and a set of physical exercises aimed at strengthening the muscles of the upper limb girdle.

Rehabilitation measures are implemented starting from day 0 in the early postoperative period. Pain management, including the use of gabapentinoids, is administered to relieve postoperative pain and prevent chronic pain. Breathing exercises are performed. Complete immobilization of the upper limb is achieved using a sling. The patient is kept in a vertical position to prevent hypodynamic respiratory complications.

On the 1st day after surgery, transition to a period of relative immobilization, including isometric exercises for the muscles of the operated limb.

All exercises are of a “gentle nature” - treatment by position.

The essence of the period of relative immobilization consists of multiple, regularly repeated and consistently increasing physical activity, which gradually improves motor activity indicators, dynamically improves and restores the functionality of the operated limb.

When performing exercises to develop the elbow joint after oncological arthroplasty, axial loading is taken into account. To achieve good functional results, it is recommended to begin with easier starting positions, ensuring a range of motion within the limits of mild and painless muscle stretching, and gradually adapt the operated limb to physical activity.

On the 7th day after elbow arthroplasty, a set of exercises is performed that include flexion, extension, pronation, supination of the upper limb, as well as raising the arm and its internal and external rotation, performed in a state of pre-tension within the pain threshold according to the following scheme:

- First week:

Exercise I: the patient sits on a chair and performs pronation/supination of the forearm, the hand lies on the couch, the elbow joint is fixed in a 90-degree position, with the edge of the palm down, at a pace of 2 minutes per exercise 4-6 times a day with an amplitude of 10 degrees, while the hyperextension of the wrist is 0 degrees (Fig. 2 a, b);

Exercise II: the patient sits on a chair, the operated arm is in a hanging position, the elbow joint is in a fixed position of 90 degrees and, with the help of a doctor-instructor, flexion is performed at the elbow joint, while the arm is turned towards the patient’s chest with an attempt to raise the elbow to the shoulder for 2-3 minutes and alternate flexion and extension movements are performed at the elbow joint 3-4 times a day (Fig. 3 a, b);

Exercise III: the patient stands on the floor, extending the operated arm forward and holding an object weighing up to 0.5 kg in his hand and “draws” the letters of the alphabet in the air for 2 minutes 4-6 times a day (Fig. 4).

- Second week:

Exercise I: the patient stands on the floor, the arm is relaxed and lies on the surface of the table, the elbow joint is in a fixed position at 90 degrees, with the edge of the palm down, and pronates/supinates the forearm with an amplitude of 10-15 degrees 3-4 times a day for 2-3 minutes (Fig. 1);

Exercise II: the patient performs pronation/supination of the forearm while sitting on a chair, the arm lies on the couch, the elbow joint is fixed in a 90-degree position, with the edge of the palm down, for 2 minutes 4-6 times a day with an amplitude of 10 to 15 degrees, while the hyperextension of the wrist is 0 degrees (Fig. 2 a, b);

Exercise III: the patient sits on a chair, the operated arm is in a hanging position, the elbow joint is in a fixed position of 90 degrees and with the help of a doctor-instructor, bending is performed at the elbow joint, while the arm is turned towards the patient’s chest and an attempt is made to raise the elbow to the shoulder for 4-5 minutes, alternately flexion and extension movements are performed at the elbow joint 4-5 times a day (Fig. 3 a, b);

Exercise IV: the patient stands on the floor, extending the operated arm forward and holding an object weighing up to 0.5 kg in his hand and “draws” letters in the air one by one for 2 minutes 6-8 times a day (Fig. 4).

- Third week:

Exercise I: the patient stands on the floor, the arm is relaxed and lies on the surface of the table, the elbow joint is in a fixed position at 90 degrees, with the edge of the palm down, and performs pronation/supination of the elbow joint with an amplitude of 15 to 20 degrees 3-5 times a day for 3-4 minutes (Fig. 1);

Exercise II: the patient performs forearm pronation/supination while sitting on a chair, the arm lies on the couch, the elbow joint is fixed in a 90-degree position, with the edge of the palm facing down, for 2 minutes 6-8 times a day with an amplitude of 10 to 15 degrees, while the wrist hyperextension is 0 degrees (Fig. 2 a, b);

Exercise III: the patient sits on a chair, the operated arm is in a hanging position, the elbow joint is in a fixed position of 90 degrees and independently performs flexion at the elbow joint, while turning the arm towards the chest and trying to raise the elbow to the shoulder for 2-3 minutes and performs alternate flexion and extension movements at the elbow joint 3-4 times a day;

Exercise IV: the patient stands on the floor, extending the operated arm forward and holding an object weighing from 0.5 to 1 kg in his hand and “draws” in the air the letters of the alphabet and numbers one by one for 2 minutes 6-8 times a day (Fig. 4).

- Week four:

Exercise I: the patient stands on the floor, the arm is relaxed and lies on the surface of the table, the elbow joint is in a fixed position at 90 degrees, with the edge of the palm down, pronation/supination of the forearm is performed with an amplitude of 20 degrees 5 times a day for 5 minutes (Fig. 1);

Exercise II: the patient performs pronation/supination of the forearm while sitting on a chair, the arm lies on the couch, the elbow joint is in a fixed position at 90 degrees, with the edge of the palm down, for 2 minutes 8-10 times a day with an amplitude of 20 degrees, while the hyperextension of the wrist is 0 degrees (Fig. 2 a, b);

Exercise III: the patient sits on a chair, the operated arm is in a hanging position, the elbow joint is in a fixed position of 90 degrees and independently performs flexion at the elbow joint, while turning the arm towards the chest with raising the elbow to the shoulder for 4-5 minutes, alternately performing flexion and extension movements in the elbow joint 4-5 times a day;

Exercise IV: the patient stands on the floor, extending the operated arm forward and holding an object weighing from 1 to 3.5 kg in his hand and “draws” in the air the letters of the alphabet and numbers one by one for 2 minutes 8-10 times a day (Fig. 4).

The classes conclude with exercises aimed at muscle relaxation, which are performed according to the traditional scheme.

Classes are held regularly: initially under the guidance of a physical therapy instructor, and then independently, including at home.

Clinical example No. 1.

Patient M., 32 years old, was treated in the onco-orthopedics department with a diagnosis of: Chondrosarcoma of the right humerus cT2N0M0G1 stage I. Pain syndrome of oncological genesis.

Upon admission, the patient complained of pain and limited range of motion in the right elbow joint. To relieve the pain, the patient took non-narcotic analgesics and NSAIDs (tramadol, nise, xefocam, etc.) several times throughout the day. His VAS pain score was 6. His functional score on the MSTS scale at the time of presentation was 52%.

The patient underwent elbow replacement surgery.

Starting from the 7th day after the operation, the patient underwent 30 days of exercise therapy sessions with psychological preparation, was taught verticalization techniques and the use of immobilization tools together with a rehabilitation physician, was taught correct deep chest and diaphragmatic breathing during breathing exercises, carried out a set of physical exercises aimed at strengthening the muscles of the upper limb girdle, flexion, extension, pronation, supination of the upper limb, as well as raising, internal and external rotation of the arm, performed from a state of pre-exertion, within the threshold of pain.

First week:

Exercise I: the patient sits on a chair and performs pronation/supination of the forearm, the hand lies on the couch, the elbow joint is fixed in a 90-degree position, with the edge of the palm down, at a pace of 2 minutes per exercise 6 times a day with an amplitude of 10 degrees, while the hyperextension of the wrist was 0 degrees (Fig. 2 a, b);

Exercise II: the patient sits on a chair, the operated arm is in a hanging position, the elbow joint is in a fixed position of 90 degrees and, with the help of a doctor-instructor, bending is performed at the elbow joint, while the arm is turned towards the patient’s chest with an attempt to raise the elbow to the shoulder for 2 minutes, alternately flexion and extension movements in the elbow joint 3 times a day (Fig. 3 a, b);

Exercise III: the patient stands on the floor, extending the operated arm forward and holding a bottle of water (0.5 kg) in his hand and “draws” the letters of the alphabet in the air for 2 minutes, 6 times a day (Fig. 4).

Week 2:

Exercise I: the patient stands on the floor, the arm is relaxed and lies on the surface of the table, the elbow joint is in a fixed position at 90 degrees, with the edge of the palm down, pronation/supination of the forearm is performed with an amplitude of 15 degrees 4 times a day for 3 minutes (Fig. 1);

Exercise II: the patient performs forearm pronation/supination while sitting on a chair, the arm lies on the couch, the elbow joint is fixed in a 90-degree position, with the edge of the palm facing down, at a tempo for one exercise of 2 minutes 6 times a day with an amplitude of 15 degrees, while the hyperextension of the wrist is 0 degrees (Fig. 2 a, b);

Exercise III: the patient sits on a chair, the operated arm is in a hanging position, the elbow joint is in a fixed position of 90 degrees and, with the help of a doctor-instructor, bending is performed at the elbow joint, while the arm is turned towards the patient’s chest and an attempt is made to raise the elbow to the shoulder for 4 minutes, alternately performing flexion and extension movements in the elbow joint 4 times a day (Fig. 3 a, b);

Exercise IV: the patient stands on the floor, extending the operated arm forward and holding a bottle of water (0.5 kg) in his hand and “draws” letters and numbers in the air one by one for 2 minutes 8 times a day (Fig. 4).

Week 3:

Exercise I: the patient stands on the floor, the arm is relaxed and lies on the surface of the table, the elbow joint is in a fixed position at 90 degrees, with the edge of the palm down, and performs pronation/supination of the elbow joint with an amplitude of 15 degrees 5 times a day for 4 minutes (Fig. 1);

Exercise II: the patient performs forearm pronation/supination while sitting on a chair, the arm lies on the couch, the elbow joint is in a fixed position at 90 degrees, with the edge of the palm facing down, at a tempo for one exercise of 2 minutes 8 times a day with an amplitude of 10 degrees, while the hyperextension of the wrist is 0 degrees (Fig. 2 a, b);

Exercise III: the patient sits on a chair, the operated arm is in a hanging position, the elbow joint is in a fixed position of 90 degrees and independently performs flexion at the elbow joint, while turning the arm towards the chest and trying to raise the elbow to the shoulder for 3 minutes, alternately performing flexion and extension movements in the elbow joint 4 times a day;

Exercise IV: the patient stands on the floor with the operated arm extended forward and holds a 1 kg dumbbell in his hand and “draws” the letters of the alphabet and numbers in the air one by one for 2 minutes, 8 times a day (Fig. 4).

Week 4:

Exercise I: the patient stands on the floor, the arm is relaxed and lies on the surface of the table, the elbow joint is in a fixed position at 90 degrees, with the edge of the palm down, pronation/supination of the forearm is performed with an amplitude of 20 degrees 5 times a day for 5 minutes (Fig. 1);

Exercise II: the patient performs pronation/supination of the forearm while sitting on a chair, the arm lies on the couch, the elbow joint is in a fixed position at 90 degrees, with the edge of the palm facing down, at a pace of 2 minutes per exercise 8 times a day with an amplitude of 20 degrees, while the hyperextension of the wrist is 0 degrees (Fig. 2 a, b);

Exercise III - the patient sits on a chair, the operated arm is in a hanging position, the elbow joint is in a fixed position of 90 degrees and independently flexes the elbow joint, while turning the arm towards the chest with the elbow raised to the shoulder for 5 minutes, alternately performing flexion and extension movements in the elbow joint 5 times a day;

Exercise IV: The patient stands on the floor, extending the operated arm forward and holding a 3.5 kg dumbbell in his hand and “draws” the letters of the alphabet and numbers in the air one by one for 2 minutes 10 times a day.

After 30 days, the maximum elbow extension angle was 170 degrees.

Clinical example No. 2.

Patient F., 81 years old, was treated in the oncology orthopedics department with a diagnosis of giant cell tumor of the right humerus.

Upon admission, the patient complained of pain and limited range of motion in her right elbow. To relieve the pain, she took NSAIDs (Nise, diclofenac, etc.) several times throughout the day; according to the Visual Analog Scale (VAS), the pain was 5 points. Her functional score on the MSTS scale at the time of presentation was 56%.

The patient underwent elbow replacement surgery.

Starting from the 7th day after the operation, the patient underwent 30 days of exercise therapy sessions with psychological preparation, was taught verticalization techniques and the use of immobilization tools together with a rehabilitation physician, was taught correct deep chest and diaphragmatic breathing during breathing exercises, carried out a set of physical exercises aimed at strengthening the muscles of the upper limb girdle, flexion, extension, pronation, supination of the upper limb, as well as raising, internal and external rotation of the arm, performed from a state of pre-tension, within the threshold of pain.

First week:

Exercise I: the patient sits on a chair and performs pronation/supination of the forearm, the hand lies on the couch, the elbow joint is fixed in a 90-degree position, with the edge of the palm down, at a pace of 2 minutes per exercise 4 times a day with an amplitude of 10 degrees, while the hyperextension of the wrist was 0 degrees (Fig. 2 a, b);

Exercise II: the patient sits on a chair, the operated arm is in a hanging position, the elbow joint is in a fixed position of 90 degrees and, with the help of a doctor-instructor, bending is performed at the elbow joint, while the arm is turned towards the patient’s chest with an attempt to raise the elbow to the shoulder for 3 minutes, alternately flexion and extension movements in the elbow joint 4 times a day (Fig. 3 a, b);

Exercise III: the patient stands on the floor, extending the operated arm forward and holding a bottle of water (0.5 kg) in his hand and “draws” the letters of the alphabet in the air for 2 minutes, 4 times a day (Fig. 4).

Week 2:

Exercise I: the patient stands on the floor, the arm is relaxed and lies on the surface of the table, the elbow joint is in a fixed position at 90 degrees, with the edge of the palm down, pronation/supination of the forearm is performed with an amplitude of 10 degrees 3 times a day for 2 minutes (Fig. 1);

Exercise II: the patient performs forearm pronation/supination while sitting on a chair, the arm lies on the couch, the elbow joint is fixed in a 90-degree position, with the edge of the palm facing down, at a tempo for one exercise of 2 minutes 4 times a day with an amplitude of 10 degrees, while the hyperextension of the wrist is 0 degrees (Fig. 2 a, b);

Exercise III: the patient sits on a chair, the operated arm is in a hanging position, the elbow joint is in a fixed position of 90 degrees and, with the help of a doctor-instructor, bending is performed at the elbow joint, while the arm is turned towards the patient’s chest and an attempt is made to raise the elbow to the shoulder for 5 minutes, alternately performing flexion and extension movements in the elbow joint 5 times a day (Fig. 3 a, b);

Exercise IV: the patient stands on the floor, extending the operated arm forward and holding a bottle of water (0.5 kg) in his hand and “draws” letters and numbers in the air one by one for 2 minutes 8 times a day (Fig. 4).

Week 3:

Exercise I: the patient stands on the floor, the arm is relaxed and lies on the surface of the table, the elbow joint is in a fixed position at 90 degrees, with the edge of the palm down, and performs pronation/supination of the elbow joint with an amplitude of 20 degrees 3 times a day for 3 minutes (Fig. 1);

Exercise II: the patient performs forearm pronation/supination while sitting on a chair, the arm lies on the couch, the elbow joint is in a fixed position at 90 degrees, with the edge of the palm facing down, at a tempo for one exercise of 2 minutes 6 times a day with an amplitude of 15 degrees, while the hyperextension of the wrist is 0 degrees (Fig. 2 a, b);

Exercise III: the patient sits on a chair, the operated arm is in a hanging position, the elbow joint is in a fixed position of 90 degrees and independently performs flexion at the elbow joint, while turning the arm towards the chest and trying to raise the elbow to the shoulder for 2 minutes, alternately performing flexion and extension movements in the elbow joint 3 times a day;

Exercise IV: the patient stands on the floor with the operated arm extended forward and holds a 0.5 kg dumbbell in his hand and “draws” the letters of the alphabet and numbers in the air one by one for 2 minutes, 6 times a day (Fig. 4).

Week 4:

Exercise I: the patient stands on the floor, the arm is relaxed and lies on the surface of the table, the elbow joint is in a fixed position at 90 degrees, with the edge of the palm down, pronation/supination of the forearm is performed with an amplitude of 20 degrees 5 times a day for 5 minutes (Fig. 1);

Exercise II: the patient performs pronation/supination of the forearm while sitting on a chair, the arm lies on the couch, the elbow joint is in a fixed position at 90 degrees, with the edge of the palm down, at a pace of 2 minutes per exercise 10 times a day with an amplitude of 20 degrees, while the hyperextension of the wrist is 0 degrees (Fig. 2 a, b);

Exercise III - the patient sits on a chair, the operated arm is in a hanging position, the elbow joint is in a fixed position of 90 degrees and independently flexes the elbow joint, while turning the arm towards the chest with the elbow raised to the shoulder for 5 minutes, alternately performing flexion and extension movements in the elbow joint 5 times a day;

Exercise IV: The patient stands on the floor, extending the operated arm forward and holding a 1 kg dumbbell in his hand and “draws” the letters of the alphabet and numbers in the air one by one for 2 minutes 8 times a day.

After 30 days, the maximum elbow extension angle was 160 degrees.

Following perioperative rehabilitation, excellent functional outcomes were achieved, measured on the MSTS scale (86%). A persistent reduction in pain was noted, and the patient significantly reduced her pain medication intake (to once a week). Her VAS score was -2.

The use of the proposed method at the P.A. Herzen Moscow Oncology Research Institute, a branch of the National Medical Research Center of Radiology of the Russian Ministry of Health, demonstrated that it improves functional outcomes and reduces pain in patients undergoing oncological elbow arthroplasty.

Claims (20)

A method of rehabilitation after oncological elbow arthroplasty that includes, in the preoperative period, psychological preparation, training in verticalization techniques using immobilization devices, as well as training in correct deep chest and diaphragmatic breathing during breathing exercises and a set of physical exercises aimed at strengthening the muscles of the upper limb girdle, characterized in that on the 7th day after elbow arthroplasty, a set of exercises is performed that include flexion, extension, pronation, supination of the upper limb, as well as raising the arm and its internal and external rotation, performed in a state of pre-tension within the pain threshold according to the following scheme: - first week: Exercise I: the patient sits on a chair and performs pronation/supination of the forearm, the hand lies on the couch, the elbow joint is fixed in the 90° position, with the edge of the palm down, at a pace of 2 minutes per exercise 4-6 times a day with an amplitude of 10°, while the hyperextension of the wrist is 0°; Exercise II: the patient sits on a chair, the operated arm is in a hanging position, the elbow joint is in a fixed position of 90°, and with the help of a doctor-instructor, flexion is performed at the elbow joint, while the arm is turned towards the patient's chest with an attempt to raise the elbow to the shoulder for 2-3 minutes and alternate flexion and extension movements are performed at the elbow joint 3-4 times a day; Exercise III: the patient stands on the floor, extending the operated arm forward, and holds a 0.5 kg bottle of water in his hand and “draws” the letters of the alphabet in the air for 2 minutes 4-6 times a day; - second week: Exercise I: the patient stands on the floor, the arm is relaxed and lies on the surface of the table, the elbow joint is in a fixed position at 90°, with the edge of the palm down, and pronates/supinates the forearm with an amplitude of 10-15° 3-4 times a day for 2-3 minutes; Exercise II: the patient sits on a chair and pronates/supinates the forearm, the arm lies on the couch, the elbow joint is fixed in the 90° position, with the edge of the palm down, for 2 minutes 4-6 times a day with an amplitude of 10 to 15°, while the hyperextension of the wrist is 0°; Exercise III: the patient sits on a chair, the operated arm is in a hanging position, the elbow joint is in a fixed position of 90°, and with the help of a doctor-instructor, bending is performed at the elbow joint, while the arm is turned towards the patient's chest and an attempt is made to raise the elbow to the shoulder for 4-5 minutes, alternately flexion and extension movements are performed at the elbow joint 4-5 times a day; Exercise IV: the patient stands on the floor, extending the operated arm forward, and holds an object weighing up to 0.5 kg in his hand and “draws” letters in the air one by one for 2 minutes 6-8 times a day; - third week: Exercise I: the patient stands on the floor, the arm is relaxed and lies on the surface of the table, the elbow joint is in a fixed position at 90°, with the edge of the palm down, and performs pronation/supination of the elbow joint with an amplitude of 15 to 20° 3-5 times a day for 3-4 minutes; Exercise II: the patient performs forearm pronation/supination while sitting on a chair, the arm lies on the couch, the elbow joint is fixed in the 90° position, with the edge of the palm down, for 2 minutes 6-8 times a day with an amplitude of 10 to 15°, while the wrist hyperextension is 0°; Exercise III: the patient sits on a chair, the operated arm is in a hanging position, the elbow joint is in a fixed position of 90°, and independently performs flexion at the elbow joint, while turning the arm towards the chest and trying to raise the elbow to the shoulder for 2-3 minutes and performs alternate flexion and extension movements at the elbow joint 3-4 times a day; Exercise IV: the patient stands on the floor, extending the operated arm forward, and holds an object weighing from 0.5 to 1 kg in his hand and “draws” in the air, alternately, the letters of the alphabet and numbers for 2 minutes, 6-8 times a day; - fourth week: Exercise I: the patient stands on the floor, the arm is relaxed and lies on the surface of the table, the elbow joint is in a fixed position at 90°, with the edge of the palm facing down, pronation/supination of the forearm is performed with an amplitude of 20° 5 times a day for 5 minutes; Exercise II: the patient performs pronation/supination of the forearm while sitting on a chair, the arm lies on the couch, the elbow joint is in a fixed position at 90°, with the edge of the palm down, for 2 minutes 8-10 times a day with an amplitude of 20°, while the hyperextension of the wrist is 0°; Exercise III: the patient sits on a chair, the operated arm is in a hanging position, the elbow joint is in a fixed position of 90°, and independently performs flexion at the elbow joint, while turning the arm towards the chest with raising the elbow to the shoulder for 4-5 minutes, alternately performing flexion and extension movements in the elbow joint 4-5 times a day; Exercise IV: the patient stands on the floor, extending the operated arm forward, and holds an object weighing from 1 to 3.5 kg in his hand and “draws” in the air, alternately, the letters of the alphabet and numbers for 2 minutes, 8-10 times a day.