Rehabilitation phases, interventions, and outcomes
| Phases | Intervention | Symptoms/outcomes |
|---|---|---|
| Initial evaluation–week 2 | Patient education on rehabilitation process. TE focused on C/S, T/S, scapular mobility, along with activation of the biceps, triceps, forearm, and grip. Gentle introduction to weightbearing.MT: focused on C/S for pain modulation, and introduction to traditional nerve glides in the median, ulnar, and radial patterns. | NPRS pain score 4/10, sharp and achy pain from left-sided C/S down LUE in the ulnar nerve pattern, worse with exertion. Centralization of T/S pain to the left-sided C/S. Continued decreased LUE strength and endurance. Signs of allodynia in the ulnar nerve pattern. 8/10 pain on exertion. Left shoulder active ROM limited 10%. C/S active ROM limited 10%. DASH: 86.7. |
| Week 3–4 | TE: progressive scapular, C/S, T/S, and GHJ load against gravity, and light resistance bands. Scapular stability in open and closed chain.Upper body ergometer intervals, light resistance, reduced time, and reps based on symptoms.MT: focused on C/S for pain modulation, and introduction to manually loaded nerve glides in the median, ulnar, and radial patterns via tensioners, and isometric load throughout ROM as tolerated.Week 4 introduced band resisted nerve glides in the median, ulnar, and radial patterns. | NPRS pain score 6/10, pain left hand continues to be intense burning. No pain in the shoulder, more pain in the medial forearm. Allodynia symptoms continue without change. Full left shoulder active ROM. Full C/S active ROM. Pain reduces to 3–4/10 post nerve glides and 2/10 post tensioners. |
| Week 5–7 | TE: progress weightbearing, overhead presses, cable loaded neurodynamics in the median, ulnar, and radial nerve glide motions. Farmer’s carry. Progressive load of distal muscle groups, and periscapular muscles. Loaded T/S mobility. Home exercise program: MLND. | NPRS pain score 2/10, discomfort in the left scapular region. Discontinued allodynia symptoms, no hand symptoms. Normalized sensation in the left hand. No ROM limitations. Progressing strength in LUE well, compared to RUE. Initiate biking outside of therapy as tolerated. |
| Week 8–11 (discharge) | TE: return to sport testing, limb symmetry of deltoids, periscapulars, biceps, triceps, ability to bear weight.Postural control on bike, with max effort. Compared to the prior level of function, monitor symptoms if applicable. Testing overhead and in closed chain.The patient was discharged after this visit, back to sports. | Shoulder front raise: 93% LSI. Shoulder lateral raise: 94% LSI. Bicep curls: 100% LSI. Triceps extension 100%.Able to bike at the prior level of function with no onset of symptoms.NPRS pain score 0/10. DASH: 2.5. |
TE: therapeutic exercise; C/S: cervical spine; T/S: thoracic spine; MT: manual therapy; NPRS: numerical pain rating scale; ROM: range of motion; MLND: mechanically loaded neurodynamics; LUE: left upper extremity; DASH: Disabilities of the Arm, Shoulder and Hand questionnaire; GHJ: glenohumeral joint; RUE: right upper extremity