Post-Surgery Challenges After Car Accident: Rehabilitation Insights for Seniors

Q: Post-Surgery Challenges After Car Accident: Rehabilitation Insights for Seniors

Hello Mr. <br>J： Based on your questions, you are truly a caring family member. <br>Before answering your questions in order, I would like to clarify some concepts. <br>First, X-rays only visualize bone structures, while soft tissues are not visible. <br>Soft tissues can be divid

Post-accident surgical issues?

I apologize for bothering you, Director Lin, but I have some questions I would like to ask.
I previously inquired about post-surgery issues related to a car accident and will be visiting the hospital for further questions.
However, I still have some doubts and would like to hear different opinions, so I am consulting here again.
Thank you, Doctor, in advance.
My elder family member (around 60 years old) underwent surgery last September, and it has been about six months since then.
They are unable to lift their arm independently, so they are currently undergoing passive rehabilitation.

1.
The X-ray images were taken after the surgery last year.
Do they appear to be normal? Previously, when I asked other doctors here, they mentioned that there might be a bone fragment attached to the supraspinatus muscle, which could be causing the inability to lift the arm.
[X-ray images: https://imgur.com/PmCcVC6, https://imgur.com/a/WSqln9S, https://imgur.com/a/NU8TdZ7]
2.
From my research, it seems there is a possibility of a rotator cuff tear, which is more common in older adults.
The surgeon did not mention this issue, and during several follow-up visits, they reassured us that rehabilitation could proceed safely and encouraged more movement in various angles.
However, I read that if this is the case, certain angles should be avoided initially to prevent further injury.
3.
I would like to understand how to confirm whether this is the situation.
What steps can be taken to determine if this is the cause? Can an X-ray reveal this?
4.
If it is indeed a rotator cuff tear, are there ways to improve the condition? Would you recommend further surgical intervention?
5.
Can rehabilitation continue at this stage? Currently, the rehabilitation mainly involves wall exercises, internal and external shoulder movements, and towel stretches behind the back.
6.
I have attempted to start active rehabilitation, but I am completely unable to do so.
Is this progress considered too slow?

Mr. J, 30~39 year old female. Ask Date: 2021/03/11

Dr. Lin Ruixiang reply Rehabilitation

Hello Mr.
J: Based on your questions, you are truly a caring family member.
Before answering your questions in order, I would like to clarify some concepts.
First, X-rays only visualize bone structures, while soft tissues are not visible.
Soft tissues can be divided into intra-articular and extra-articular categories.
Extra-articular tissues can further be classified into movable structures (muscles, tendons) and non-movable structures (nerves, ligaments).
With this basic understanding, I will address your questions in order:
1.
The defect at the attachment site of the supraspinatus muscle seen on the X-ray resembles a bone fragment.
Although it is not located within the joint, it is trapped between the acromion and the humeral head, which can affect joint function similarly to an intra-articular lesion, potentially causing joint locking during movement.

2.
The diagnosis of tendon rupture primarily relies on diagnostic ultrasound.

3.
Tendons are not visible on X-rays.
Additionally, during physical examination, passive range of motion (movement involving non-movable structures) is significantly greater than active range of motion (movement involving both movable and non-movable structures), which can also aid in preliminary diagnosis.

4.
Intra-articular lesions generally do not respond well to rehabilitation and can only be removed surgically, but extra-articular issues may still persist.

5.
Passive movement (involving non-movable structures) may not restore full function, but it still plays a significant role in maintaining functionality.

6.
Generally, after a fracture surgery, recovery becomes more challenging after six months.

Wishing you good health from Hualien Hospital, Ministry of Health and Welfare.

Reply Date: 2021/03/11

More Info

Post-surgery rehabilitation after a car accident, especially for seniors, can be a complex and challenging process. Given the details you've provided about your elder's condition, it’s important to approach rehabilitation with a comprehensive understanding of the potential issues and strategies for improvement.

1. X-ray Evaluation: The X-ray images you referenced are crucial for assessing the structural integrity of the shoulder joint post-surgery. If there are concerns about a bone fragment affecting the rotator cuff, this should be evaluated by an orthopedic specialist. X-rays can show fractures or dislocations but may not clearly indicate soft tissue injuries like rotator cuff tears. An MRI is often recommended for a detailed view of soft tissues, including muscles and tendons, to confirm any suspected injuries.

2. Rotator Cuff Injury: You are correct that rotator cuff injuries are common in older adults, particularly after trauma or surgery. If the shoulder joint is not functioning properly, it could be due to a tear in the rotator cuff or other soft tissue injuries. While passive rehabilitation is beneficial, it’s essential to ensure that the exercises being performed do not exacerbate any underlying issues. Consulting with a physical therapist who specializes in shoulder rehabilitation can provide tailored exercises that promote healing while avoiding further injury.

3. Diagnosis Confirmation: To determine whether a rotator cuff tear is present, an MRI is the most effective imaging technique. It provides a clear view of the soft tissues and can confirm the presence of tears or other injuries. If your elder has not yet undergone an MRI, it may be worth discussing this option with their physician.

4. Treatment Options: If a rotator cuff tear is confirmed, treatment options vary based on the severity of the tear. Minor tears may respond well to physical therapy, while more severe tears might require surgical intervention. The decision to operate should be made collaboratively with the healthcare team, considering the patient’s overall health, activity level, and rehabilitation goals.

5. Continued Rehabilitation: Continuing rehabilitation is crucial, even if progress seems slow. Passive exercises, such as wall slides and towel stretches, are beneficial for maintaining range of motion. However, it’s important to gradually introduce active exercises as tolerated. The goal is to promote strength and mobility without causing pain or further injury. A physical therapist can help design a progressive program that includes both passive and active exercises tailored to your elder's specific needs.

6. Progress Monitoring: It’s normal for recovery to take time, especially in older adults. If your elder is unable to perform active movements, it may indicate that they need more time or a different approach to rehabilitation. Regular follow-ups with the healthcare provider can help assess progress and adjust the rehabilitation plan as necessary.

In summary, rehabilitation after a car accident for seniors requires a careful and individualized approach. It’s essential to ensure that any underlying issues, such as rotator cuff injuries, are properly diagnosed and treated. Continuing rehabilitation, with a focus on both passive and active exercises, is vital for recovery. Regular communication with healthcare providers and physical therapists will help ensure that your elder receives the best possible care and support throughout their rehabilitation journey.

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