Highlights
- •The necessity of sternal precautions has been questioned.
- •The skin deformation was negative for flexion, abduction, lifting, and pushing.
- •The only movement requiring attention is bilateral shoulder extension.
- •No significant difference for flexion and the amounts of weights for lifting.
- •Preoperative physical therapy should include stabilizing scapular muscles.
Abstract
Background
The necessity of sternal precautions for patients following cardiac surgery with median
sternotomy has been questioned by clinicians, researchers, and even patients. The
primary purpose was to determine if sternal skin deformation during shoulder movements
and upper extremity activities is compressive or distractive and if there are any
significant differences between the skin deformation at different positions during
shoulder movements and upper extremity activities. The secondary purpose was to determine
if sternal skin deformation is correlated with scapular stabilizer muscle strength.
Methods
The research design was a cross-sectional non-experimental descriptive study. A 3D
electromagnetic tracking system was used to measure sternal skin deformation quantified
by strain.
Findings
The sternal skin strain was −10.8 (SD 6.2) % and −9.8 (SD 6.1) % at 90 and 180° flexion (P = 0.45), −2.7 (SD 3.4) % and −10.4 (SD 7.9) % at 90 and 180° abduction (P < 0.01), −3.6 (SD 4.1) %, −4.9 (SD 6.4) %, and −6.8 (SD 5.2) % when lifting 0, 5, and 10 lb weights (P = 0.07), 0.7 (SD 2.5) % for extension, and −1.1 (SD 5.0) % for pushing up from a chair. There is a trend of strain magnitude decrease
with the increase of rhomboid strength without significant association (R = 0.14).
Interpretation
Our data does not support the restriction for most of the shoulder movements and upper
extremity activities following cardiac surgery. The only exception is bilateral shoulder
extension. We propose a strategy for preoperative physical therapy to stabilize scapular
muscles to decrease mechanical loading translated from shoulder to sternum.
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Article info
Publication history
Published online: May 12, 2017
Accepted:
May 11,
2017
Received:
September 28,
2016
Footnotes
☆This paper was partly presented previously in abstract format at the World Confederation for Physical Therapy (WCPT) Congress 2015 on May 1–4, 2015, Singapore.
☆☆Ethics approval for this study was sought and obtained from the Institutional Review Board at Youngstown State University.
Identification
Copyright
© 2017 Elsevier Ltd. All rights reserved.
