Pre-Surgery Rehab for a Child With Humeral Head and Shaft Deformity: A Case Report

Pre-operative Rehabilitation Protocol for a Pediatric Patient With Humeral Head and Shaft Deformity: A Case Report

The goal of this observational study (single-patient case report) is to learn whether a structured pre-operative physical therapy rehabilitation program can improve shoulder function, reduce pain, and improve quality of life in an 11-year-old girl with humeral head and shaft deformity (post-inflammatory changes).

The main questions it aims to answer are:

Does shoulder range of motion and muscle strength improve after the program? Does pain and functional ability (including posture) improve after the program?

Participants will:

Attend 12 sessions over October-November 2025 (2 sessions/week) at the Faculty of Physical Therapy, Cairo University

Receive a standardized session program that may include:

TENS, low-level laser therapy, manual therapy (Spencer technique), phonophoresis PNF stretching and progressive exercises, plus scapular taping Complete evaluations at baseline, mid-program, and after the program, including goniometry (ROM), manual muscle testing, pain scale (VAS), postural assessment, and a functional ability checklist

Study Overview

• Status: Completed
• Conditions: Osteomyelitis Chronic; Bone Defects
• Intervention / Treatment: Device: Transcutaneous Electrical Nerve Stimulation; Device: Low-Level Laser Therapy; Other: Manual Therapy; Other: Phonophoresis; Other: PNF stretching; Other: kinesio taping

Detailed Description

This study is a single-patient case report describing the design, delivery, and observed response to a pre-operative rehabilitation program for a pediatric patient with deformity involving the humeral head and shaft. The report will document the patient's baseline presentation, the clinical reasoning used to select pre-operative rehabilitation goals, and the step-by-step rehabilitation approach used to optimize the shoulder and upper-limb condition before planned surgical management.

The rehabilitation program is intended to maximize safe functional capacity pre-operatively by addressing modifiable impairments commonly associated with this condition, such as pain, limited range of motion, weakness, altered scapulohumeral mechanics, and compensatory movement patterns. The case report will describe treatment components (e.g., education, therapeutic exercise, flexibility and strengthening strategies, neuromuscular re-education, and other noninvasive physical therapy modalities as clinically indicated), how the program is progressed over time, and any precautions used to ensure age-appropriate and condition-appropriate care.

To evaluate response to the program, the study will collect structured pre- and post-program measurements relevant to shoulder/upper-limb status, such as:

• Pain and symptom severity
• Shoulder range of motion
• Muscle strength and/or functional performance
• Activity limitations and functional use of the affected arm
• Observed posture and movement quality (as clinically applicable) The report will also capture treatment adherence, any adverse events, and notable barriers/facilitators to participation (e.g., tolerance, fatigue, caregiver involvement). Findings will be presented descriptively to help clinicians and families understand what a pre-operative rehabilitation plan may include for a child with humeral deformity, and what types of short-term changes may be observed during the pre-surgical period.

• Study Type: Interventional
• Enrollment (Actual): 1
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Egypt
  • Giza, Egypt, 11432
    • Out patinets clinics, Faculty of Physical Therapy Cairo University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

- Not applicable (case report; single patient case).

Exclusion Criteria:

- Not applicable (case report; single patient case).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: interventional; This single-arm case report includes a structured pre-operative physical therapy rehabilitation program for a pediatric patient with humeral head and shaft deformity. The intervention consists of supervised sessions incorporating pain-modulation modalities (as clinically indicated), manual therapy to improve shoulder mobility, therapeutic exercises for flexibility, strengthening, and neuromuscular control, and scapular stabilization/positioning strategies (including taping as needed). Treatment is progressed based on tolerance and clinical response, with the goal of improving pre-operative shoulder pain, range of motion, strength, posture, and functional use of the upper limb.

Device: Transcutaneous Electrical Nerve Stimulation; a method of pain relief that uses a device to send low-voltage electrical impulses through electrodes placed on the skin; Device: Low-Level Laser Therapy; a non-invasive medical treatment that uses low-level lasers or light-emitting diodes (LEDs) to stimulate cell function and accelerate the body's natural healing process; Other: Manual Therapy; a hands-on treatment approach; Other: Phonophoresis; a medical procedure that uses therapeutic ultrasound to deliver topical medications through the skin and into deeper tissues; Other Names: Ultrasound; Other: PNF stretching; is an advanced technique that combines muscle contraction and relaxation to increase flexibility and range of motion; Other: kinesio taping; Kinesio tape will be applied to the shoulder and scapular region to support improved alignment and scapular control during movement.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Range of Motion	Shoulder range of motion will be assessed using a standard universal goniometer to quantify the motion of the affected upper limb.	4 weeks
Manual Muscle Testing	Upper-limb and shoulder muscle strength will be assessed using standardized Manual Muscle Testing procedures. Key muscle groups around the shoulder and scapula (e.g., shoulder flexors, abductors, internal/external rotators, and scapular stabilizers)	4 weeks
Functional Ability	Functional status of the affected upper limb will be assessed using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. The patient (with caregiver assistance as needed) will rate the difficulty of performing common daily activities and the impact of symptoms such as pain on function. Responses are summed and converted to a 0-100 score, where higher scores indicate greater disability.	4 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain intensity	Pain intensity will be measured using a Visual Analog Scale (VAS). The patient will be asked to rate her pain by marking on a 10-cm line anchored by "no pain" (0) and "worst pain imaginable" (10).	4 weeks

Collaborators and Investigators

• Sponsor: Cairo University

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2025
• Primary Completion (Actual): November 1, 2025
• Study Completion (Actual): November 1, 2025

Study Registration Dates

• First Submitted: December 2, 2025
• First Submitted That Met QC Criteria: December 2, 2025
• First Posted (Actual): December 15, 2025

Study Record Updates

• Last Update Posted (Actual): December 15, 2025
• Last Update Submitted That Met QC Criteria: December 2, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Keywords: Pre-operative rehabilitation; Humeral head deformity; Upper limb deformity; Pre-operative rehabilitation (prehabilitation)
• Additional Relevant MeSH Terms: Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena; Therapeutics; Drug Administration Routes; Drug Therapy; Complementary Therapies; Physical Therapy Modalities; Physical Phenomena; Patient Care; Exercise Therapy; Rehabilitation; Aftercare; Continuity of Patient Care; Anesthesia and Analgesia; Radiation; Exercise; Radiation, Nonionizing; Electric Stimulation Therapy; Laser Therapy; Phototherapy; Analgesia; Ultrasonic Waves; Sound; Low-Level Light Therapy; Musculoskeletal Manipulations; Transcutaneous Electric Nerve Stimulation; High-Energy Shock Waves; Muscle Stretching Exercises; Phonophoresis
• Other Study ID Numbers: P.T.REC/012/006101

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No