An alternative approach to prescribing sternal precautions after median sternotomy, "Keep Your Move in the Tube"

Jenny Adams, Ana Lotshaw, Emelia Exum, Mark Campbell, Cathy B Spranger, Jim Beveridge, Shawn Baker, Stephanie McCray, Tim Bilbrey, Tiffany Shock, Anne Lawrence, Baron L Hamman, Jeffrey M Schussler, Jenny Adams, Ana Lotshaw, Emelia Exum, Mark Campbell, Cathy B Spranger, Jim Beveridge, Shawn Baker, Stephanie McCray, Tim Bilbrey, Tiffany Shock, Anne Lawrence, Baron L Hamman, Jeffrey M Schussler

Abstract

Traditional sternal precautions, given to sternotomy patients as part of their discharge education, are intended to help prevent sternal wound complications. They vary widely but generally include arbitrary load and time restrictions (lifting no more than a specified weight for up to 12 weeks) and may prohibit common shoulder joint and shoulder girdle movements. Having observed the negative effects of restrictive sternal precautions for many years, our research team performed a series of studies that measured the forces exerted during various common activities and their relationship to the sternum. The results, though informative, led us to realize that the goal of identifying "the" appropriate load restriction to prescribe for sternotomy patients was futile. The alternative approach that we introduce applies standard kinesiological principles and teaches patients how to perform load-bearing movements in a way that avoids excessive stress to the sternum.

Figures

Figure 1.
Figure 1.
Illustration used to teach patients about their sternotomy, the attachments of the pectoralis major, and the imaginary truncal tube that is the basis of the Keep Your Move in the Tube approach.
Figure 2.
Figure 2.
Keep Your Move in the Tube graphic used to teach load-bearing upper extremity movements to patients recovering from median sternotomy. A teaching script is available from the corresponding author or from http://www.baylorhealth.edu/Documents/BUMC%20Proceedings/2016_Vol_29/No_1/29_1_Teaching_Script.pdf.

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Source: PubMed

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