Rehabilitation Protocol for Patients with Saphenous Neuropathy After Sartorius Sarcoma Excision
A comprehensive multidisciplinary rehabilitation approach focusing on neurovascular recovery, balance training, and progressive strengthening is essential for optimal recovery after sartorius sarcoma excision with saphenous neuropathy. 1
Initial Assessment and Early Intervention
- Perform thorough neurovascular assessment focusing on saphenous nerve distribution to establish baseline sensory and motor function 2
- Implement early lymphedema intervention including breathing exercises and range of motion (ROM) exercises as part of complete decongestive therapy (CDT) 1
- Address post-surgical adhesions and scar sensitivity through myofascial assessment and treatment 1
- Evaluate for balance impairments associated with neuropathy to establish appropriate safety measures 1
Neurovascular Recovery Protocol
- Implement nerve gliding exercises specific to the saphenous nerve to prevent further entrapment and promote nerve healing 3
- Provide sensory re-education exercises in areas of altered sensation along the medial knee and lower leg 2
- Monitor for signs of nerve entrapment including localized pain and tenderness along the course of the saphenous nerve 3
- Avoid compression or stretching of the medial knee area during early rehabilitation phases 2
Progressive Strengthening Program
- Begin with low resistance, higher repetition exercises focusing on quadriceps and hip adductor muscle groups 1
- Gradually progress to moderate resistance training as tolerated, avoiding excessive strain on the surgical site 1
- Include scapular and rotator cuff strengthening to assist with postural retraining and prevent compensatory mechanics 1
- Implement graded activity progression based on patient's tolerance and functional goals 1
Balance and Proprioceptive Training
- Provide specific balance and proprioceptive training to address neuropathy-related deficits 1
- Progress from static to dynamic balance activities as patient improves 1
- Include fall risk assessment and prevention strategies 1
- Incorporate functional balance activities that mimic daily living requirements 1
Functional Rehabilitation
- Establish specific functional goals based on patient's pre-cancer activity level and vocational requirements 1
- Implement task-specific training to address activity limitations in daily living 4
- Progress rehabilitation to address participation restrictions including return to work considerations 1
- Evaluate for appropriate assistive devices if needed for safety during recovery 4
Monitoring and Progression
- Obtain baseline measures and repeat over time to gauge meaningful change and ensure program effectiveness 1
- Adjust exercise parameters based on patient's response and progression 1
- Monitor for signs of lymphedema development or worsening neuropathy symptoms 1
- Provide education on long-term self-management strategies 1
Special Considerations
- If surgical clips were placed during excision, they should remain in place as they mark high-risk areas for recurrence and guide potential future radiation therapy 5
- Rehabilitation should continue until maximum function is achieved as recommended for extremity sarcomas 1
- Supervised exercise programs show better outcomes than unsupervised programs for cancer rehabilitation 1
- Moderate to vigorous intensity exercise is safe and appears to provide greater benefit than lower intensity exercise once neurovascular symptoms are stabilized 1
Common Pitfalls and Caveats
- Avoid excessive stretching of the medial knee area which may exacerbate saphenous nerve symptoms 3
- Be aware that interruption in rehabilitation for more than six weeks can significantly reduce functional outcomes 6
- Exercise prescription, when incorrectly applied, may magnify underlying neuromuscular conditions 1
- Recognize that therapeutic interventions may be more appropriate than general exercise for addressing specific neuropathy symptoms 1