The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone an arthroscopic assistedminiopen rotator cuff repair. Rotator cuff repair protocol south shore orthopedics. Rotator cuff and shoulder rehabilitation exercises to ensure that this program is safe and effective for you, it should be performed under your doctors supervision. It is designed for rehabilitation following large to massive rotator cuff repairs. Department of rehabilitation services physical therapy arthroscopic rotator cuff repair protocol. Remove sling for light activity and home exercise program as indicated by therapist. Protocol s3 accelerated physical therapy protocol for. Rehabilitation protocol for rotator cuff repair this protocol is intended to guide clinicians and patients through the postoperative course of a rotator cuff repair.
For this reason the shoulder is the most mobile joint in the body. Postoperative rehabilitation protocol rotator cuff repair. Kate hopman2, lee krahe1, sue lukersmith2, alexander mccoll1, kris vine1. Arthroscopic and open rotator cuff repair rehabilitation protocol week 1 2 shoulder sling and swathe full time day and night. Figure 5 rotator cuff repair technique using anchors and sutures. The primary goal of this protocol is to protect the repair while steadily progressing towards and ultimately achieving preinjury level of activity. A large size rotator cuff tear is defined as a tear 35cm, massive 5cm. Supraspinatus open can patient stands with theraband under their foot while grasping theraband, bring shoulders back and down. Strengthen deltoid, rotator cuff and scapular stabilizers. Scapular control exercises such as the scapular squeeze and elevation exercises are important to maintain the correct movement patterns in the shoulder joint as rehabilitation progresses. The socket portion of the joint is not naturally deep.
The glsm rotator cuff repair rehabilitation program is an evidencebased and soft tissue healing. This protocol will vary in length and aggressiveness depending on factors such as. Summary table post op phasegoals range of motion therapeutic exercise precautions days 1 7 wear sling during the day and at night remove sling for showeringbathing remove sling 4 to 5 times per day for gentle elbow, forearm, wrist and finger exercises. Conservativelarge rotator cuff repair protocol week one weeks two to three initial evaluation evaluate posture and position of the shoulder girdle passive range of motion inspect for signs of infection, and ensure integrity of the incision assess rtw and sport expectations support physician prescribed meds. The rotator cuff is responsible for stabilization and active movement of the glenohumeral joint. Rotator cuff repair protocol this rehabilitation protocol has been developed for the patient following a rotator cuff surgical procedure. It provides stability and strength for the shoulder joint, anchoring the humerus upper arm bone to the scapula shoulder blade so that movements of the arm can occur in a.
The patient before you is participating in a study to determine the effectiveness of physical therapy in treating rotator cuff tears. No resisted rotator cuff strengthening exercises until weeks patients this protocol should be used as a guide during your rehabilitation after surgery. The shoulder moon group is a multicenter orthopaedic outcomes network, a consortium of institutions working together to bring patients the best possible care with disorders of the shoulder. Type i and type ii rotator cuff repair and isolated. Size and location of tear degree of shoulder instabilitylaxity prior to surgery acute versus chronic condition. Initiate manual resistance er in supine in scapular plane light. To provide an overview of the characteristics and timing of rotator cuff healing and provide an update on treatments used in rehabilitation of rotator cuff repairs. Rotator cuff repair large to massive 5cm rehabilitation guideline this rehabilitation program is designed to return the individual to their activities as quickly and safely as possible. Phase i immediate postoperative phase weeks 0 6 days 014 patient is seen 2 days postoperative to remove surgical dressings and pain catheter. Introduction its been an ache and a joy both to look over this big shoulder of mine at all my yesterdays ethel waters. Rotator cuff repair postsurgical rehabilitation protocol postop days 1 21 immobilizer with abductor pillow x 46 weeks even while sleeping place pillow under shoulder arm while sleeping for comfort hand squeezing exercises elbow and wrist active motion arom with shoulder in neutral position at side.
However, for a rotator cuff strain, it may not be until later in the rehabilitation process that strengthening exercises can begin. Specific changes in the program will be made by the physician as appropriate for an individual patient. The first classification is a partial thickness or a full thickness tear. Your surgeon will advise when you should start physiotherapy at your first followup appointment. Stretching of the shoulder rotator cuff muscles is easily performed both as treatment for inflammation and as a warmup before activity. For example, for skiing, with a ski pole held firmly with one hand at the basket and one hand on the handle. A gentle rehabilitation protocol with limits in range of motion and exercise times after arthroscopic rotator cuff repair would be better for tendon healing without. Rotator cuff repair large to massive 5cm rehabilitation. Talk to your doctor or physical therapist about which exercises will best help you meet your rehabilitation goals. Rotator cuff tears can be classified in various ways. Type three rotator cuff repair miniopen or neer approach large to massive tear greater than 5 cm i. This protocol is intended to guide clinicians and patients through the post operative course of a rotator cuff repair.
Rehabilitation after rotator cuff repair the open orthopaedics journal, 2017, volume 11 157 about the surgery, such as the size of the tear, the exact tendons involved, the quality of tissue and. Rotator cuff repair the following is a protocol for postoperative patients following rotator cuff repair. Intermittently apply grade ii mobilizations in the open packed position of the shoulder. The deltoid muscle is separated to expose the torn rotator cuff tendons.
The shoulder is a wonderfully complex joint that is made up of the ball and socket connection between the humerus ball and the glenoid portion of the scapula socket. The physician will make specific changes to the program as appropriate for an individual patient. The conservative rehabilitation protocol allows sharpey fibers to form before stressing the repair with resistive exercises. Rehabilitation guidelines for type i and type ii rotator. We provide our patients with comprehensive, coordinated care from experts who understand the unique needs of women in sports. Rotator cuff repair postoperative rehabilitation protocol. The gundersen health system rehabilitation programs are evidencebased and soft tissue healing dependent programs designed to allow patients to progress to vocational and sportrelated activities as quickly and safely as possible. This protocol is intended to guide clinicians and patients through the postoperative course of a rotator cuff repair. Postoperative rotator cuff repair rehabilitation protocol. Hagan rotator cuff repair rehabilitation protocol overview. Rotator cuff sprain and strains university of california. You should rest from all activities that cause shoulder pain.
This protocol provides you with general guidelines for the rehabilitation of patients following a massive open andor arthroscopic rotator cuff repair. The sports physical therapy service is an integral part of the sports medicine center and the department of. Pdf rehabilitation after rotator cuff repair researchgate. Most rotator cuff tears can be repaired surgically by reattaching the torn tendons to the humerus. Clinical practice guidelines for the management of rotator. No active elevation for 6 weeks or per md orders wear sling for 2 weeks when active avoid abduction aarom x 2 weeks overall goals. Sling immobilization with supporting abduction pillow to be worn at all times except for showering and rehab under guidance of pt. Continue with end range stretching and manual therapy as.
Rotator cuff repair rehab protocol the stone clinic. Rehabilitation guidelines for rotator cuff repair and isolated subscapularis repair. An acute or overuse injury may cause the rotator cuff to be injured and varying widths of tears may cause increased pain and dysfunction of the shoulder joint. Initiate erir strengthening using exercise tubing at 0o of abduction use towel roll under arm. This evidencebased small to medium rotator cuff repair physical therapy guideline is.
Protocol s3 accelerated physical therapy protocol for rotator cuff repair arthroscopic or miniopen technique recommended for mild. If you have any questions regarding the progress of the patient, the physician should be. Level of detail regarding sets and repetitions of exercises also differed between protocols. Partial thickness tears start on one surface of the tendon, but do not progress through the depth of the tendon. Sports medicine physical therapy rehabilitation protocols. Showering is allowed once dressings and catheter is removed.
With the advent of newer techniques, good to excellent results can be expected in the appropriately selected and compliant patient. Numerous rehabilitation protocols for the management of rotator cuff disease are based primarily on anecdotal clinical observation. Find pdfs of our most common rehabilitation protocols. Rehabilitation protocol for small to moderate rotator cuff tear. Hagan rotator cuff repair rehabilitation protocol overview key. Shoulder rotator cuff repair oxford university hospitals. This protocol provides you with general guidelines for the conservative rehabilitation of the patient with a rotator cuff tear rct. Table slide for passive flexion and extension exercise. After 72 hours, ice the shoulder after activity or exercise. Abduction bracesling, remove sling only to bathe and to complete exercises. It is not a big operation to repair a torn rotator cuff, but the rehabilitation time can be long depending on the size of the tear and the quality of the tendonsmuscles.
Specific stretches are targeted to the desired activity. The role of anterior deltoid reeducation in patients with. Rotator cuff repair postoperative rehabilitation protocol orthoindy. The conservative approach may be associated with postoperative stiffness which can be managed once healing has occurred. Rehabilitation protocol for rotator cuff repair massachusetts. Rotator cuff and shoulder rehabilitation exercises. Place an ice bag on the shoulder for 1520 minutes, 35 times a day for the first 2472 hours. Clinical practice guidelines for the management of rotator cuff syndrome in the workplace the university of new south wales, medicine, rural clinical school, port macquarie campus 20 research team. Tears of the rotator cuff rc have been inherited by man from his ancestors with an association leading to the great apes1,2. Questions or concerns regarding the rehabilitation protocol may be sent to the moon shoulder group research hub, listed on the back of this book. Rotator cuff repair protocol boston shoulder institute. Few protocols based the rehabilitation upon tissue quality and size of rotator cuff tear. A physiotherapist should be consulted throughout to teach and individually modify the exercises.
Pulley with gentle passive flexion to approximately 90. The authors protocol of choice, used within a large sports medicine rehabilitation center, is presented and the rationale behind its implementation is. Help and feedback was given from people who have had rotator cuff repair surgery. Clinic appointments at 8 to 12 days, then at 6 weeks, 12 weeks, 18 weeks, and possibly 24 weeks physical therapy appointment starting at 9 weeks, lasting 18 to 24 weeks acute phase. The rotator cuff is made up of four muscles supraspinatus, infraspinatus, subscapularis, and teres minor and their tendons. At a 30 degree angle in front of the body with thumb pointed up, slowly raise arm to shoulder height. Specific interventions should be based on the needs of the individual and should consider exam findings and clinical decision making.
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