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. No arom exercise of the shoulder consistent use of sling unless otherwise instructed weaning starting at week 4. 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. Microfracture of greater tuberosity speeds healing of. Rehabilitation of the shoulder after rotatorcuff repair. Rom 1 codmanspendulum bend over chairtable, hang affected arm straight. The four phases of healing during rehabilitation following rotator cuff surgery. 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. Rotator cuff repair is the surgery used to repair a tear in one of these tendons. Modified rehabilitation program after rotator cuff repair.
Download shoulder surgery rehabilitation protocol pdf. How to do the exercises posterior stretching exercise 1. Whether nonsurgical or surgical, successful management of rotator cuff disease is dependent on appropriate. Continued c canstick exercises for external rotation you can passively externally rotate your surgical shoulder and arm to the plane of your body. The safest resting position after rotator cuff repair is 30 of elevation in the scapular plane, with 0 to 60 of external rotation which can be attained with the abduction sling. This type of rotator cuff tear can usually be repaired but sometimes the tear may not need to be repaired and sometimes cannot be repaired. Rehabilitation guidelines for type i and type ii rotator cuff repair and isolated subscapularis repair the anatomic configuration of the shoulder joint glenohumeral joint is often compared to that of a golf ball on a tee.
Modified rehabilitation program after rotator cuff repair robert e. Tears or ruptures of these muscles can be caused by trauma, such as a sports injury, a fall or a motor vehicle accident, but they can also be caused by other factors such as. The procedure involves stitching the torn tendon back onto its attachment to the humerus. Manual resisted proprioceptive neuromuscular facilitation through diagonal. Small rotator cuff repair protocol the intent of this protocol is to provide the clinician with instruction, direction, rehabilitative guidelines and functional goals for all rotator cuff repair procedures. The intent of this protocol is to provide the clinician with a. Arthroscopic rotator cuff repair is commonly performed and is generally a safe procedure. Rehabilitation after rotator cuff repair the open orthopaedics journal, 2017, volume 11 159 known as jump training or plyos, which for example include a patient throwing and catching a. Complete ruptures usually require surgery if your goal is to return your shoulder to optimal function. Victoria bc v8z 0b9 tel 250 940 4444 fax 250 385 9600 page 1 june 2017 v1s. Accelerated physical therapy protocol for rotator cuff repair arthroscopic or miniopen technique recommended for mild. Exercise therapy following surgical rotator cuff repair protocol. Rehabilitation exercises for rotator cuff tears, tendonitis and impingement syndrome after an injury or surgery an exercise conditioning program will help you return to daily activities and enjoy a more active, healthy lifestyle. Mar 23, 2017 and more confusing is the lack of consensus among surgeons regarding the optimal postoperative rehabilitation protocol following arthroscopic rotator cuff repair.
Rehabilitation protocol following arthroscopic rotator cuff. These results suggest that rotator cuff healing is protracted and that pro tecting the repair from excessive loading, particularly early in the rehabilitation process, is vital. Rotator cuff and shoulder rehabilitation exercises. Now also begin to perform rotator cuff strengthening exercises. Traditional rehabilitation following rotator cuff repair has. This is because the articular surface of the round humeral head is approximately four times greater than that of the. Anteriorly, the capsulecoracohumeral complex, which merges together, contracts and. Microfracture of greater tuberosity speeds healing of rotator cuff tears. The rotator cuff surgery to repair a torn rotator cuff muscle or tendon usually involves one or more of the following surgical goals.
Dugas et al 20 examined 20 normal cadaveric rotator cuff specimens and. Footprint anatomy the insertion site of the rotator cuff tendon at the greater tuberosity is often referred to as the footprint. None stepbystep directions lean forward and place one hand on a counter or table for support. Rotator cuff repair can require a long recovery period, especially if the tear was large. An evaluationbased approach abstract rotator cuff disease of the shoulder, a common condition, is often incapacitating. Synchronized or isolated protocol the primary goal of postsurgical rehabilitation following rotator cuff repair is to control pain, protect repaired tissue during the healing process, restore function, improve rangeofmotion, restore strength and prevent a. The team at the stone clinic has been repairing rotator cuffs for over twenty years and has progressively improved the techniques.
Rehabilitation guidelines for type i and type ii rotator. Strengthen deltoid, rotator cuff and scapular stabilizers. 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 supported pendulum exercises. However, to make an informed decision and give your. Rotator cuff and shoulder conditioning program stretching exercises 1. Rehabilitation guidelines for type i and type ii rotator cuff. Recovering from rotator cuff surgery usually takes 4 to 6 months, but a full recovery can take up to a year. The lines joining the boxes represent the median values for each group dashed line is the im. If initial nonsurgical treatment of a rotator cuff tear fails, surgical repair is often the next line of treatment. The rotator cuff can also wear out as a result of degenerative changes. Rehabilitation following arthroscopic rotator cuff repair core.
People having rotator cuff surgery should understand each step of rehab as a good outcome is highly dependent on the healing and rehabilitation that follows surgery. Specific interventions should be based on the needs of the individual and should consider exam findings and clinical decision making. It is evident that a successful outcome after surgical rotator cuff repair is as much dependent on surgical technique as it is on rehabilitation. Massive rotator cuff tears arthroscopic rotator cuff repair arthroscopic assisted miniopen rotator cuff repair sling immobilization active rom elbow, wrist and hand passive only rom shoulder pendulums, supine elevation in scapular plane 140 degrees external rotation 40 degrees scapular stabilization exercises sidelying. When you lay it out like that, we simply combine those goals. Rotator cuff repair rehab has changed dramatically in the past several years due to improved surgical techniques, emphasis on immediate motion, early strengthening and functional activities. Sep 26, 2019 the surgical procedure to repair a torn rotator cuff is sometimes the easiest and most straightforward aspect of treatment, and the rehab and recovery is the most challenging. Tears are considered massive when they involve multiple tendons. Intermittently apply grade ii mobilizations in the open packed position of the shoulder. Combining orthopedic special tests to improve diagnosis of shoulder. Degenerative rotator cuff tears also tend to coexist with poor muscle bulk muscle atrophy and fatty infiltration of the one or more rotator cuff muscles. A torn rotator cuff due to an injury is usually best treated by immediate surgical repair. Your doctor or therapist will tell you when you can start these exercises and which ones will work best for you.
Rotator cuff repair a rotator cuff repair is designed to improve pain and function in cases of rotator cuff tears. Symptoms of rotator cuff injuries people of all ages injure their rotator cuffs. Therefore, incorporation of the anterior tendon into rotator cuff tendon repair is an important. Clinical guidelines for cpm following rotator cuff repair. Before suggesting the operation, your doctor will have considered that the benefits of the procedure outweigh any disadvantages. Rotator cuff repair protocol boston shoulder institute. Rotator cuff repair arthroscopic this protocol is based on maintaining range of movement in the first phase and then gradually building strength in the middle to the last phase. Department of rehabilitation services physical therapy arthroscopic rotator cuff repair protocol.
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. Maximise shoulder strength of deltoid, intact cuff muscles and scapula stabilisers. Performing a formulated conditioning program will als. For larger tears 4 cm, failure occurs even sooner, with as many as 78% of failures occur ring within the. Talk to your doctor or physical therapist about which exercises will best help you meet your rehabilitation goals.
Shawn hennigan, md rotator cuff repair rehabilitation protocol the following document is an evidencebased protocol for arthroscopic rotator cuff repair rehabilitation. And more confusing is the lack of consensus among surgeons regarding the optimal postoperative rehabilitation protocol following arthroscopic rotator cuff repair. Rehabilitation following rotator cuff repair introduction rehabilitation following cuff repair rehab plan rotator cuff repairs in overhead throwers conway. Tens, and manual therapy or mobilization techniques will be included. General time frames are given for reference to the average, but individual patients will progress at.
Surgery to repair a torn rotator cuff is often successful in relieving pain in the shoulder. Even when surgery and rehabilitation are successful, the repaired rotator cuff tendon is prone to reinjury up to 12 months following the procedure. Protocols can vary as drastically as beginning gentle passive range of motion and isometric exercises postoperative week 1 to delaying 12 weeks for the initiation of similar exercises. Arthroscopic rotator cuff repair guys and st thomas. Of critical importance is the type of surgery performed. Rotator cuff tearsurgery rehabilitation exercise program. It is not intended to be a substitute for clinical decision making regarding the progression of a patients postoperative course based. Rotator cuff repair protocol boston sports medicine. Following arthroscopic rotator cuff repair huberty2009 arthroscopy 489arthroscopic rotator cuff repairs 24 patients 4. Protocol s3 accelerated physical therapy protocol for. Omearas rotator cuff repair rehabilitation protocol. Although exercise protocols following rotator cuff surgery may have similar goals.
The term rotator cuff describes four muscletendon units that connect the upper. The purpose of this study was to compare the clinical and imaging of arthroscopic rotator cuff repair with and. The current literature on tissue engineering application for rotator cuff repair is scanty. Shawn hennigan, md rotator cuff repair rehabilitation protocol. Exercises using bands to rehabilitate an injured shoulder, rotator cuff, broken scapula, or broken collar bone. The procedure may not always return strength to the shoulder.
Appropriate communication between the therapist, patient and surgeon is key to a successful outcome. A rotator cuff repair involves stitching the torn tendon back onto its attachment to the arm bone humerus. There are many factors that determine the speed of recovery. To ensure that this program is safe and effective for you, it should be performed under your doctors supervision. Exercises here are some examples of typical rehabilitation exercises for your condition. Arthroscopic rotator cuff repair shoulderdoc by prof. You cam use the forum search at the top of this page and enter your search criteria and read every post ever written here at hw and that may give you some better understanding. Size and location of tear degree of shoulder instabilitylaxity prior to surgery. You will use your nonoperative arm as the motor, but do not bring your surgical arm past the plane of your. Debridement this is the removal of any loose fragments of tendon, bursa, bone or other debris from the space within which the rotator cuff moves. The american society of shoulder and elbow therapists. Romeo, md, and bernard bach, jr, md normal shoulder function requires a balanced relationship between glenohumeral mobility and glenohumeral stability. These muscles merge into tendons and this muscle structure allows the arm to be lifted and rotated. Pdf rotator cuff disease of the shoulder, a common condition, is often.
This rehabilitation protocol has been developed for the patient following a rotator cuff surgical procedure. Deltoids, supraspinatus, infraspinatus, subscapularis equipment needed. Exercise therapy following surgical rotator cuff repair morris, ac. Rehabilitation protocol following arthroscopic rotator. Pdf rehabilitation after arthroscopic rotator cuff repair. Patients with irreparable tears and shoulder pseudoparalysis may be offered rehabilitation therapy. It is not intended to be a substitute for clinical decision. Shoulder pain is a highly prevalent complaint and disorders of the rotator cuff are considered to be the most common cause.
Tears and lesions of the rotator cuff are a frequent cause of shoulder pain and disability. The term rotator cuff describes four muscletendon units that connect the upper bone of the arm to the shoulder blade. Is rehabilitation effective in massive rotator cuff tears. Rotator cuff repair rehab protocol the stone clinic.
The impact of rotator cuff tears on range of motion depends on the site of the lesions. Whether nonsurgical or surgical, successful management of rotator cuff disease is dependent on appropriate rehabilitation. Rehabilitation protocol for rotator cuff repair this protocol is intended to guide clinicians and patients through the postoperative course of a rotator cuff repair. Rotator cuff rehab the physical therapy clinic, inc. Advanced asiapacific journal of sports medicine, arthroscopy, rehabilitation and technology. Many of us have had rotator tears and surgery to repair them but post procedure we just dont have major issues. This protocol will vary in length and aggressiveness depending on factors such as. If studies are heterogeneous clinically, we will not combine the. This may be performed arthroscopically or through open surgery, using sutures and bone anchors. The rotator cuff is a group of muscles and tendons, which hold the glenohumeral joint together and help lift the arm overhead, such as throwing a ball or swimming. Stone invented one of the first suture anchors designed for rotator cuff repair, the questis suture anchor, and has been involved in technique design, modifications, and improvements ever since. Arthroscopic rotator cuff repair, rehabilitation, scientific rationale.
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