Protocol s3 accelerated physical therapy protocol for. How to do the exercises posterior stretching exercise 1. 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. Clinical guidelines for cpm following rotator cuff repair. Rotator cuff repair rehab protocol the stone clinic. If studies are heterogeneous clinically, we will not combine the estimates for.
Surgery to repair a torn rotator cuff is often successful in relieving pain in the shoulder. Shawn hennigan, md rotator cuff repair rehabilitation protocol. Tens, and manual therapy or mobilization techniques will be included. However, to make an informed decision and give your. Rotator cuff tearsurgery rehabilitation exercise program. No arom exercise of the shoulder consistent use of sling unless otherwise instructed weaning starting at week 4 at earliest. The current literature on tissue engineering application for rotator cuff repair is scanty. Romeo, md, and bernard bach, jr, md normal shoulder function requires a balanced relationship between glenohumeral mobility and glenohumeral stability. Microfracture of greater tuberosity speeds healing of rotator cuff tears. Arthroscopic rotator cuff repair, rehabilitation, scientific rationale. This is because the articular surface of the round humeral head is approximately four times greater than that of the. 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 and shoulder rehabilitation exercises. 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.
Shawn hennigan, md rotator cuff repair rehabilitation protocol the following document is an evidencebased protocol for arthroscopic rotator cuff repair rehabilitation. Rom 1 codmanspendulum bend over chairtable, hang affected arm straight. 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. Continued c canstick exercises for external rotation you can passively externally rotate your surgical shoulder and arm to the plane of your body. Even when surgery and rehabilitation are successful, the repaired rotator cuff tendon is prone to reinjury up to 12 months following the procedure. The protocol is both chronologically and criterion based for advancement through four postoperative phases. Shoulder pain is a highly prevalent complaint and disorders of the rotator cuff are considered to be the most common cause. These muscles merge into tendons and this muscle structure allows the arm to be lifted and rotated. Performing a formulated conditioning program will als. Therefore, incorporation of the anterior tendon into rotator cuff tendon repair is an important.
The rotator cuff can also wear out as a result of degenerative changes. Now also begin to perform rotator cuff strengthening exercises. The intent of this protocol is to provide the clinician with a. 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. The purpose of this study was to compare the clinical and imaging of arthroscopic rotator cuff repair with and. Rotator cuff surgery rehabilitation programs are often based on both surgeon. If initial nonsurgical treatment of a rotator cuff tear fails, surgical repair is often the next line of treatment.
Rotator cuff repair a rotator cuff repair is designed to improve pain and function in cases of rotator cuff tears. Manual resisted proprioceptive neuromuscular facilitation through diagonal. Footprint anatomy the insertion site of the rotator cuff tendon at the greater tuberosity is often referred to as the footprint. Exercise therapy following surgical rotator cuff repair protocol. Accelerated physical therapy protocol for rotator cuff repair arthroscopic or miniopen technique recommended for mild. None stepbystep directions lean forward and place one hand on a counter or table for support. The rotator cuff surgery to repair a torn rotator cuff muscle or tendon usually involves one or more of the following surgical goals. Protocol s3 accelerated physical therapy protocol for rotator. Rehabilitation following rotator cuff repair introduction rehabilitation following cuff repair rehab plan rotator cuff repairs in overhead throwers conway. It is evident that a successful outcome after surgical rotator cuff repair is as much dependent on surgical technique as it is on rehabilitation.
Victoria bc v8z 0b9 tel 250 940 4444 fax 250 385 9600 page 1 june 2017 v1s. Microfracture of greater tuberosity speeds healing of. 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. Although exercise protocols following rotator cuff surgery may have similar goals.
Combining orthopedic special tests to improve diagnosis of shoulder. No arom exercise of the shoulder consistent use of sling unless otherwise instructed weaning starting at week 4. Strengthen deltoid, rotator cuff and scapular stabilizers. A torn rotator cuff due to an injury is usually best treated by immediate surgical repair. A rotator cuff repair involves stitching the torn tendon back onto its attachment to the arm bone humerus. 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. Size and location of tear degree of shoulder instabilitylaxity prior to surgery.
Modified rehabilitation program after rotator cuff repair. Rotator cuff repair can require a long recovery period, especially if the tear was large. Specific interventions should be based on the needs of the individual and should consider exam findings and clinical decision making. 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. Rehabilitation following arthroscopic rotator cuff repair core. 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. Following arthroscopic rotator cuff repair huberty2009 arthroscopy 489arthroscopic rotator cuff repairs 24 patients 4. Exercises using bands to rehabilitate an injured shoulder, rotator cuff, broken scapula, or broken collar bone. Complete ruptures usually require surgery if your goal is to return your shoulder to optimal function. The procedure involves stitching the torn tendon back onto its attachment to the humerus. Rehabilitation guidelines for type i and type ii rotator cuff. 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.
Rehabilitation protocol following arthroscopic rotator cuff. Many of us have had rotator tears and surgery to repair them but post procedure we just dont have major issues. 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. 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. 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. 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. You will use your nonoperative arm as the motor, but do not bring your surgical arm past the plane of your. Talk to your doctor or physical therapist about which exercises will best help you meet your rehabilitation goals.
To ensure that this program is safe and effective for you, it should be performed under your doctors supervision. 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. The impact of rotator cuff tears on range of motion depends on the site of the lesions. This may be performed arthroscopically or through open surgery, using sutures and bone anchors. There are many factors that determine the speed of recovery. Orthop no am 01 14 baseball players pitchers intratendinous repair average follow up 16 mos 89 89% followed for 1 yr or more returned to preinjury level. Rehabilitation protocol for rotator cuff repair this protocol is intended to guide clinicians and patients through the postoperative course of a rotator cuff repair. General time frames are given for reference to the average, but individual patients will progress at. Rotator cuff repair is the surgery used to repair a tear in one of these tendons. Arthroscopic rotator cuff repair shoulderdoc by prof. Pdf rotator cuff disease of the shoulder, a common condition, is often.
Rotator cuff repair protocol boston shoulder institute. Modified rehabilitation program after rotator cuff repair robert e. The term rotator cuff describes four muscletendon units that connect the upper bone of the arm to the shoulder blade. The image below is an mri sagittal plane of the rotator cuff. Exercise therapy following surgical rotator cuff repair morris, ac. The american society of shoulder and elbow therapists.
Arthroscopic rotator cuff repair guys and st thomas. Dugas et al 20 examined 20 normal cadaveric rotator cuff specimens and. Patients with irreparable tears and shoulder pseudoparalysis may be offered rehabilitation therapy. Recovering from rotator cuff surgery usually takes 4 to 6 months, but a full recovery can take up to a year. Intermittently apply grade ii mobilizations in the open packed position of the shoulder. Omearas rotator cuff repair rehabilitation protocol. 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. When you lay it out like that, we simply combine those goals. Department of rehabilitation services physical therapy arthroscopic rotator cuff repair protocol.
Rehabilitation protocol following arthroscopic rotator cuff repair. Download shoulder surgery rehabilitation protocol pdf. Rehabilitation protocol following arthroscopic rotator. Arthroscopic rotator cuff repair is commonly performed and is generally a safe procedure. Is rehabilitation effective in massive rotator cuff tears.
Pdf rehabilitation after arthroscopic rotator cuff repair. 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. The procedure may not always return strength to the shoulder. The four phases of healing during rehabilitation following rotator cuff surgery. Rotator cuff repair protocol boston sports medicine. Advanced asiapacific journal of sports medicine, arthroscopy, rehabilitation and technology. It is not intended to be a substitute for clinical decision. An evaluationbased approach abstract rotator cuff disease of the shoulder, a common condition, is often incapacitating. The lines joining the boxes represent the median values for each group dashed line is the im. For larger tears 4 cm, failure occurs even sooner, with as many as 78% of failures occur ring within the.
Of critical importance is the type of surgery performed. 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. 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. Rotator cuff rehab the physical therapy clinic, inc. And more confusing is the lack of consensus among surgeons regarding the optimal postoperative rehabilitation protocol following arthroscopic rotator cuff repair. It is not intended to be a substitute for clinical decision making regarding the progression of a patients postoperative course based.
Rotator cuff and shoulder conditioning program stretching exercises 1. The term rotator cuff describes four muscletendon units that connect the upper. Your doctor or therapist will tell you when you can start these exercises and which ones will work best for you. Anteriorly, the capsulecoracohumeral complex, which merges together, contracts and. Whether nonsurgical or surgical, successful management of rotator cuff disease is dependent on appropriate. This protocol will vary in length and aggressiveness depending on factors such as. 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.
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. Rehabilitation guidelines for type i and type ii rotator. Exercises here are some examples of typical rehabilitation exercises for your condition. If studies are heterogeneous clinically, we will not combine the. Deltoids, supraspinatus, infraspinatus, subscapularis equipment needed. Before suggesting the operation, your doctor will have considered that the benefits of the procedure outweigh any disadvantages. 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. Tears and lesions of the rotator cuff are a frequent cause of shoulder pain and disability. Symptoms of rotator cuff injuries people of all ages injure their rotator cuffs. Rehabilitation of the shoulder after rotatorcuff repair. Appropriate communication between the therapist, patient and surgeon is key to a successful outcome. 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 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. When you can return to work or play sports depends on the surgery that was done. Tears are considered massive when they involve multiple tendons. The team at the stone clinic has been repairing rotator cuffs for over twenty years and has progressively improved the techniques. Traditional rehabilitation following rotator cuff repair has. Mar 23, 2017 and more confusing is the lack of consensus among surgeons regarding the optimal postoperative rehabilitation protocol following arthroscopic rotator cuff repair. 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. This rehabilitation protocol has been developed for the patient following a rotator cuff surgical procedure.
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