Rehabilitation protocol for rotator cuff repair this protocol is intended to guide clinicians and patients through the postoperative course of a rotator cuff repair. Postoperative rotator cuff repair rehabilitation protocol. 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. Arthroscopic rotator cuff repair protocol medium to large. The protocol is both chronologically and criterion based for advancement through four postoperative phases. Rehabilitation guidelines for type i and type ii rotator cuff. Rehabilitation protocol for rotator cuff repair massachusetts.
The protective protocol, in which muscle strengthening exercises are delayed, is applied after arthroscopic repair of rotator cuff tears greater than 5 cm or involving more than 2 tendons, poor tissue quality, or repairs with greater tension. Postoperative rehabilitation guidelines for rotator cuff tears please note that these instructions are general guidelines to be followed. It should be stressed that this is only a protocol and. Rotator cuff repair of protocol page3 phase 1 immediate post operative this phase involves the initial recovery period after surgery and generally lasts until 46 weeks post operative. Sling immobilization with supporting abduction pillow to be worn at all times except for showering and rehab under guidance of pt.
Rehabilitation following rotator cuff repair introduction rehabilitation following cuff repair rehab plan rotator cuff repairs in overhead throwers conway. If you have any questions regarding the progress of the patient, the physician should be. It is no means intended to be a substitute for ones. Rotator cuff repair with biceps releasetenodesis brian bjerke, md postoperative protocol phase i maximum protection week 0 to 6 goals. Appropriate communication between the therapist, patient and surgeon is key to a. Many different factors influence the postoperative rotator cuff repair rehabilitation outcome, including rotator cuff tear size, type of repair, tissue quality, number of. Starting the first day after surgery you should remove the sling 34 times per day to perform pendulum exercises and elbowwrist range of motion unless. Arthroscopic and open rotator cuff repair rehabilitation protocol week 1 2 shoulder sling and swathe full time day and night. Rotator cuff tears are classified into one of 4 categories.
Find pdfs of our most common rehabilitation protocols. For this reason the shoulder is the most mobile joint in the body. The primary goal of this protocol is to protect the repair while steadily progressing towards and ultimately achieving preinjury level of activity. Rotator cuff and shoulder rehabilitation exercises. The intent of this protocol is to provide the therapist and patient with guidelines for the postoperative rehabilitation course after arthroscopic rotator cuff repair. Most rotator cuff tears can be repaired surgically by reattaching the torn tendons to the humerus. Cole,md,mba range of motion immobilizer exercises phase i 04 weeks 02 weeks. The sports physical therapy service is an integral part of the sports medicine center and the department of. 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. The conservative approach may be associated with postoperative stiffness which can be managed once healing has occurred.
The rotator cuff is a group of four tendons that attach to the ball of the shoulder joint. Prom as instructed restrictionsexercise progression. Arthroscopic rotator cuff repair protocol medium to large tear size this protocol was developed to provide the rehabilitation professional with a guideline of postoperative rehabilitation course for a patient who has undergone an arthroscopic medium to large size rotator cuff tear repair. Rotator cuff repair postoperative rehabilitation protocol. The physician will make specific changes to the program as appropriate for an individual patient. 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. Pdf rehabilitation after rotator cuff repair researchgate. Biceps tenotomy protocol boston shoulder institute. They attach from the shoulder blade onto the top of the arm bone. The american society of shoulder and elbow therapists.
Rotator cuff repair protocol boston shoulder institute. 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. 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. 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. 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. Purpose of the abductor pillow is to keep tension off of the repair, avoid adduction. 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. 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. 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.
It is essential that he or she follow this rehabilitation program very closely. The intent of this protocol is to provide the clinician with a. Distal rom with scapular retraction manual scapular manipulation with patient lying on nonoperative side supine. Repair guideline background the rotator cuff is responsible for stabilization and active movement of the glenohumeral joint. Keep the abductor pillow in for the 4 weeks as well. Rehabilitation guidelines after rotator cuff repair mark a. Arthroscopic rotator cuff repair postoperative rehab protocol. The therapist can provide instruction on patient directed active range. Sports medicine physical therapy rehabilitation protocols. Shawn hennigan, md rotator cuff repair rehabilitation protocol. The overarching philosophy of rehabilitation is centered on the principle of the gradual application of controlled stresses to the healing rotator cuff repair with consideration of rotator cuff tear size, tissue quality, and patient variables. Brace abduction bracesling, remove sling only to bathe and to complete exercises. Rotator cuff repair the following is a protocol for postoperative patients following rotator cuff repair. Rotator cuff repair protocol south shore orthopedics.
Specific changes in the program will be made by the physician as appropriate for an individual patient. 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. When the arm is moved away from the body or over the head the tendons act to hold the ball in the socket correctly so that smooth fluid motion can be achieved. Shawn hennigan, md rotator cuff repair rehabilitation protocol the following document is an evidencebased protocol for arthroscopic rotator cuff repair rehabilitation. Tear size largemassive tear or 1 tendon repair difficult to achieve full rom, caution with arom and resisted exercises with chroniclarge tears. Rotator cuff repair postoperative rehabilitation protocol orthoindy. It is not intended to be a substitute for clinical decision making. Starting the first day after surgery you should remove the sling 34 times per day to perform pendulum exercises and elbowwrist range of motion unless otherwise specified by dr. Rotator cuff repair protocol general guidelines this purpose of this protocol is to discuss the safe rehab management of rotator cuff repairs involving the supraspinatus, infraspinatus, teres minor and subscapularis tendons. The intent of this protocol is to provide the patient, clinician and physical therapist with a guideline of the postoperative rehabilitation course of a patient that has undergone an arthroscopic rotator cuff repair. To ensure that this program is safe and effective for you, it should be performed under your doctors supervision. It is not intended to be a substitute for clinical decision.
A large size rotator cuff tear is defined as a tear 35cm. No arom exercise of the shoulder consistent use of sling unless otherwise instructed weaning starting at week 4. If the treating physical therapist needs to learn more about biceps tenotomy and rehabilitation we recommend reading. Sling x 6 weeks ultrasling x 46 weeks, larger tears may be in ultrasling x 6 weeks then. Postoperative rehabilitation guidelines for rotator cuff tears. Multiple factors can impact the repair, including tissue quality, the age and size of the tear, compliance with postoperative restrictions, patient age and smoking history. Abduction bracesling, remove sling only to bathe and to complete exercises. Biceps tenotomy protocol the intent of this protocol is to provide the clinician with a guideline of the post. This protocol provides you with general guidelines for the rehabilitation of patients following a massive open andor arthroscopic rotator cuff repair. Rotator cuff repair rehab protocol the stone clinic. The stability and movement of the shoulder is controlled primarily by the rotator cuff muscles, with assistance from the ligaments, glenoid labrum and capsule of the shoulder. This is because the articular surface of the round humeral head is approximately four times greater than that of the.
Specific interventions should be based on the needs of the individual and should consider exam findings and clinical decision making. Rotation medical patch rehabilitation protocol phase i. This protocol is designed for the patient following arthroscopic rotator cuff repair. Sad subacromial decompression protocol phase i postop until week 2 protective phase. Department of rehabilitation services physical therapy arthroscopic rotator cuff repair protocol. These muscles help keep the joint in the correct position and control shoulder movements. The socket portion of the joint is not naturally deep.
The conservative rehabilitation protocol allows sharpey fibers to form before stressing the repair with resistive exercises. 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. Rotator cuff repair page 4 page 5 rotator cuff repair the rotator cuff the rotator cuff is a group of muscles closely wrapped around the shoulder. Large 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.
They surround the ball much like the cuff of a sleeve fits snuggly around the wrist. Those patients who have good rotator cuff tissue integrity, a one to two tendon repair, with a tear 3 centimeters or less will typically be progressed on the quicker end of these time frames. It is not intended to be a substitute for clinical decision making regarding the progression of a patients postoperative course based. Verma or either physician assistant supersede the instructions below and should be followed. 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. It is designed for rehabilitation following large to massive rotator cuff repairs. Remove sling for light activity and home exercise program as indicated by therapist. No arom exercise of the shoulder consistent use of sling unless otherwise instructed weaning starting at week 4 at earliest. Passive, aarom, and arom exercises as symptoms allow starting with passive.
This protocol provides you with general guidelines for the conservative rehabilitation of the patient with a rotator cuff tear rct. Arthroscopic rotator cuff repair frequently asked questions. Talk to your doctor or physical therapist about which exercises will best help you meet your rehabilitation goals. Those patients with poor rotator cuff tissue integrity, tear of 2. Cole,md,mba range of motion immobilizer exercises phase i 06 weeks 03 weeks. The team at the stone clinic has been repairing rotator cuffs for over twenty years and has progressively improved the techniques. Rotator cuff repair surgery can now be performed arthroscopically and is. Surgery to repair a torn rotator cuff most often involves reattaching the tendon to the humerus. Rotator cuff repair large to massive 5cm rehabilitation. This rehabilitation program has been distilled from seven level 1 or level 2 randomized controlled trials that demonstrate benefits from physical therapy for treating rotator cuff pain.
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