Conventional rehabilitation protocols after reconstruction. Quality of tissue and integrity of repair2 stronger tissue if rehabilitation for the patient with good or adequate tissue would be a. Find out how physical therapy exercises and other treatment can help you feel better. 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. Specific interventions should be based on the needs of the individual and should consider exam findings and clinical decision making. Nov 08, 2016 recovery phase rotator cuff strain rehabilitation. All of the exercises should be performed with slow and controlled motion. Pictures courtesy of simpleset, used with permission. Please dont hesitate to contact amy baer pt, atc or geoff omiatek pt, at, ms, scs at 614 8271050 with any. Rehabilitation guidelines for type i and type ii rotator. Brace abduction bracesling, remove sling only to bathe and to complete exercises. Repair guideline background the rotator cuff is responsible for stabilization and active movement of the glenohumeral joint. The effects of a standard postoperative rehabilitation. Rehabilitation guidelines rehabilitation guidelines after rotator cuff repair mark a.
After an injury or surgery, an exercise conditioning program will help you return to. 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 designed for rehabilitation following large to massive rotator cuff repairs. Victoria bc v8z 0b9 tel 250 940 4444 fax 250 385 9600 page 1 june 2017 v1s. Rotator cuff repair protocol boston shoulder institute. Rehabilitation, arthroscopic rotator cuff repair, shoulder, scientific. Arthroscopic rotator cuff repair rehabilitation protocol. In fact, some rotator cuff tears will increase in size if. Rotator cuff repair postoperative rehabilitation protocol. Rehabilitation recovery from a shoulder surgery takes several months. 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.
If initial nonsurgical treatment of a rotator cuff tear fails, surgical repair is often the next line of treatment. No resisted rotator cuff strengthening exercises until weeks. The socket portion of the joint is not naturally deep. Gently stretching after strengthening exercises can help reduce muscle soreness and. 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. The recovery phase begins when the initial pain and inflammation have gone and most normal daily activities are pain free and the injured arm has at least 75% range of movement compared to the uninjured one. Clv pt arthroscopic rotator cuff repair small rehab protocol. In rotator cuff repair surgery one or more of these muscles are reattached to the bone using.
Rehabilitation following rotator cuff repair introduction rehabilitation following cuff repair rehab plan rotator cuff repairs in overhead throwers conway. 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. Immobilized at all times day and night off for hygiene and. The conservative rehabilitation protocol allows sharpey fibers to form before stressing the repair with resistive exercises.
Talk to your doctor or physical therapist about which exercises will best help you meet your rehabilitation goals. This evidencebased small to medium rotator cuff repair physical therapy. Large rotator cuff repair protocol fowler kennedy sport. Rotator cuff repair rehabilitation guide matthew boes, md.
Many different factors influence the postoperative rotator cuff repair rehabilitation outcome, including rotator cuff tear size, type of repair, tissue quality, number of. Rehabilitation protocol for rotator cuff repair this protocol is intended to guide clinicians and patients through the postoperative course of a rotator cuff repair. Rehabilitation of the shoulder following rotator cuff injury or surgery clive brewster, ms, rpt diane r. Unfortunately, there is no consensus on the rehabilitation protocols and contents following the surgical procedure. Progressive painfree range of motion prom aarom arom. Department of rehabilitation services physical therapy arthroscopic rotator cuff repair protocol. Rotator cuff repair and rehabilitation surgical indications and considerations anatomical considerations. Rehabilitation guidelines for type i and type ii rotator cuff. The rotator cuff complex is comprised of four tendons from four muscles.
After a rotator cuff repair surgery, patients are required to wear a sling for four weeks. The american society of shoulder and elbow therapists. Exercises and physical therapy for rotator cuff tear. The prevalence of full thickness tears in the general population is about 20% and markedly increased after the age of 50. 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. Rotator cuff and shoulder conditioning program orthoinfo aaos. Rotator cuff tears do not heal, or repair themselves. Rehabilitation of the shoulder following rotator cuff injury. Tears of the rotator cuff tendons rc are a frequent cause of shoulder complaints. The four shoulder muscles that make up the rotator cuff can get worn or tear. Initiate with submax painfree isometrics and arom as outlined in the protocol. A large size rotator cuff tear is defined as a tear 35cm.
Conservative treatment of rotator cuff injuries to avoid surgical repair by jill schuldt, lmt through a systematic investigation, the rotator cuff was studied to evaluate and define its associated injuries and how conservative treatment of these injuries leads to corrective resolution, eliminating the need for surgical repair. Level of evidence this is a level iv, therapeutic case series. When appropriate, sub maximal and painfree multiangle isometrics for er and ir should be performed to prevent muscular atrophy and to minimize rotator cuff. For this reason the shoulder is the most mobile joint in the body.
Rotator cuff repair is the surgery used to repair a tear in one of these tendons. 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 post operative rehabilitation protocol. Pdf rehabilitation after rotator cuff repair researchgate. Inclusion criteria were patients undergoing arthroscopic rotator cuff repair. 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. It is designed for rehabilitation following small to medium rotator cuff repairs. Whether nonsurgical or surgical, successful management of rotator cuff disease is dependent on appropriate rehabilitation. These exercises are intended for the initial strengthening of acute shoulder problems, andor longterm rehabilitation for massive rotator cuff tears and other conditions resulting in longterm severe weakness. Phase 1 maximum protection phase 2 active range of motion.
The criteria to progress from phase i to phase ii is a pain free passive motion. Following arthroscopic rotator cuff repair huberty2009 arthroscopy 489arthroscopic rotator cuff repairs 24 patients 4. Use a weight that makes the last few repetitions difficult, but pain free. This protocol is designed for the patient following arthroscopic rotator cuff repair. Symptoms of rotator cuff injuries people of all ages injure their rotator cuffs. 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. Introduction proper rehabilitation after rotator cuff repair is essential for success, and progresses in stages. Rotator cuff repair large to massive 5cm rehabilitation.
Are pulley exercises initiated 6 weeks after rotator cuff. Rotator cuff repair rehabilitation program largemassive 5cm. Madison, wi 53718 surgical repair of a rotator cuff tear can be done arthroscopically or with a miniopen procedure. Rotator cuff and shoulder rehabilitation exercises. Generally speaking, the anchors and suture used to repair your cuff are very strong and rarely fail, but the tissue itself can tear free from the sutures. Arthroscopic rotator cuff repair small tear rehab protocol craig l. Rotator cuff repair small to medium rehabilitation guideline this rehabilitation program is designed to return the individual to their activities as quickly and safely as possible. Moynes schwab, ms, rpt2 r otator cuff injuries oc cur because of mechan ical abrasion within a decreased glenohu meral joint space. 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 goals of rehabilitation are to eliminate pain, restore strength, flexibility, and function, and maintain the integrity of the repair. Rehabilitation following surgical rotator cuff repair may enable return to preinjury function. Welcome to our rotator cuff repair rehabilitation video series. Rehabilitation protocol for rotator cuff repair massachusetts. Shawn hennigan, md rotator cuff repair rehabilitation protocol. The principles of crosseducation can be used early in the rehabilitation phase. The protocol is both chronologically and criterion based for advancement through four postoperative phases.
Use a weight that makes the last few repetitions difficult, but painfree. The team at the stone clinic has been repairing rotator cuffs for over twenty years and has progressively improved the techniques. Rotator cuff repair protocol south shore orthopedics. A small size rotator cuff tear is defined as a tear rotator cuff repair is performed, either arthroscopically or via miniopen procedure, by suturing the torn tendon to the. Rotator cuff repair guidelines our physicians at orthopedic one are committed to working with any licensed rehabilitation provider to assist with their patients postoperative care. The conservative approach may be associated with postoperative stiffness which can be managed once healing has occurred.
Arthroscopic and open rotator cuff repair rehabilitation protocol week 1 2 shoulder sling and swathe full time day and night. The glsm rotator cuff repair rehabilitation program is an evidencebased and soft tissue healing dependent program. Rehabilitation introduction rotator cuff pathology is a common cause of shoulder pain, weakness, limitations to daily activity, and time off from work 1,2. Those patients with poor rotator cuff tissue integrity, tear of 2. Regain normal strength and painfree function of the shoulder. Move the arm by rocking the body forwardback, side to side, or in a circle. Pdf background rotator cuff tears are a very common condition that is often. A total of 27 patients who underwent rotator cuff repair were randomized to a rehabilitation group that used pulleys initiated 6 weeks postoperatively, and 26 patients followed a rehabilitation protocol without pulleys. Improvement in terms of strength, movement and pain reduction can be expected after rotator cuff repair surgery.
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. Optimal recovery is facilitated by the use of postoperative protocols that enhance communication. The authors protocol of choice, used within a large sports medicine rehabilitation center, is presented and the rationale behind its implementation is discussed. Evidence from two or more high quality studies with consistent findings for recommending. Conservative treatment of rotator cuff injuries to avoid. Rotator cuff rc disease is a frequent cause of shoulder pain and can result in weakness, alterations in glenohumeral kinematics, and shoulder instability in some circumstances. Cole,md,mba range of motion immobilizer exercises phase i 04 weeks 02 weeks. On the other hand, 25% of all individuals over the age of 60 have a rotator cuff tear.
Conservative rotator cuff tear protocol sports and ortho. General time frames are given for reference to the average, but individual patients will progress at. Open surgery is required to repair the rotator cuff tear that is medium to large in size. 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. Postoperative rotator cuff repair rehabilitation protocol. Full functioning may not return for six months or more. Arthroscopic rotator cuff repair protocol medium to large. How ever, the most frequent cause in an active young adult is excessive ante. Isometrics targeting the rotator cuff of the unoperated arm e. Rehabilitation of the shoulder following rotator cuff. Rotator cuff repair rehabilitation protocol the following document is an evidencebased protocol for arthroscopic rotator cuff repair rehabilitation. Arthroscopic rotator cuff repair frequently asked questions.
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