Return of strength is variable with massive tears 4. 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. Early passive range of motion is highly beneficial to enhance circulation within the joint to promote healing. Rotator cuff repair rehabilitation protocol the following document is an evidencebased protocol for arthroscopic rotator cuff repair rehabilitation. Rehabilitation guidelines for type i and type ii rotator cuff. Rehabilitation protocol for rotator cuff repair massachusetts. Immobilized at all times day and night off for hygiene and. Following rotator cuff repair surgery, a postoperative abduction pillow brace supporting the shoulder 30 abduction is used, for a minimum of 26 weeks, as there is documented evidence that there is less strain on the. The socket portion of the joint is not naturally deep. Rehabilitation protocol after arthroscopic rotator cuff repair. Accelerated rotator cuff repair protocol 3 applying your sling it may be helpful to support your arm on a firm surface while placing the wedge under the arm of your operated shoulder, however the arm can hang at your side.
Rotator cuff repair rehab protocol physical therapy referral peter g. Minimize postoperative stiffness while protecting repair during early phase of healing. Numerous rehabilitation protocols for the management of rotator cuff disease are based primarily on clinical experience and expert opinion. Improvements in strength come slowly takes 1 year to end result 3. This may be performed arthroscopically or through open surgery, using sutures and bone anchors. Arthroscopic rotator cuff repair guys and st thomas. Rehabilitation after rotator cuff repair the open orthopaedics journal, 2017, volume 11 155 outpatient procedure and mainly enables secure fixation and. Rotator cuff repair protocol rotator cuff protocol physical. James andrews, we have recently revised and expanded all of our protocols and made them completely online and downloadable. Specific interventions should be based on the needs of the individual and should consider exam findings and clinical decision making. Three of four rc tendons were torn full thickness, large tears.
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. Rotator cuff repair and rehab i reported to the surgery center at 0600, surgery at 0730, recovery room at, discharged to go home around 1. Arthroscopic rotator cuff repair shoulderdoc by prof. 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. 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. And more confusing is the lack of consensus among surgeons regarding the optimal postoperative rehabilitation protocol following arthroscopic rotator cuff repair. Rehabilitation after rotator cuff repair the open orthopaedics journal, 2017, volume 11 155 outpatient procedure and mainly enables secure fixation and sequentially early return to motion 3, 4. I now have two anchors and a bunch of sutures that i will take to the grave. Shawn hennigan, md rotator cuff repair rehabilitation protocol. Phase 1 sling 1 full time use for 6 weeks 2 sleep in sling until after week 6 3 discontinue only after week 6 weeks 06 1 passive motion only beginning first postoperative day. The primary goal of this protocol is to protect the repair while steadily progressing towards and ultimately achieving preinjury level of activity. No supporting of body weight by hand on involved side. The protocol is both chronologically and criterion based for advancement through four postoperative phases.
Many different factors influence the postoperative rotator cuff repair rehabilitation outcome, including rotator cuff tear size, type of repair, tissue quality, number. Brace abduction bracesling, remove sling only to bathe and to complete exercises. During miniopen repair, any damaged tissue or bone spurs are removed or repaired using an arthroscope. Tear size largemassive tear or 1 tendon repair difficult to achieve full rom, caution with arom and resisted exercises with chroniclarge tears. Phase i immediate postoperative phase weeks 0 6 days 014 patient is seen 2 days postoperative to remove surgical dressings and pain catheter. 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. If the tear is large, the extent of recovery cannot be accurately predicted until the repair and rehabilitation is completed. No arom exercise of the shoulder consistent use of sling unless otherwise instructed weaning starting at week 4 at earliest pendulum exercises, elbow aarom and. Rotator cuff surgery to repair frayed or thinned tendon tissue is less likely to work than surgery to repair an injury to a healthy tendon.
This is because the articular surface of the round humeral head is approximately four times greater than that of the. An evaluationbased approach abstract rotator cuff disease of the shoulder, a common condition, is often incapacitating. No arom exercise of the shoulder consistent use of sling unless otherwise instructed weaning starting at week 4 at earliest pendulum exercises, elbow aarom and gripping 4x per day starting pod 3. Phase 1 maximum protection phase 2 active range of motion. Mar 23, 2017 rehabilitation protocol following arthroscopic rotator cuff repair if you are interested in using the protocols that i have helped develop with kevin wilk and dr. Following a wellstructured conditioning program will also help you return to sports and other.
The intent of this protocol is to provide the clinician with a guideline to establish and progress a patient through post operative rehabilitation. Rotator cuff repair surgery for a tear from a sudden injury works best if it is done within a few weeks of the injury. Arthroscopic rotator cuff repair is commonly performed and is generally a safe procedure. In the general population, the prevalence of rotator cuff. It is not intended to be a substitute for clinical decision making regarding the progression of a patients postoperative course based. Most rotator cuff tears can be repaired surgically by reattaching the torn tendons to the humerus. Rotator cuff repair physical therapy protocol preoperative guidelines restore arom strengthen involved extremity in pain free rom, emphasize rotator cuff scapular stabilization musculature instruct in use of abduction pillow immobilizer, icing, hand gripping, elbow rom educate patient on postop protocol and importance of compliance for good.
Feb 28, 2017 postsurgical outcomes for patients having had rotator cuff repair can be quite good. A successful outcome is much dependent on surgical technique as it is on rehabilitation. The success of surgery to repair the rotator cuff depends upon the size of the tear and how long ago the tear occurred usually, a small tear has a good chance for full recovery. Postoperative rotator cuff repair rehabilitation protocol. Rotator cuff repair rehab protocol concord orthopaedics. Then during the open part of the surgery, a 2 to 3inch 5 to 7. Rotator cuff repair positions of significant length and tension penn shoulder and elbow service penn therapy and fitness presbyterian medical center retear and outcome n retear % surgery function fu tech tear size harryman, 1991 105 1t20 2t47 3t68 open yes us yes liu, 1994 35 34 mopen no mri yes klepps, 2004 32 1t26 2t38. Exercise in the treatment of rotator cuff impingement. Success of repair depends on several factors that include patient age, tear size, type of fixation, smoking status, and. Rehabilitation following rotator cuff repair springerlink. 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. 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.
Weather ache for 1 2 years is common after rc repair 2. Asps rotator cuff repair rehab protocol weeks 04 sling should be worn at rest. Control pain, inflammation, and effusion regain normal upper extremity strength and endurance. However, there is no consensus concerning the rehabilitation protocol following surgery. Type two rotator cuff repair arthroscopic or miniopen medium to large tear greater than 1 cm and less than 5 cm i. It is also recommended to consult the operative report for further information on the surgical procedure. The procedure involves stitching the torn tendon back onto its attachment to the humerus. Movement gently squeeze your shoulder blades together, relax, and then repeat. 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. Phase 1 sling 1 full time use for 6 weeks 2 sleep in sling until after week 6 3 discontinue only after week 6 weeks 06 1 passive motion only beginning first postoperative day forward elevation goal.
The conservative rehabilitation protocol allows sharpey fibers to form before stressing the repair with resistive exercises. Rotator cuff repair postoperative rehabilitation protocol. Rotator cuff repair a rotator cuff repair is designed to improve pain and function in cases of rotator cuff tears. Prior to rotator cuff repair surgery for rotator cuff tear, you are advised to visit your physiotherapist to make sure you are ready for your postop rehab. Rotator cuff repair postoperative rehabilitation protocol orthoindy. Rotator cuff repair protocol south shore orthopedics. Contact dr kevin murphy at 9046340640 to know more. Rotator cuff repair protocol boston sports medicine. If the tear is large, the extent of recovery cannot be accurately predicted until. Maximise shoulder strength of deltoid, intact cuff muscles and scapula stabilisers. However, to make an informed decision and give your. Abduction bracesling, remove sling only to bathe and to complete exercises. Rotator cuff repair revised august 2008 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.
Evolution of suture anchors and suture configurations have also resulted in more secure repairs 4. Rotator cuff repair phase 1 seated scapular retraction reps. 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 the following is a protocol for postoperative patients following rotator cuff repair. A rotator cuff repair involves stitching the torn tendon back onto its attachment to the arm bone humerus. Rehabilitation guidelines for rotator cuff repair and isolated subscapularis repair 2 uwsportsmedicine. Rotator cuff repair protocol boston shoulder institute. Surgical repair via open or arthroscopic techniques is associated with improved function and patient satisfaction. Rotator cuff repair protocol is a rehabilitation protocol to provide patient with the guidelines following a rotator cuff surgical procedure. Rehabilitation guidelines for type i and type ii rotator. It is not intended to be a substitute for ones clinical decision making. Madison, wi 53718 surgical repair of a rotator cuff tear can be done arthroscopically or with a miniopen procedure. 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.
Shawn hennigan, md rotator cuff repair rehabilitation. The conservative approach may be associated with postoperative stiffness which can be managed once healing has occurred. The shoulder is a wonderfully complex joint that is made up of the ball and socket connection. Whether nonsurgical or surgical, successful management of rotator cuff disease is dependent on appropriate rehabilitation. Rotator cuff physical therapy physiotherapy treatment. Before suggesting the operation, your doctor will have considered that the benefits of the procedure outweigh any disadvantages. The intent of this protocol is to provide the therapist and patient with guidelines for the postoperative rehabilitation course after arthroscopic rotator cuff repair. Rotator cuff repair rehab protocol in the early 1990s, dr. The intent of this protocol is to provide the clinician with a. The below outlines recommendations of your rehab over the first 3 months following your procedure. Showering is allowed once dressings and catheter is removed. Rotator cuff physical therapy protocol has been developed for the patient following a rotator cuff surgical procedure.
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