Summary table post op phasegoals range of motion therapeutic exercise precautions days 1 7 wear sling during the day and at night remove sling for showeringbathing remove sling 4 to 5 times per day for gentle elbow, forearm, wrist and finger exercises. The socket portion of the joint is not naturally deep. The therapist can provide instruction on patient directed active range of motion, patient directed flexibility, and patient directed. 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 south shore orthopedics.
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. Immediate postop phase first 57 days after surgery, prior to starting pt goals. This protocol is intended to guide clinicians and patients through the postoperative course of a rotator cuff repair. 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. Specific interventions should be based on the needs of the individual and should. The conservative approach may be associated with postoperative stiffness which can be managed once healing has occurred. Treatment should be modified based on the condition of the rotator cuff. Specific interventions should be based on the needs of the individual and should consider exam findings and clinical decision making. Rotator cuff and shoulder conditioning program orthoinfo aaos. This protocol is intended to guide clinicians and patients through the post operative course of a rotator cuff repair. This protocol is designed for the patient following arthroscopic rotator cuff repair. Brace abduction bracesling, remove sling only to bathe and to complete exercises. 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. Rotator cuff and shoulder rehabilitation exercises.
The authors protocol of choice, used within a large sports medicine rehabilitation center. The intent of this protocol is to provide the therapist and patient with guidelines for the postoperative rehabilitation course after arthroscopic rotator cuff repair. No resisted rotator cuff strengthening exercises until weeks patients this protocol should be used as a guide during your rehabilitation after surgery. A physiotherapist should be consulted throughout to teach and individually modify the exercises. 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. Do not have the patient perform fullcan or emptycan supraspinatus exercises. Rotator cuff repair the following is a protocol for postoperative patients following rotator cuff repair. Rotator cuff repair rehab protocol in the early 1990s, dr. Purpose of the abductor pillow is to keep tension off of the repair, avoid adduction.
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. 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. The shoulder is a wonderfully complex joint that is made up of the ball and socket connection. The rotator cuff is made up of four muscles supraspinatus, infraspinatus, subscapularis, and teres minor and their tendons. To provide an overview of the characteristics and timing of rotator cuff healing and provide an update on treatments used in rehabilitation of rotator cuff repairs. Postoperative rehabilitation guidelines for rotator cuff tears please note that these instructions are general guidelines to be followed. Rotator cuff repair rehab protocol the stone clinic. The protocol is both chronologically and criterion based for advancement through four postoperative phases. Rotator cuff sprain and strains university of california.
Rotator cuff repair small to medium rehabilitation guideline. Department of rehabilitation services physical therapy arthroscopic rotator cuff repair protocol. Rehabilitation protocol for small to moderate rotator cuff tear. Postoperative rehabilitation guidelines for rotator cuff tears. The primary goal of this protocol is to protect the repair while steadily progressing towards and ultimately achieving preinjury level of activity. Rotator cuff tendonitis rehabilitation protocol impingement is a chronic inflammatory process produced as the rotator cuff muscles supraspinatus, infraspinatus, teres major, and subscapularis and the subdeltoid bursa are pinched against the coracoacromial ligament and the anterior acromion when the arm is raised above 90 degrees.
Your surgeon will advise when you should start physiotherapy at your first followup appointment. Move the arm by rocking the body forwardback, side to side, or in a circle. This handout serves as a guideline for your rehabilitation after rotator cuff repair. Rotator cuff repair protocol boston shoulder institute. Rehabilitation protocol for rotator cuff repair massachusetts. Rehabilitation guidelines for type i and type ii rotator cuff. It is designed for rehabilitation following small to medium rotator cuff repairs. Conservative rotator cuff tear protocol sports and orthopedic. The physician will make specific changes to the program as appropriate for an individual patient. Abduction bracesling, remove sling only to bathe and to complete exercises. Arthroscopic rotator cuff repair frequently asked questions. Physical therapy standards of care and protocol the following standards of care and protocols are the property of bwh and should not be copied or otherwise used without the permission of the director of rehabilitation services. The rotator cuff is responsible for stabilization and active movement of the glenohumeral joint. Strengthening of the rotator cuff is done within limits of pain.
Tear size largemassive tear or 1 tendon repair difficult to achieve full rom, caution with arom and resisted exercises with chroniclarge tears. Rotation medical patch rehabilitation protocol phase i. It provides stability and strength for the shoulder joint, anchoring the humerus upper arm bone to the scapula shoulder blade so that movements of the arm can occur in a. The shoulder joint is a ball and socket joint that connects. It is no means intended to be a substitute for ones. This is because the articular surface of the round humeral head is approximately four times greater than that of the. For this reason the shoulder is the most mobile joint in the body.
After an injury or surgery, an exercise conditioning. It is essential that he or she follow this rehabilitation program very closely. Rotator cuff repair postoperative rehabilitation protocol. Most rotator cuff tears can be repaired surgically by reattaching the torn tendons to the humerus. We have remained at the forefront of medicine by fostering a culture of collaboration, pushing the boundaries of medical research, educating the brightest medical minds and maintaining an unwavering commitment to the diverse communities we serve. 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. Remove sling for light activity and home exercise program as indicated by therapist.
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 strengthening internal and external rotation isometrics against a wall. Reduce pain and inflammation maximize romflexibility of glenohumeral and scapulothoracic joints maximize strengthendurance of rotator cuff and scapular musculature educate client in short term use of sling for protection and activerest if necessary. The intent of this protocol is to provide the clinician with a. Prom as instructed restrictionsexercise progression. No arom exercise of the shoulder consistent use of sling unless otherwise instructed weaning starting at week 4 at earliest. Rehabilitation protocol for rotator cuff repair this protocol is intended to guide clinicians and patients through the postoperative course of a rotator cuff repair. 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. Postoperative rotator cuff repair rehabilitation protocol. Johns hopkins shoulder surgery arthroscopic acromioplasty rehabilitation program johns hopkins shoulder surgeons introduction. Sports medicine physical therapy rehabilitation protocols. Clv pt arthroscopic rotator cuff repair small rehab protocol.
Arthroscopic rotator cuff repair postoperative rehab protocol. Shawn hennigan, md rotator cuff repair rehabilitation. Rotator cuff and shoulder rehabilitation exercises orthoinfo aaos. The shoulder rehabilitation protocol consists of two major components. Rotator cuff repair with biceps releasetenodesis brian bjerke, md postoperative protocol phase i maximum protection week 0 to 6 goals. Arthroscopic and open rotator cuff repair rehabilitation protocol week 1 2 shoulder sling and swathe full time day and night. The team at the stone clinic has been repairing rotator cuffs for over twenty years and has progressively improved the techniques. One high standard, three local partners for more information go to. A large size rotator cuff tear is defined as a tear 35cm, massive 5cm.
The conservative rehabilitation protocol allows sharpey fibers to form before stressing the repair with resistive exercises. Robertsons office and begin a rehabilitation program. At a 30 degree angle in front of the body with thumb pointed up, slowly raise arm to shoulder height. Rotator cuff repair postoperative rehabilitation protocol orthoindy. Nonoperative rotator cuff tear protocol acuteearly phase limited, painful arom, painful resisted testing subacutemid phase full arom, minimal to no pain with resisted testing initial evaluation evaluate. Rotator cuff injury protocols university of california. Sad subacromial decompression protocol phase i postop until week 2 protective phase. Cole,md,mba range of motion immobilizer exercises phase i 04 weeks 02 weeks. This protocol provides you with general guidelines for the conservative rehabilitation of the patient with a rotator cuff tear rct.
It is not intended to be a substitute for clinical decision making regarding the progression of a patients postoperative course based. Supraspinatus open can patient stands with theraband under their foot while grasping theraband, bring shoulders back and down. Keep the abductor pillow in for the 4 weeks as well. All of the exercises should be performed with slow and controlled motion. Shawn hennigan, md rotator cuff repair rehabilitation protocol the following document is an evidencebased protocol for arthroscopic rotator cuff repair rehabilitation. 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. Talk to your doctor or physical therapist about which exercises will best help you meet your rehabilitation goals. Arthroscopic rotator cuff repair postoperative rehab protocol postoperatively you will be placed in a sling. Sling x 6 weeks ultrasling x 46 weeks, larger tears may be in ultrasling x 6 weeks then. Three of the four rotator cuff muscles attach from the back of the shoulder blade to the arm bone. Avoid provocative maneuvers or exercises that cause discomfort o includes both offending rom exercises and strengthening exercises. Verma or either physician assistant supersede the instructions below and should be followed.
This is summary of the evaluation and rehabilitation of a patient following an arthroscopic acromioplasty. Sling immobilization with supporting abduction pillow to be worn at all times except for showering and rehab under guidance of pt. 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. Johns hopkins shoulder surgery arthroscopic acromioplasty.
Those patients with poor rotator cuff tissue integrity, tear of 2. 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. Rehabilitation guidelines for type i and type ii rotator. Arthroscopic rotator cuff repair small tear rehab protocol craig l. 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.
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