Rehabilitation guidelines for type i and type ii rotator cuff. Sling immobilization with supporting abduction pillow to be worn at all times except for showering and rehab under guidance of pt. Rotator cuff repair protocol is a rehabilitation protocol to provide patient with the guidelines following a rotator cuff surgical procedure. Arthroscopic rotator cuff repair guys and st thomas.
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. Whilst dr gupta, your gp and your physio will help guide and motive you through your recovery, the more you can help on your own, the better the result for all. If the tear is large, the extent of recovery cannot be accurately predicted until. 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. 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.
This may be performed arthroscopically or through open surgery, using sutures and bone anchors. Rotator cuff repair uf health, university of florida health. Success of repair depends on several factors that include patient age, tear size, type of fixation, smoking status, and. Arthroscopic rotator cuff repair is commonly performed and is generally a safe procedure. Postoperative rotator cuff repair rehabilitation protocol.
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. 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 supporting of body weight by hand on involved side. 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. However, there is no consensus concerning the rehabilitation protocol following surgery. 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. Most rotator cuff tears can be repaired surgically by reattaching the torn tendons to the humerus. Rotator cuff repair rehab protocol concord orthopaedics.
Rotator cuff repair rehab protocol physical therapy referral peter g. Rotator cuff repair protocol boston shoulder institute. 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. Rehabilitation protocol for rotator cuff repair massachusetts. For this reason the shoulder is the most mobile joint in the body. Rotator cuff repair a rotator cuff repair is designed to improve pain and function in cases of rotator cuff tears. It is also recommended to consult the operative report for further information on the surgical procedure.
Many different factors influence the postoperative rotator cuff repair rehabilitation outcome, including rotator cuff tear size, type of repair, tissue quality, number. Rotator cuff pathology can contribute to shoulder pain, weakness, and limitations to both activities and work. Complete ruptures usually require surgery if your goal is to return your shoulder to optimal function. Early passive range of motion is highly beneficial to enhance circulation within the joint to promote healing. Showering is allowed once dressings and catheter is removed. 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. Following a wellstructured conditioning program will also help you return to sports and other. Type two rotator cuff repair arthroscopic or miniopen medium to large tear greater than 1 cm and less than 5 cm i. Tear size largemassive tear or 1 tendon repair difficult to achieve full rom, caution with arom and resisted exercises with chroniclarge tears. Shawn hennigan, md rotator cuff repair rehabilitation protocol. Rotator cuff repair postoperative rehabilitation protocol orthoindy. An evaluationbased approach abstract rotator cuff disease of the shoulder, a common condition, is often incapacitating. Return of strength is variable with massive tears 4. Before suggesting the operation, your doctor will have considered that the benefits of the procedure outweigh any disadvantages.
This is because the articular surface of the round humeral head is approximately four times greater than that of the. Rotator cuff repair rehab protocol in the early 1990s, dr. The intent of this protocol is to provide the clinician with a. Numerous rehabilitation protocols for the management of rotator cuff disease are based primarily on clinical experience and expert opinion. The below outlines recommendations of your rehab over the first 3 months following your procedure. Control pain, inflammation, and effusion regain normal upper extremity strength and endurance. Rotator cuff repair protocol south shore orthopedics. The conservative rehabilitation protocol allows sharpey fibers to form before stressing the repair with resistive exercises. Phase 1 maximum protection phase 2 active range of motion. James andrews, we have recently revised and expanded all of our protocols and made them completely online and downloadable. A rotator cuff repair involves stitching the torn tendon back onto its attachment to the arm bone humerus.
The intent of this protocol is to provide the clinician with a guideline to establish and progress a patient through post operative rehabilitation. Rehabilitation protocol for rotator cuff repair this protocol is intended to guide clinicians and patients through the postoperative course of a rotator cuff repair. 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. Arthroscopic rotator cuff repair shoulderdoc by prof. Rehabilitation guidelines for type i and type ii rotator. 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. Then during the open part of the surgery, a 2 to 3inch 5 to 7.
Phase i immediate postoperative phase weeks 0 6 days 014 patient is seen 2 days postoperative to remove surgical dressings and pain catheter. The procedure involves stitching the torn tendon back onto its attachment to the humerus. 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. During miniopen repair, any damaged tissue or bone spurs are removed or repaired using an arthroscope. Specific interventions should be based on the needs of the individual and should consider exam findings and clinical decision making. Rotator cuff repair protocol rotator cuff protocol physical. Rehabilitation guidelines for rotator cuff repair and isolated subscapularis repair 2 uwsportsmedicine. The protocol is both chronologically and criterion based for advancement through four postoperative phases. Rotator cuff repair rehabilitation protocol the following document is an evidencebased protocol for arthroscopic rotator cuff repair rehabilitation. The socket portion of the joint is not naturally deep. Additionally, there has been a plethora of research relating to the effectiveness of surgical repair 5. I now have two anchors and a bunch of sutures that i will take to the grave.
Evolution of suture anchors and suture configurations have also resulted in more secure repairs 4. 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. Abduction bracesling, remove sling only to bathe and to complete exercises. Minimize postoperative stiffness while protecting repair during early phase of healing. Rehabilitation protocol after arthroscopic rotator cuff repair. 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.
It is not intended to be a substitute for clinical decision making regarding the progression of a patients postoperative course based. 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. 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. Brace abduction bracesling, remove sling only to bathe and to complete exercises. 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. 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.
Feb 28, 2017 postsurgical outcomes for patients having had rotator cuff repair can be quite good. Contact dr kevin murphy at 9046340640 to know more. However, to make an informed decision and give your. Rotator cuff repair surgery for a tear from a sudden injury works best if it is done within a few weeks of the injury.
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. Surgical repair via open or arthroscopic techniques is associated with improved function and patient satisfaction. Madison, wi 53718 surgical repair of a rotator cuff tear can be done arthroscopically or with a miniopen procedure. And more confusing is the lack of consensus among surgeons regarding the optimal postoperative rehabilitation protocol following arthroscopic rotator cuff repair. In the general population, the prevalence of rotator cuff. Rotator cuff repair postoperative rehabilitation protocol. Rehabilitation program following shoulder arthroscopic. 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. Rotator cuff repair the following is a protocol for postoperative patients following rotator cuff repair. It is not intended to be a substitute for ones clinical decision making.
Weather ache for 1 2 years is common after rc repair 2. If the tear is large, the extent of recovery cannot be accurately predicted until the repair and rehabilitation is completed. The primary goal of this protocol is to protect the repair while steadily progressing towards and ultimately achieving preinjury level of activity. Exercise in the treatment of rotator cuff impingement. 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. Rotator cuff repair phase 1 seated scapular retraction reps. Asps rotator cuff repair rehab protocol weeks 04 sling should be worn at rest. 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. Improvements in strength come slowly takes 1 year to end result 3.
Shawn hennigan, md rotator cuff repair rehabilitation. 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. Rotator cuff physical therapy protocol has been developed for the patient following a rotator cuff surgical procedure. 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. Maximise shoulder strength of deltoid, intact cuff muscles and scapula stabilisers.
Rotator cuff physical therapy physiotherapy treatment. The conservative approach may be associated with postoperative stiffness which can be managed once healing has occurred. Three of four rc tendons were torn full thickness, large tears. Movement gently squeeze your shoulder blades together, relax, and then repeat. 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. Immobilized at all times day and night off for hygiene and. Rotator cuff repair protocol boston sports medicine. This protocol will vary in length and aggressiveness depending on factors such as. Rehabilitation following rotator cuff repair springerlink.
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