Rotator cuff repair postoperative physical therapy protocol. Sling immobilization with supporting abduction pillow to be worn at all times except for showering and rehab under guidance of pt. The effects of a standard postoperative rehabilitation. Full and pain free none progress phase iv activities, return to. This protocol is intended to guide clinicians and patients through the post operative course of a rotator cuff repair. Rehabilitation protocol for small to moderate rotator cuff tear. The shoulder rehabilitation protocol consists of two major components. Initiate manual resistance er in supine in scapular plane light resistance. 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. Early passive range of motion of the glenohumeral joint to prevent capsular adhesions is essential.
Rotator cuff tendonitis bursitis rehabilitation protocol. Rotator cuff repair protocol south shore orthopedics. Rotator cuff and shoulder conditioning program orthoinfo aaos. Biceps tenotomy protocol the intent of this protocol is to provide the clinician with a guideline of the post operative rehabilitation course of a patient that has undergone a biceps tenotomy for. Rotator cuff repair therapy protocol page 1 of 6 bart eastwood d. Plymouth rotator cuff repair rehabilitation protocol. It is designed for rehabilitation following large to massive rotator cuff repairs. 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. Stone invented one of the first suture anchors designed for rotator cuff repair, the questis suture anchor, and has been involved in technique design. No resisted rotator cuff strengthening exercises until weeks. The goals of rehabilitation are first to protect the repair and second to restore pain free function. Considerations for the postoperative rotator cuff repair rehabilitation program. Purpose of the abductor pillow is to keep tension off of the repair, avoid adduction.
Rehabilitation protocol for small to moderate rotator cuff. Keep the abductor pillow in for the 4 weeks as well. 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. Rotator cuff repair large to massive 5cm rehabilitation. Rotator cuff postoperative rehabilitation protocol general considerations. Suite 224a blacksburg, va 24060 54055273 all information contained in this protocol. Eleven randomized, controlled trials level 1 and 2 evaluating the effect of exercise in the treatment of impingement were identified. Initiate with submax painfree isometrics and arom as outlined in the protocol. 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. Oct 31, 2018 conclusion the present study confirmed an excellent outcome at 1 year after rotator cuff repair using a traditional 4week immobilization followed by a 2week rehabilitation protocol without evidence of tendon unhealing or retearing. Rotator cuff repair protocol rotator cuff protocol. Rotator cuff bursitis tendonitis rehabilitation protocol.
Protocol s3 accelerated physical therapy protocol for. This is because the articular surface of the round humeral head is approximately four times greater than that of the. Strengthen deltoid, rotator cuff and scapular stabilizers. Are there differences between an arthroscopic and open rotator cuff repair. The rotator cuff is responsible for stabilization and active movement of the glenohumeral joint. 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. Specific interventions should be based on the needs of the individual and should consider exam findings and clinical decision making. The protocol is both chronologically and criterion based for advancement through four post. Do not add, alter, or skip any of the treatments in this protocol. Manual technique to address posterior capsular hypomobility use conservatively and.
No arom exercise of the shoulder consistent use of sling unless otherwise instructed weaning starting at week 4. Passive, aarom, and arom exercises as symptoms allow starting with passive. Pictures courtesy of simpleset, used with permission. Conservativelarge rotator cuff repair protocol week one weeks two to three initial evaluation evaluate posture and position of the shoulder girdle passive range of motion inspect for signs of infection, and ensure integrity of the incision assess rtw and sport expectations support physician prescribed meds. Bedi et al2 reported a recurrence rate of up to 94%. Rehabilitation protocol for total shoulder arthroplasty and hemiarthroplasty this protocol is intended to guide clinicians and patients through the postoperative course after a total shoulder arthroplasty tsa and hemiarthroplasty. This protocol will vary in length and aggressiveness depending on factors such as. 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. Rotator cuff sprain and strains university of california. Use a weight that makes the last few repetitions difficult, but painfree.
Progressive painfree range of motion prom aarom arom. The conservative rehabilitation protocol allows sharpey fibers to form before stressing the repair with resistive exercises. 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. Arthroscopic rotator cuff repair protocol brigham and womens. Manual laborers will likely be out of work for at least six months. Sad subacromial decompression protocol phase i postop until week 2 protective phase. 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. However the torn tendon has a poor blood supply and is frequently weaker than healthy tissue. The goals of rehabilitation are to eliminate pain, restore strength, flexibility, and function, and maintain the integrity of the repair.
Do not perform long lever arm strengthening exercise for the rotator cuff. 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. Rotator cuff repair protocol b initial 5 days pre physical therapy surgeon instructed pendulum exercises use of sling ice and analgesia week 06 goals. Talk to your doctor or physical therapist about which exercises will best help you meet your rehabilitation goals. Harold schock iii, md rotator cuff repair rehabilitation. No arom exercise of the shoulder consistent use of sling unless otherwise instructed weaning starting at week 4 at earliest.
Resistance exercises should be done 3 daysweek, with rest between sessions o postural and periscapular exercises within a pain free range, including rows, chair press, shrugs, pressup, posterior deltoid, etc o jackins exercises for patients with limited active ff ability o notes. Level of evidence this is a level iv, therapeutic case series. Emphasis is on aarom and a high repetition, low weight free weight program. The socket portion of the joint is not naturally deep. 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. Rotator cuff repair protocol boston shoulder institute. Protocol s3 accelerated physical therapy protocol for rotator. 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. The team at the stone clinic has been repairing rotator cuffs for over twenty years and has progressively improved the techniques. The rotator cuff tissue is not very strong and can retear before healing if you do not follow these guidelines. Rotator cuff rehabilitation protocol rotator cuff repair is a well proven and durable operation which results in decreased pain, improved strength and range of motion for many years after surgery. Department of rehabilitation services physical therapy arthroscopic rotator cuff repair protocol.
Size and location of tear degree of shoulder instabilitylaxity prior to surgery acute versus chronic condition. The deltoid muscle is separated to expose the torn rotator cuff tendons. No resisted rotator cuff strengthening exercises until weeks patients this protocol should be used as a guide during your rehabilitation after surgery. Rehabilitation protocol for rotator cuff repair massachusetts.
General time frames are given for reference to the average, but individual patients will progress at. Rotator cuff repair rehab protocol the stone clinic. Your surgeon will advise when you should start physiotherapy at your first followup appointment. The glsm rotator cuff repair rehabilitation program is an evidencebased and soft tissue healing dependent program. Physical therapy prescription rotator cuff nonoperative. The conservative approach may be associated with postoperative stiffness which can be managed once healing has occurred. It is not intended to be a substitute for clinical decision. Rehabilitation protocol for total shoulder arthroplasty. This protocol should be used as a guide during your rehabilitation after surgery. Arthroscopic and open rotator cuff repair rehabilitation protocol week 1 2 shoulder sling and swathe full time day and night. This protocol is intended to guide clinicians and patients through the postoperative course of a rotator cuff repair. Conservative rotator cuff tear protocol sports and orthopedic. Full and pain free none progress phase iv activities, return to full activity as tolerated if a distal clavicle excision is performed, horizontal adduction is restricted for 8 weeks postop.
Contact dr kevin murphy at 9046340640 to know more. Protocol s3 accelerated physical therapy protocol for rotator cuff repair arthroscopic or miniopen technique recommended for mild. Harold schock iii, md rotator cuff repair rehabilitation protocol the following document is an evidencebased protocol for arthroscopic rotator cuff repair rehabilitation. Plymouth rotator cuff repair rehabilitation protocol phase 1. Introduction proper rehabilitation after rotator cuff repair is essential for success, and progresses in stages. Strengthening the muscles that support your shoulder will help keep your shoulder joint stable. Remove sling for light activity and home exercise program as indicated by therapist.
Arthroscopic rotator cuff repair protocol medium to large. The physician will make specific changes to the program as appropriate for an individual patient. 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. To ensure that this program is safe and effective for you, it should be performed under your doctors supervision.
He recommends delaying strengthening until 3 to 4 months postoperatively. The path to regaining range of motion, strength and function can require a sustained and coordinated effort from the patient, his or her family, the ohio state sports medicine physical therapy team and sometimes, other healthcare providers. 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. Postoperative rotator cuff repair rehabilitation protocol. Rotator cuff repair therapy protocol sideline orthopedics. Rotator cuff repair protocol is a rehabilitation protocol to provide patient with the guidelines following a rotator cuff surgical procedure. Arthroscopic rotator cuff repair rehabilitation protocol. Rotator cuff and shoulder rehabilitation exercises. The authors protocol of choice, used within a large sports medicine rehabilitation center, is presented and the rationale behind its implementation is discussed. Aarom progressing to minimal manual resistance for pnf patterns. Small to moderate rotator cuff tear department of orthopaedic surgery. Understanding the characteristics of the tear as well as the surgical approach.
A large size rotator cuff tear is defined as a tear 35cm, massive 5cm. The criteria to progress from phase i to phase ii is a pain free passive motion. Rotator cuff repair protocol this rehabilitation protocol has been developed for the patient following a rotator cuff surgical procedure. A comparison of rehabilitation methods after arthroscopic rotator cuff repair. 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. This protocol provides you with general guidelines for the conservative rehabilitation of the patient with a rotator cuff tear rct.
Nov 08, 2016 recovery phase rotator cuff strain rehabilitation. Rehabilitation protocols ohio state sports medicine. Most rotator cuff tears can be repaired surgically by reattaching the torn tendons to the humerus. It is not intended to be a substitute for clinical decision making. 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.
Rotator cuff repair surgery can now be performed arthroscopically and is in most cases an. For this reason the shoulder is the most mobile joint in the body. Specific interventions should be based on the needs of the individual and. 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. A physiotherapist should be consulted throughout to teach and individually modify the exercises. Allan hunt phase i 02 weeks maximum protection educate the patient on selfcarehygiene, supporting shoulder with slingabductor support, warning signs including fever, erythema and excessiveunrelenting pain, use of tens unit no motion. Postoperative rehabilitation protocol rotator cuff repair. Begin active and manual scapula strengthening exercises.
Biceps tenotomy protocol boston shoulder institute. Exercise in the treatment of rotator cuff impingement. Rotator cuff repair post operative rehabilitation protocol. The intent of this protocol is to provide the clinician with a guideline of the post. Rehabilitation guidelines for type i and type ii rotator cuff. Pain free with all basic adls and previous strengthening exercises. 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.