The intent of this protocol is to provide the therapist and patient with guidelines for the postoperative rehabilitation course after arthroscopic rotator cuff repair. 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 conservative rehabilitation protocol allows sharpey fibers to form before stressing the repair with resistive exercises. Time frames allow for optimal healing and should be used as criteria for advancement along with a patients functional ability. This is summary of the evaluation and rehabilitation of a patient following an arthroscopic acromioplasty. 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. The chronic nature of these tears along with poor underlying quality of the tissue often results in recurrent tears. It is no means intended to be a substitute for ones. 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. 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 repair protocol boston shoulder institute. This protocol is intended to guide clinicians and patients through the postoperative course of a rotator cuff repair. Type ii rotator cuff repair protocol arthroscopic tears for large to massive tears 5 cm joseph r.
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. They attach from the shoulder blade onto the top of the arm bone. No arom exercise of the shoulder consistent use of sling unless otherwise instructed weaning starting at week 4. A rotator cuff tear of greater than 5 cm is considered a massive tear. Learn about physical therapy standards of care and protocols from the rehabilitation services at brigham and womens hospital. Rotator cuff repair with biceps releasetenodesis brian bjerke, md postoperative protocol phase i maximum protection week 0 to 6 goals. If biceps tenodesis was performed no biceps strengthening until 8 weeks postop frequency. Multiple factors can impact the repair, including tissue quality, the age and size of the tear, compliance with postoperative restrictions, patient age and smoking history. Rotator cuff repair rehab protocol the stone clinic. Size and location of tear degree of shoulder instabilitylaxity prior to surgery acute versus chronic condition. 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. Arthroscopic rotator cuff repair frequently asked questions. Rotator cuff repair postoperative rehabilitation protocol. This protocol is designed for the patient following arthroscopic rotator cuff repair.
The intent of this protocol is to provide the clinician with instruction, direction, rehabilitative guidelines and functional goals for all rotator cuff repair procedures. Intermittently apply grade ii mobilizations in the open packed position of the shoulder. Remove sling for light activity and home exercise program as indicated by therapist. Ohio state physicians and physical therapists work collaboratively to develop best clinical practices for postsurgical rehabilitation. This may be performed arthroscopically or through open surgery, using sutures and bone anchors. It is essential that he or she follow this rehabilitation program very closely.
Rehabilitation protocol for rotator cuff repair massachusetts. It is not intended to be a substitute for clinical decision making regarding the progression of a patients postoperative course based. The rotator cuff is a group of four tendons that attach to the ball of the shoulder joint. 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 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. 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.
Time frames allow for optimal healing and should be used as criteria for advancement along with a patients functional. Physical therapy standards of care brigham and womens. Rehabilitation protocols ohio state sports medicine. 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. 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. It should be stressed that this is only a protocol 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 supported pendulum 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 repair page 4 page 5 rotator cuff repair the rotator cuff the rotator cuff is a group of muscles closely wrapped around the shoulder. A large size rotator cuff tear is defined as a tear 35cm. Rotator cuff tears are classified into one of 4 categories. The deltoid muscle is separated to expose the torn rotator cuff tendon s. Treatment should be modified based on the condition of the rotator cuff. Prom as instructed restrictionsexercise progression.
Arthroscopic rotator cuff repair postoperative rehab protocol. Rotator cuff repair postoperative rehabilitation protocol orthoindy. Arthroscopic rotator cuff repair protocol medium to large. The procedure involves stitching the torn tendon back onto its attachment to the humerus. Arthroscopic and open rotator cuff repair rehabilitation protocol week 1 2 shoulder sling and swathe full time day and night. 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.
Now that your rotator cuff tear has been repaired it is very important that you follow this rehabilitation protocol in order to optimize your results. Rotator cuff repair protocol rotator cuff protocol physical. Shoulder rotator cuff repair oxford university hospitals. Sling immobilization with supporting abduction pillow to be worn at all times except for showering and rehab under guidance of pt. Appropriate communication between the therapist, patient and surgeon is key to a. The therapist can provide instruction on patient directed active range. Arthroscopic rotator cuff repair protocol brigham and womens.
Repair guideline background the rotator cuff is responsible for stabilization and active movement of the glenohumeral joint. Standard rotator cuff repair protocol this protocol is designed to serve as a patient rehabilitation guide following a standard rotator cuff repair procedure. This protocol provides you with general guidelines for the conservative rehabilitation of the patient with a rotator cuff tear rct. Those patients with poor rotator cuff tissue integrity, tear of 2. These muscles help keep the joint in the correct position and control shoulder movements. Specific interventions should be based on the needs of the individual and should consider exam findings and clinical decision making. Rotator cuff repair a rotator cuff repair is designed to improve pain and function in cases of rotator cuff tears.
Surgery to repair a torn rotator cuff most often involves reattaching the tendon to the humerus. 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. Rotator cuff repair post operative rehabilitation protocol. Postoperative rotator cuff repair rehabilitation protocol. Rotator cuff repair protocol weeks full time in sling range of motion. This protocol will vary in length and aggressiveness depending on factors such as.
When the arm is moved away from the body or over the head the tendons act to hold the ball in the socket correctly so that smooth fluid motion can be achieved. These tears are usually chronic in nature and often involve poor tissue quality with fatty infiltration and muscle atrophy. Debridement of an acromial bone spur and removal of the inflammed bursa arthroscopic repair of your rotator cuff mini open repair of your rotator cuff deltoid splitting large open repair of your rotator cuff took down deltoid rotator cuff debridement. The socket portion of the joint is not naturally deep. Keep the abductor pillow in for the 4 weeks as well. Sling x 6 weeks ultrasling x 46 weeks, larger tears may be in ultrasling x 6 weeks then. The physician will make specific changes to the program as appropriate for an individual patient.
Brace abduction bracesling, remove sling only to bathe and to complete exercises. Rehabilitation guidelines for type i and type ii rotator. Purpose of the abductor pillow is to keep tension off of the repair, avoid adduction. Stretching of the shoulder rotator cuff muscles is easily performed both as treatment for inflammation and as a warmup before activity. Rehabilitation protocol for rotator cuff repair this protocol is intended to guide clinicians and patients through the postoperative course of a rotator cuff repair.
Rotator cuff repair protocol rotator cuff protocol. Abduction bracesling, remove sling only to bathe and to. This is because the articular surface of the round humeral head is approximately four times greater than that of the. Johns hopkins shoulder surgery arthroscopic acromioplasty. This information booklet has been produced to help you gain the maximum benefit after your operation. The intent of this protocol is to provide the clinician with a. Most rotator cuff tears can be repaired surgically by reattaching the torn tendons to the humerus. No arom exercise of the shoulder consistent use of sling unless otherwise instructed weaning starting at week 4 at earliest. Rehabilitation guidelines for type i and type ii rotator cuff. The conservative approach may be associated with postoperative stiffness which can be managed once healing has occurred. Johns hopkins shoulder surgery arthroscopic acromioplasty rehabilitation program johns hopkins shoulder surgeons introduction. Rotator cuff repair protocol the following procedures were performed.
For this reason the shoulder is the most mobile joint in the body. It is not intended to be a substitute for clinical decision. Cole,md,mba range of motion immobilizer exercises phase i 04 weeks 02 weeks. 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. During rehabilitation after rotator cuff repair, there should be constant. Rotator cuff repair protocol this rehabilitation protocol has been developed for the patient following a rotator cuff surgical procedure. Type ii rotator cuff repair protocol medical staff. Rotator cuff repair protocol is a rehabilitation protocol to provide patient with the guidelines following a rotator cuff surgical procedure. They surround the ball much like the cuff of a sleeve fits snuggly around the wrist. The shoulder is a wonderfully complex joint that is made up of the ball and socket connection.
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