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. Ohio state physicians and physical therapists work collaboratively to develop best clinical practices for postsurgical rehabilitation. 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. 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. Purpose of the abductor pillow is to keep tension off of the repair, avoid adduction. 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. 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. Rotator cuff repair protocol general guidelines this purpose of this protocol is to discuss the safe rehab management of rotator cuff repairs involving the supraspinatus, infraspinatus, teres minor and subscapularis tendons. Sling immobilization with supporting abduction pillow to be worn at all times except for showering and rehab under guidance of pt. This protocol provides you with general guidelines for the conservative rehabilitation of the patient with a rotator cuff tear rct. Rotator cuff tears are classified into one of 4 categories. The therapist can provide instruction on patient directed active range. Sling x 6 weeks ultrasling x 46 weeks, larger tears may be in ultrasling x 6 weeks then. Rotator cuff repair postoperative rehabilitation protocol. 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 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.
Arthroscopic rotator cuff repair frequently asked questions. 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. The conservative approach may be associated with postoperative stiffness which can be managed once healing has occurred. The procedure involves stitching the torn tendon back onto its attachment to the humerus. Rehabilitation protocols ohio state sports medicine. The shoulder is a wonderfully complex joint that is made up of the ball and socket connection. 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. During rehabilitation after rotator cuff repair, there should be constant. Shoulder rotator cuff repair oxford university hospitals. Arthroscopic rotator cuff repair protocol medium to large. Time frames allow for optimal healing and should be used as criteria for advancement along with a patients functional.
Contact dr kevin murphy at 9046340640 to know more. For this reason the shoulder is the most mobile joint in the body. Type ii rotator cuff repair protocol arthroscopic tears for large to massive tears 5 cm joseph r. The intent of this protocol is to provide the therapist and patient with guidelines for the postoperative rehabilitation course after arthroscopic rotator cuff repair. Remove sling for light activity and home exercise program as indicated by therapist. 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 the stone clinic. The intent of this protocol is to provide the clinician with a. The conservative rehabilitation protocol allows sharpey fibers to form before stressing the repair with resistive exercises. No arom exercise of the shoulder consistent use of sling unless otherwise instructed weaning starting at week 4.
The socket portion of the joint is not naturally deep. Intermittently apply grade ii mobilizations in the open packed position of the shoulder. Treatment should be modified based on the condition of the rotator cuff. Arthroscopic rotator cuff repair postoperative rehab protocol. Most rotator cuff tears can be repaired surgically by reattaching the torn tendons to the humerus. Rotator cuff repair post operative rehabilitation protocol. Rotator cuff repair protocol is a rehabilitation protocol to provide patient with the guidelines following a rotator cuff surgical procedure. This protocol will vary in length and aggressiveness depending on factors such as. Size and location of tear degree of shoulder instabilitylaxity prior to surgery acute versus chronic condition.
Repair guideline background the rotator cuff is responsible for stabilization and active movement of the glenohumeral joint. Rotator cuff repair postoperative rehabilitation protocol orthoindy. The rotator cuff is a group of four tendons that attach to the ball of the shoulder joint. Rotator cuff repair protocol rotator cuff protocol. The chronic nature of these tears along with poor underlying quality of the tissue often results in recurrent tears. Cole,md,mba range of motion immobilizer exercises phase i 04 weeks 02 weeks. 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. 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. The physician will make specific changes to the program as appropriate for an individual patient.
A rotator cuff tear of greater than 5 cm is considered a massive tear. Prom as instructed restrictionsexercise progression. 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. They attach from the shoulder blade onto the top of the arm bone.
The intent of this protocol is to provide the clinician with instruction, direction, rehabilitative guidelines and functional goals for all rotator cuff repair procedures. It is no means intended to be a substitute for ones. A large size rotator cuff tear is defined as a tear 35cm. It is not intended to be a substitute for clinical decision making regarding the progression of a patients postoperative course based. The deltoid muscle is separated to expose the torn rotator cuff tendon s. Johns hopkins shoulder surgery arthroscopic acromioplasty rehabilitation program johns hopkins shoulder surgeons introduction. 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. Rehabilitation guidelines for type i and type ii rotator cuff. Arthroscopic rotator cuff repair protocol brigham and womens.
Surgery to repair a torn rotator cuff most often involves reattaching the tendon to the humerus. 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. If biceps tenodesis was performed no biceps strengthening until 8 weeks postop frequency. These tears are usually chronic in nature and often involve poor tissue quality with fatty infiltration and muscle atrophy. Johns hopkins shoulder surgery arthroscopic acromioplasty. Rotator cuff repair a rotator cuff repair is designed to improve pain and function in cases of rotator cuff tears. It should be stressed that this is only a protocol and. This information booklet has been produced to help you gain the maximum benefit after your operation.
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. Rehabilitation guidelines for type i and type ii rotator. Type ii rotator cuff repair protocol medical staff. 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. Postoperative rotator cuff repair rehabilitation protocol. Rotator cuff repair protocol the following procedures were performed. 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. Rotator cuff repair protocol this rehabilitation protocol has been developed for the patient following a rotator cuff surgical procedure.
Rotator cuff repair protocol rotator cuff protocol physical. No arom exercise of the shoulder consistent use of sling unless otherwise instructed weaning starting at week 4 at earliest. This protocol is intended to guide clinicians and patients through the post operative course of a rotator cuff repair. 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. 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. Stretching of the shoulder rotator cuff muscles is easily performed both as treatment for inflammation and as a warmup before activity. It is essential that he or she follow this rehabilitation program very closely. Specific interventions should be based on the needs of the individual and should consider exam findings and clinical decision making.
Standard rotator cuff repair protocol this protocol is designed to serve as a patient rehabilitation guide following a standard rotator cuff repair procedure. Learn about physical therapy standards of care and protocols from the rehabilitation services at brigham and womens hospital. Those patients with poor rotator cuff tissue integrity, tear of 2. It is not intended to be a substitute for clinical decision. Rehabilitation protocol for rotator cuff repair massachusetts. Time frames allow for optimal healing and should be used as criteria for advancement along with a patients functional ability. Rotator cuff repair with biceps releasetenodesis brian bjerke, md postoperative protocol phase i maximum protection week 0 to 6 goals. Rehabilitation protocol for rotator cuff repair this protocol is intended to guide clinicians and patients through the postoperative course of a rotator cuff repair. Brace abduction bracesling, remove sling only to bathe and to complete exercises. Physical therapy standards of care brigham and womens. This may be performed arthroscopically or through open surgery, using sutures and bone anchors. Rotator cuff repair protocol weeks full time in sling range of motion.
This is summary of the evaluation and rehabilitation of a patient following an arthroscopic acromioplasty. 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. This protocol is designed for the patient following arthroscopic rotator cuff repair. 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. 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. Abduction bracesling, remove sling only to bathe and to. They surround the ball much like the cuff of a sleeve fits snuggly around the wrist. 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. Rotator cuff repair protocol south shore orthopedics.
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