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. The protocol is both chronologically and criterion based for advancement through four postoperative phases. Sling for everyone with or without abduction pillow as directed by dr. In addition, few studies have evaluated the clinical results of contemporary revision arthroscopic rotator cuff repair15. Type one rotator cuff repair arthroscopic or miniopen small tear less than 1 cm i. The intent of this protocol is to provide the clinician with a. Rotator cuff repair protocol this rehabilitation protocol has been developed for the patient following a rotator cuff surgical procedure. Rotator cuff repair therapy protocol sideline orthopedics. The protective protocol, in which muscle strengthening exercises are delayed, is applied after arthroscopic repair of rotator cuff tears greater than 5 cm or involving more than 2 tendons, poor tissue quality, or repairs with greater tension. 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. 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. Bend forward and support your unoperated arm on a table.
James andrews, we have recently revised and expanded all of our protocols and made them completely online and downloadable. Rehabilitation guidelines for rotator cuff repair and isolated subscapularis repair 2 uwsportsmedicine. Keep the abductor pillow in for the 4 weeks as well. If you have questions, contact the referring physician. Sling immobilization with supporting abduction pillow to be worn at all times except for showering and rehab under guidance of pt. Rotator cuff repair postoperative physical therapy protocol. Suite 224a blacksburg, va 24060 54055273 all information contained in this protocol is to be used as general guidelines only.
Rotator cuff repair postoperative rehabilitation protocol orthoindy. However, to make an informed decision and give your. This rehabilitation protocol has been developed for the patient following a rotator cuff surgical procedure. Abduction bracesling, remove sling only to bathe and to complete exercises. The conservative rehabilitation protocol allows sharpey fibers to form before stressing the repair with resistive exercises. Strengthen deltoid, rotator cuff and scapular stabilizers. For this reason the shoulder is the most mobile joint in the body. Please dont hesitate to contact amy baer pt, atc or geoff omiatek pt, at, ms, scs at 614 8271050 with any. Maximise shoulder strength of deltoid, intact cuff muscles and scapula stabilisers. Rotator cuff repair protocol northeast orthopedics and. If you have any questions regarding the progress of the patient, the. Brace abduction bracesling, remove sling only to bathe and to complete exercises.
Degree of shoulder instabilitylaxity prior to surgery. Showering is allowed once dressings and catheter is removed. Madison, wi 53718 surgical repair of a rotator cuff tear can be done arthroscopically or with a miniopen procedure. Phase i immediate postoperative phase weeks 0 6 days 014 patient is seen 2 days postoperative to remove surgical dressings and pain catheter. Rotator cuff repair protocol south shore orthopedics. Specific changes in the program will be made by the physician as appropriate for an individual patient.
Contact dr kevin murphy at 9046340640 to know more. Type three rotator cuff repair miniopen or neer approach large to massive tear greater than 5 cm i. Rotator cuff repair guidelines our physicians at orthopedic one are committed to working with any licensed rehabilitation provider to assist with their patients postoperative care. Rolf phase i immediate post surgical phase weeks 14. Relax and let gravity help you to swing the operated arm forward and flexion. 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. Rotator cuff repair protocol boston shoulder institute. Rotator cuff repair protocol rotator cuff protocol. 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. Elbow therapists consensus statement on rehabilitation following arthroscopic rotator cuff repair. The socket portion of the joint is not naturally deep. No supporting of body weight by hand on involved side.
Rehabilitation program following shoulder arthroscopic. Progression of arom against gravity and duration of sling use is predicated both on the size of tear and quality of tissue and should be guided by referring physician. Phase 1 maximum protection phase 2 active range of motion. Rotator cuff repair protocol rotator cuff protocol physical. The conservative approach may be associated with postoperative stiffness which can be managed once healing has occurred. If the tear is large, the extent of recovery cannot be accurately predicted until the repair and rehabilitation is completed. 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. If you have any questions regarding the progress of the patient, the physician should be. Considerations for the postoperative rotator cuff repair rehabilitation program. Accelerated rotator cuff repair protocol 5 and clockwise and counterclockwise. This protocol provides you with general guidelines for the rehabilitation of patients following a standard open, mini open andor arthroscopic rotator cuff repair. 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.
Standard open or arthroscopic rotator cuff repair 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. Shawn hennigan, md rotator cuff repair rehabilitation protocol. Rotator cuff repair protocol the following procedures were performed. Rehabilitation guidelines for type i and type ii rotator cuff. Specific interventions should be based on the needs of the individual and should consider exam findings and clinical decision making.
There is a need for welldesigned level i and level ii trials to elucidate the optimal rotator cuff repair rehabilitation protocol. Specific variations may be appropriate for each patient and may be specified by the physician. Type ii rotator cuff repair protocol arthroscopic tears for large to massive tears 5 cm joseph r. Rotator cuff repair physical therapy protocol preoperative guidelines restore arom strengthen involved extremity in pain free rom, emphasize rotator cuffscapular 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.
The intent of this protocol is to provide the therapist and patient with guidelines for the postoperative rehabilitation course after arthroscopic rotator cuff repair. Rotator cuff repair therapy protocol page 1 of 6 bart eastwood d. Begins immediately after surgery to approximately 4 weeks postop. Rotator cuff repair rehabilitation protocol protocol for subscapularis repair rehabilitation prepared by dr boyle. Before suggesting the operation, your doctor will have considered that the benefits of the procedure outweigh any disadvantages. Protocol s3 accelerated physical therapy protocol for. It is not intended to be a substitute for clinical decision making regarding the progression of a patients postoperative course based. The rate limiting factor in arthroscopic rotator cuff repair is the biologic healing of the cuff tendon to the humerus, which is thought to be a minimum of 812 weeks. Arthroscopic rotator cuff repair protocol medium to large. Asps rotator cuff repair rehab protocol weeks 04 sling should be worn at rest. Now that your rotator cuff tear has been repaired it is very important that you follow. This is because the articular surface of the round humeral head is approximately four times greater than that of the.
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. To improve your overhead elevation flexion, you need to move your arm upward. Rotator cuff repair post operative rehabilitation protocol. Rotator cuff repair rehabilitation protocol the following document is an evidencebased protocol for arthroscopic rotator cuff repair rehabilitation. 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. Arthroscopic rotator cuff repair protocol brigham and womens. Department of rehabilitation services physical therapy arthroscopic rotator cuff repair protocol.
Rotator cuff repair protocol boston sports medicine. Postoperative rehabilitation protocol rotator cuff repair. Protocol s3 accelerated physical therapy protocol for rotator cuff repair arthroscopic or miniopen technique recommended for mild. Most rotator cuff tears can be repaired surgically by reattaching the torn tendons to the humerus. The general treatment for a variety of shoulder procedures involves protection of the repair, stretchingmobilizing tight or restricted structures, strengthening the rotator cuff and strengthening and retraining the scapular musculature. 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. One high standard, three local partners for more information go to. 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 this protocol is intended to guide clinicians and patients through the postoperative course of a rotator cuff repair. And more confusing is the lack of consensus among surgeons regarding the optimal postoperative rehabilitation protocol following arthroscopic rotator cuff repair. Type ii rotator cuff repair protocol medical staff. Rehabilitation protocol after arthroscopic rotator cuff repair. The procedure involves stitching the torn tendon back onto its attachment to the humerus. 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.
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. Rotator cuff repair protocol is a rehabilitation protocol to provide patient with the guidelines following a rotator cuff surgical procedure. Rehabilitation guidelines for type i and type ii rotator. Rotator cuff repair a rotator cuff repair is designed to improve pain and function in cases of rotator cuff tears. This protocol will vary in length and aggressiveness depending on factors such as. 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. 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. The primary purpose of the present study was to evaluate the tendon repair integrity and clinical outcomes for a cohort of patients. Rotator cuff repair postoperative rehabilitation protocol.
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. 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. Maintain integrity of repair diminish pain and inflammation prevent muscular inhibition independent with adls with modifications while maintaining the integrity of the. Rotator cuff repair rehabilitation protocol matthew. This may be performed arthroscopically or through open surgery, using sutures and bone anchors. 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. This protocol provides you with general guidelines for the rehabilitation of patients following a massive open andor arthroscopic rotator cuff repair. Size and location of tear degree of shoulder instabilitylaxity prior to surgery acute versus chronic condition. Rehabilitation protocol for rotator cuff repair massachusetts. Boyle cryotherapy as needed for pain relief cryocuff or ice pack no pendulum. If biceps repair no resisted elbow flexion or forearm supination x 6 weeks, no lifting greater than coffee cup x 6 weeks.
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