The clinical outcomes of the surgical methods of rotator cuff repair open, miniopen, and allarthroscopic cuff repair vary, as each method provides an. These exercises are intended for the initial strengthening of acute shoulder problems, andor longterm rehabilitation for massive rotator cuff tears and other conditions resulting in longterm severe weakness. Throwers begin return to throwing protocol at 6 months collision. The glsm rotator cuff repair rehabilitation program is an evidencebased and soft tissue healing dependent program. The protocol is both chronologically and criterion based for advancement through four postoperative phases.
If initial nonsurgical treatment of a rotator cuff tear fails, surgical repair is often the next line of treatment. Pdf rehabilitation after rotator cuff repair researchgate. Rotator cuff repair rehabilitation garner rotator cuff. Rom to tolerance these should be done supine and should be pain free. The conservative rehabilitation protocol allows sharpey fibers to form before stressing the repair with resistive exercises. Rehabilitation guidelines for type i and type ii rotator cuff. It is not intended to be a substitute for clinical decision. Rotator cuff repair large to massive 5cm rehabilitation. The best rotator cuff strengthening routine bulletproof your. It is not a big operation to repair a torn rotator cuff, but the rehabilitation time can be. Loss of motion from preoperative range is not normal for our shoulders. Pdf background rotator cuff tears are a very common condition that is often.
Clinic appointments at 8 to 12 days, then at 6 weeks, 12 weeks, 18 weeks, and possibly 24 weeks physical therapy appointment starting at 9 weeks, lasting 18 to 24 weeks acute phase. Exercises and physical therapy for rotator cuff tear. Exercises that involve pressing your arm against a wall can help strengthen the muscles that make up your rotator cuff. The team at the stone clinic has been repairing rotator cuffs for over twenty years and has progressively improved the techniques. Rehabilitation guidelines for rotator cuff repair and isolated subscapularis repair 2 uwsportsmedicine.
The recovery phase begins when the initial pain and inflammation have gone and most normal daily activities are painfree and the injured arm has at least 75% range of movement compared to the uninjured one. Postoperative rehabilitation protocol rotator cuff repair patient will wean and abductionneutral rotation sling for 6 weeks postop if concomitant biceps tenodesis then no active biceps for 6 weeks. However, the existing clinical studies of postoperative treatment targeting patients with rotator cuff repair are of moderate to low quality lack of blinding, small sample sizes, lackpoor responsiveness on outcomes, andor with only per protocol analyses 1520, making it difficult to unequivocally conclude what treatment regimen is the best. The goal of rotator cuff repair is to eliminate pain and improve function with increased shoulder strength and range of motion. 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. Rotator cuff repair rehabilitation program largemassive 5cm.
Remove sling for light activity and home exercise program as indicated by therapist. Small 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 exercises to improve shoulder mobility should begin as soon as pain allows. 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. Rehabilitation, arthroscopic rotator cuff repair, shoulder, scientific. Rotator cuff repair the following is a protocol for postoperative patients following rotator cuff repair. Surgery to repair a torn rotator cuff most often involves reattaching the tendon to the humerus. Arthroscopic rotator cuff repair protocol medium to large. Postoperative rotator cuff repair rehabilitation protocol. General time frames are given for reference to the average, but individual patients will progress at. The suturesanchors hold the tendons so they can heal back to the bone.
Talk to your doctor or physical therapist about which exercises will best help you meet your rehabilitation goals. Many different factors influence the postoperative rotator cuff repair rehabilitation outcome, including rotator cuff tear size, type of repair, tissue quality, number of. The goals of rehabilitation are first to protect the repair and second to restore pain free function. Rotator cuff repair most rotator cuff tears can be repaired surgically by reattaching the torn tendons to the humerus. Rotator cuff repair with biceps releasetenodesis brian bjerke, md postoperative protocol phase i maximum protection week 0 to 6 goals. Rotator cuff repair rehab protocol the stone clinic. The primary goal of this protocol is to protect the repair while steadily progressing towards and ultimately achieving preinjury level of activity. It is no means intended to be a substitute for ones. The conservative approach may be associated with postoperative stiffness which can be managed once healing has occurred. Isometric exercises are muscle tightening exercises performed with no joint movement. Progressive early passive and active exercise therapy.
Rotator cuff surgical repair return to sport protocol. Welcome to our rotator cuff repair rehabilitation video series. Sling immobilization with supporting abduction pillow to be worn at all times except for showering and rehab under guidance of pt. Harold schock iii, md rotator cuff repair rehabilitation protocol the following document is an evidencebased protocol for arthroscopic rotator cuff repair rehabilitation. Multiple factors can impact the repair, including tissue quality, the age and size. Shoulder rotator cuff tear center for sports medicine. Rotator cuff and shoulder conditioning program orthoinfo aaos. When shoulder pain gets you down, heres a rotator cuff rehab guide that will help you recover and quick. If pain, weakness, and stiffness in your shoulder see figure in appendix are related to problems with your rotator cuff, a doctor will usually first recommend nonsurgical treatment. Jul 14, 2019 the above exercises can be performed as a routine 23 times per week, and are summarized with tutorials in the below pdf. Rehabilitation protocol for rotator cuff repair massachusetts. Rehabilitation after rotator cuff repair jeffrey d stone, m.
It is evident that a successful outcome after surgical rotator cuff repair is as much dependent on surgical technique as it is on rehabilitation. The rotator cuff is made up of 4 muscles supraspinatus, infraspinatus, subscapularis, and teres minor that help stabilize the shoulder. Harold schock iii, md rotator cuff repair rehabilitation. 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. 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. Waking up with serious pain after sleeping on your side. Rotator cuff repair protocol boston shoulder institute. The four shoulder muscles that make up the rotator cuff can get worn or tear. Sling x 6 weeks ultrasling x 46 weeks, larger tears may be in ultrasling x 6 weeks then.
To ensure that this program is safe and effective for you, it should be performed under your doctors supervision. No arom exercise of the shoulder consistent use of sling unless otherwise instructed weaning starting at week 4 at earliest. Arthroscopic and open rotator cuff repair rehabilitation protocol week 1 2 shoulder sling and swathe full time day and night. Our goal is to achieve pain free, smooth shoulder motion that is normal, or near normal. The goals of rehabilitation are first to protect the repair and second to restore pain free. Pain free functional range of movement good control of rotator cuff and scapular musculature. Standard open or arthroscopic rotator cuff repair protocol. Purpose of the abductor pillow is to keep tension off of the repair, avoid adduction. No resisted rotator cuff strengthening exercises until weeks.
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. Clinical guidelines for cpm following rotator cuff repair. It doesnt take long with a strained rotator cuff to realize how important the shoulder joint is to nearly every move you make. The intent of this protocol is to provide the clinician with a guideline of the post. 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. Exercises should be relatively pain free with only short term minimal discomfort stage iii weeks6 months. After an injury or surgery, an exercise conditioning program will help you return to. Surgery to repair a torn rotator cuff most often involves reattaching the tendon to the.
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. Understanding the characteristics of the tear as well as. The interesting thing is that only of the tears cause pain and 23 are without pain. Rotator cuff repair protocol south shore orthopedics. Nov 08, 2016 recovery phase rotator cuff strain rehabilitation. Use a weight that makes the last few repetitions difficult, but painfree. These videos should not be used as a substitute for regular physical therapy visits and guidance from your physician. Prom as instructed restrictionsexercise progression. Arthroscopic repair is often used for patients with small to mediumsized tears about 3 cm or smaller.
Orthop no am 01 14 baseball players pitchers intratendinous repair average follow up 16 mos 89 89% followed for 1 yr or more returned to preinjury level. Synchronized or isolated protocol the primary goal of postsurgical rehabilitation following rotator cuff repair is to control pain, protect repaired tissue during the healing process, restore function, improve rangeofmotion, restore strength and prevent a. It is essential that he or she follow this rehabilitation program very closely. The criteria to progress from phase i to phase ii is a pain free passive motion. Progressive painfree range of motion prom aarom arom.
Pictures courtesy of simpleset, used with permission. For all exercises, stand with good posture by pulling your shoulder blades slightly down and. Exercises you can do at home exercises are a very important part of treatment for a rotator cuff disorder. Madison, wi 53718 surgical repair of a rotator cuff tear can be done arthroscopically or with a miniopen procedure. All of the exercises should be performed with slow and controlled motion. 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. The goal of these videos is to help maximize your recovery following rotator cuff surgery. Strengthening the muscles that support your shoulder will help keep your. Their action is to increase circulation for healing and strengthening muscles with minimal joint irritation.
Your aim is to restore full, pain free mobility to your shoulder joint. Famous physical therapists bob schrupp and brad heineck demonstrate the 10 best rotator cuff exercises for strengthening your shoulder from beginner to advanced. In rotator cuff repair surgery one or more of these muscles are reattached to the bone using anchorssutures. 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 large to massive 5cm rehabilitation guideline this rehabilitation program is designed to return the individual to their activities as quickly and safely as possible. In some patients, mobility could already be good, but this will depend on how bad the injury is. Initiate with submax painfree isometrics and arom as outlined in the protocol. This is because the articular surface of the round humeral head is approximately four times greater than that of the.
Keep the abductor pillow in for the 4 weeks as well. In rotator cuff repair surgery one or more of these muscles are reattached to the bone using. Top 3 rotator cuff exercises fix your shoulder pain. Rehabilitation guidelines for type i and type ii rotator. 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 protocol for rotator cuff repair this protocol is intended to guide clinicians and patients through the postoperative course of a 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. Open, miniopen, and allarthroscopic rotator cuff repair. 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. According to general population surveys, the prevalence of rotator cuff tear is 25 % in those older than 50 years of age and 20 % in those older than 20 years of age.
Progress range of movement to restore functional range no forced end range mobilisation. This may include physical therapy, antiinflammatory medication, rest, and activity modification. Rotator cuff and shoulder rehabilitation exercises. Rotator cuff repair surgery can now be performed arthroscopically and is. Specific interventions should be based on the needs of the individual and should consider exam findings and clinical decision making. Rehabilitation guidelines for rotator cuff repair and isolated subscapularis repair. It is designed for rehabilitation following large to massive rotator cuff repairs. Our general interest enewsletter keeps you up to date on a wide variety of health topics. Find out how physical therapy exercises and other treatment can help you feel better. Department of rehabilitation services physical therapy arthroscopic rotator cuff repair protocol. Maximise shoulder strength of deltoid, intact cuff muscles and scapula stabilisers. The fastest way to rehab a strained rotator cuff precision.
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