Kaar, md department of orthopaedic surgery sports medicine and shoulder service rotator cuff repair rehab protocol prescription. After the acquisition, the signals of the movement. Feb 28, 2017 numerous rehabilitation protocols for the management of rotator cuff disease are based primarily on clinical experience and expert opinion. Rehabilitation guidelines for rotator cuff repair and isolated subscapularis repair 2 uwsportsmedicine. The level i and ii evidence for rotator cuff repair rehabilitation is exceedingly small. Therapy services patient information torbay massive cuff. Rotator cuff repair with biceps releasetenodesis brian bjerke, md postoperative protocol phase i maximum protection week 0 to 6 goals. Rotator cuff repair protocol this rehabilitation protocol has been developed for the patient following a rotator cuff surgical procedure. Rotator cuff tears rct result in disability, poor quality of life, expensive utilization of. Damage to any or all of the four muscles and the ligaments that attach these muscles to bone can occur because of acute injury, chronic overuse, or gradual aging.
A rotator cuff injury is one of the most common issues faced by athletes and hardcore fitness enthusiasts. The conservative rehabilitation protocol allows sharpey fibers to form before stressing the repair with resistive exercises. One of the most common injuries is shoulder impingement. Pdf background rotator cuff tears are a very common condition that is often. It is prone to injury, but doing specific exercises can help prevent this. Talk to your doctor or physical therapist about which exercises will best help you meet your rehabilitation goals. Theoretically, the ideal patch for the repair of rotator cuff should combine the features of. It is suggested that concern about early initiation of rehabilitation and introduction of functional load, in the form of patient directed active exercise, following surgical repair of the rotator cuff might not be warranted in terms of adverse.
Is rehabilitation effective in massive rotator cuff tears. 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. Rehabilitation protocol for rotator cuff repair this protocol is intended to guide clinicians and patients through the postoperative course of a 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, modifications, and improvements ever since. An evaluationbased approach abstract rotator cuff disease of the shoulder, a common condition, is often incapacitating.
The rotator cuff is made up of four muscles that help move and stabilize the shoulder joint. The rotator cuff is then repaired directly to the bone with a. 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. Partialthickness tears do not completely sever the tendon where full thickness tears do. B 2006 physiotherapy rehabilitation in patients with massive, irreparable rotator cuff tears. However, for a rotator cuff strain, it may not be until later in the rehabilitation process that strengthening exercises can begin.
Begin with 510 repetitions, advancing to 30 repetitions as able. Department of rehabilitation services physical therapy arthroscopic rotator cuff repair protocol. It doesnt take long with a strained rotator cuff to realize how important the shoulder joint is to nearly every move you make. The rotator cuff is the group of tendons and muscles in the shoulder which hold the shoulder joint in place and allow you to move your arm and shoulder.
Clinical decision rule for rotator cuff tear probability a decision tool to determine probability of rotator cuff tear. Type three rotator cuff repair miniopen or neer approach large to massive tear greater than 5 cm i. Modifications to this guideline may be necessary dependent on physician. We first classified the patients into five groups based on the site of the tears. Your surgeon will advise when you should start physiotherapy at your first followup appointment. Size and location of tear degree of shoulder instabilitylaxity prior to surgery acute versus chronic condition.
Exercises and physical therapy for rotator cuff tear. The rotator cuff is a group of muscles that rotate the arm, and form a cuff or sleeve around the shoulder joint and capsule. The term rotator cuff describes four muscletendon units that connect the upper. Modifications to this guideline may be necessary dependent on physician specific.
Multiple nonoperative rehabilitation protocols have been described for the treatment of the spectrum of rotator cuff injury. A physiotherapist should be consulted throughout to teach and individually modify the exercises. Injuries to the four muscles comprising the rotator cuff the supraspinatus, infraspinatus, teres minor, and subscapularis muscles have. Rehabilitation protocol following arthroscopic rotator cuff. Pdf rotator cuff disease of the shoulder, a common condition, is often incapacitating. Romeo, md, and bernard bach, jr, md normal shoulder function requires a balanced relationship between glenohumeral mobility and glenohumeral stability. Jan 19, 20 one of the primary conditions targeted in rehabilitation of the shoulder is rotator cuff injury. This protocol will vary in length and aggressiveness depending on factors such as. Rotator cuff repair small to medium rehabilitation guideline. Rotator cuff and shoulder rehabilitation exercises. Rehabilitation of the shoulder after rotatorcuff repair.
The rotator cuff is a sling of four shoulder muscles that act as a functional unit to. Prom as instructed restrictionsexercise progression. Rotator cuff repair protocol boston shoulder institute. This article describes the different rehabilitation protocols that aim to protect the repair in the immediate postoperative period, minimize postoperative stiffness and muscle atrophy. Oneyear clinical results of the repair of irreparable rotator cuff tears by.
Physical therapy following shoulder rotator cuff repair ravindiran appunni the university of western ontario supervisor dr. Your rotator cuff is an important group of control and stability muscles that maintain centralisation of your shoulder joint. Bone marrowderived msc injection as an adjunctive therapy during rotator cuff repair enhanced the healing rate and improved the. Scapular control exercises such as the scapular squeeze and elevation exercises are important to maintain the correct movement patterns in the shoulder joint as rehabilitation progresses. How to manage shoulder impingement and other rotator cuff. Rotator cuff repair protocol the following procedures were performed. These muscles merge into tendons and this muscle structure allows the arm to be lifted and rotated. Rotator cuff injury russian federation pdf ppt case. The protocol is both chronologically and criterion based for advancement through four postoperative phases. Rotator cuff injurysubacromial bursitis injuries and. Clinical practice guidelines for the management of rotator.
Rotator cuff tendonitisimpingement rehabilitation protocol. Exercise therapy, fullthickness rotator cuff tear, nonoperative management. Once you suspect a rotator cuff injury, it is important to confirm the exact type of your rotator cuff injury since treatment does vary depending on the specific or combination of rotator cuff injuries. A rotator cuff tear is often the result of wear and tear from daily use. Rotator cuff bursitis tendonitis rehabilitation protocol. Learn about the causes, symptoms, and treatment options here. Specific interventions should be based on the needs of the individual and should consider exam findings and clinical decision making. Postoperative rotator cuff repair rehabilitation protocol. Synopsis the hallmark characteristics of rotator cuff rc tendinopathy are pain. Rotator cuff injury united states pdf ppt case reports. 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.
Find out how physical therapy exercises and other treatment can help you feel better. Arthroscopic rotator cuff repair protocol medium to large. Specific interventions should be based on the needs of the individual and should. Rehabilitation protocol for small to moderate rotator cuff tear. Translation of the humeral head scale is associated with success of. Rotator cuff pinching impingement and tendinitis often occur in sports that require the arms to be moved over the head repeatedly, such as pitching in baseball, lifting heavy weights over the shoulder, serving the ball in racket sports, and swimming freestyle, butterfly, or backstroke. Shoulder rotator cuff repair oxford university hospitals. In other words, your rotator cuff helps you move your arm freely in all directions. It is designed for rehabilitation following large to massive rotator cuff repairs. Rotator cuff repair rehab protocol the stone clinic. A rotator cuff that becomes irritated or damaged may need surgical repair andor occupational therapy. Rotator cuff injuries are very common, affecting over 3 million people in the united states every year.
Rehabilitation, arthroscopic rotator cuff repair, shoulder, scientific. The importance of impingement in the pathogenesis of rotator cuff rupture is supported by various. The conservative approach may be associated with postoperative stiffness which can be managed once healing has occurred. Due to his selfconfidence in the capability to repair the rotator cuff in a steady fashion, he has been comfortable pressing the rehabilitation program in ways that specifically protect the rotator cuff during the recovery period but allow range of motion and strengthening exercises to be carried out under the careful guidance of the knowledgeable rehab team at. Rotator cuff repair small to medium rehabilitation guideline this rehabilitation program is designed to return the individual to their activities as quickly and safely as possible. The depth of a partial thickness rotator cuff tear is the most important factor in the decision to repair or debride. Rotator cuff rehabilitation therapist directed program date of irb approval. Help and feedback was given from people who have had rotator cuff repair surgery. Kate hopman2, lee krahe1, sue lukersmith2, alexander mccoll1, kris vine1.
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. If initial nonsurgical treatment of a rotator cuff tear fails, surgical repair is often the next line of treatment. Rehabilitation guidelines for type i and type ii rotator. Clinical practice guidelines for the management of rotator cuff syndrome in the workplace the university of new south wales, medicine, rural clinical school, port macquarie campus 20 research team. Care of the injured rotator cuff david fausone, dpt, pt, ompt rotator cuff injury with and without surgical repair is a common diagnosis in multiple rehabilitation settings including home healthcare. The rotator cuff is a group of muscles that surround your shoulder joint and keep the top of your upper arm bone stabilized. Rotator cuff sprain and strains university of california. A comprehensive approach to nonoperative rotator cuff. One high standard, three local partners for more information go to. Rehabilitation following rotator cuff repair keys to success rehabilitation following cuff repair maximizing tendon healing biomechanical factors biologic factors patient factors effect of smoking on rotator cuff repairs mallon et al. It is designed for rehabilitation following small to medium rotator cuff repairs. Arthroscopic and open rotator cuff repair rehabilitation protocol week 1 2 shoulder sling and swathe full time day and night.
Rotator cuff rc tendinopathy refers to pain and weakness. Control pain, inflammation, and effusion regain normal upper extremity strength and endurance. 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. A comprehensive approach to nonoperative rotator cuff rehabilitation aaron sciascia daun karolich published online. To ensure that this program is safe and effective for you, it should be performed under your doctors supervision. 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. Shawn hennigan, md rotator cuff repair rehabilitation protocol the following document is an evidencebased protocol for arthroscopic rotator cuff repair rehabilitation. The deltoid is divided in line with the portal site with a small incision. Phase i immediate postoperative phase weeks 0 6 days 014 patient is seen 2 days postoperative to remove surgical dressings and pain catheter. Shawn hennigan, md rotator cuff repair rehabilitation protocol. Rotator cuff rehabilitation protocol orthopedics ne. The rotator cuff is an integral part of the anatomy of the shoulder. Stage i 0 to 4 weeks wear sling continuously for 4 weeks. Full thickness rotator cuff tears are rarely seen in those younger than 40 years of age.
A torn rotator cuff can cause significant pain and limit the movement of the shoulder and arm. Rotator cuff tendonitis bursitis rehabilitation protocol. Madison, wi 53718 surgical repair of a rotator cuff tear can be done arthroscopically or with a miniopen procedure. 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. 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.
The highest activation level of the teres minor muscle was found in exercise 1. On the other hand, 25% of all individuals over the age of 60 have a rotator cuff tear. Care of the injured rotator cuff team rehabilitation. Sports medicinearthroscopic surgery the intent of this protocol is to provide the therapist and patient with guidelines for the postoperative rehabilitation course after arthroscopic rotator cuff repair. Pdf rotator cuff disease of the shoulder, a common condition. Introduction the shoulder moon group is a multicenter orthopaedic outcomes network, a consortium of institutions working together to bring patients the best possible care with disorders of the shoulder. May remove sling for tabletop activities eating, brushing teeth, keyboardtyping if painfree. 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. My procedures are generally an arthroscopic evaluation, subacromial bursectomy, or an acromioplasty with miniopen rotator cuff repair. It is evident that a successful outcome after surgical rotator cuff repair is as much dependent on surgical technique as it is on rehabilitation. 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. Pdf biologic augmentation of rotator cuff repair with mesenchymal. This shoulder rehabilitation program focuses on strengthening the muscles that support your shoulder to help keep your shoulder joint stable, relieve pain and.
The rotator cuff is made up of four muscles supraspinatus, infraspinatus, subscapularis, and teres minor and their tendons. The team at the stone clinic has been repairing rotator cuffs for over twenty years and has progressively improved the techniques. Jses 2004 84% vs 30% rehabilitation following rotator cuff repair introduction whats the concern about early. We therefore designed a study to evaluate the effects of a standardised rehabilitation programme on range of motion recovery in patients with massive rotator cuff tears. Arthroscopic rotator cuff repair protocol small to medium sized tears david j. Multiple nonoperative rehabilitation protocols have. The prevalence of massive rotator cuff tears has been reported to be as high as 40% of all rotator cuff tears. Clinical decision rule for rotator cuff tear probability. Rotator cuff and shoulder conditioning program orthoinfo aaos. Jazrawi, md associateprofessoroforthopaedics chief2divisionofsportsmedicine tel. The overarching philosophy of rehabilitation is centered on the principle of the gradual application of controlled stresses to the healing rotator cuff repair with consideration of rotator cuff tear size, tissue quality, and patient variables.
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. Pdf rehabilitation after rotator cuff repair researchgate. Nonoperative rotator cuff tear protocol acuteearly phase limited, painful arom, painful resisted testing subacutemid phase. When pain subsides, strengthening the rotator cuff. However, more serious injuries, such as complete rotator cuff tears, may require surgical repair. The four shoulder muscles that make up the rotator cuff can get worn or tear. Macdermid the university of western ontario graduate program in health and rehabilitation sciences a thesis submitted in partial fulfillment of the requirements for the degree in doctor of philosophy.
Rotator cuff repair large to massive 5cm rehabilitation. Clinical results of arthroscopic polyglycolic acid sheet patch graft for. Most protocols are implemented under the pretense of treating areas local to the site of symptoms. Download shoulder surgery rehabilitation protocol pdf. James bicos fox 2 news head injury helmet injuries injuries kevin durant kids kids activity knee knee injury march madness mlb neocart oakland university olympics pain performance orthopedics prevention research reverse total shoulder rio rotator. Marsh brook rehabilitation service wentworthdouglass hospital durham. Showering is allowed once dressings and catheter is removed. Whether nonsurgical or surgical, successful management of rotator cuff disease is dependent on appropriate rehabilitation. All of the exercises should be performed with slow and controlled motion. The american society of shoulder and elbow therapists. 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.
Youre more likely to have this if you have a job where you need to move your arm a certain way over and over, like a. Few studies of rehabilitation therapy are available. No arom exercise of the shoulder consistent use of sling unless otherwise instructed weaning starting at week 4 at earliest. Rotator cuff rc tendinopathy is a very common problem of the shoulder complex, being the third most common musculoskeletal complaint, 4 with poor longterm outcomes. The deltoid muscle is separated to expose the torn rotator cuff tendons. When shoulder pain gets you down, heres a rotator cuff rehab guide that will help you recover and quick. However, a comprehensive approach aimed at identifying all possible. Most rotator cuff tears can be repaired surgically by reattaching the torn tendons to the humerus. Rehabilitation is a mainstay of nonoperative treatment of rotator cuff disorders. Mar 23, 2017 and more confusing is the lack of consensus among surgeons regarding the optimal postoperative rehabilitation protocol following arthroscopic rotator cuff repair.
1422 730 1480 1209 761 1389 961 140 1571 570 717 1036 914 28 938 753 472 1272 295 263 1120 1081 86 925 288 1470 1307 136 1415 20 1452 109 667 821 758 1406 990 572