Specific interventions should be based on the needs of the individual and should consider exam findings and clinical decision making. Rotator cuff repair therapy protocol sideline orthopedics. A rotator cuff tear is a common injury, especially in sports like baseball or tennis, or in jobs like painting or cleaning windows. A full or complete tear will split the soft tissue into two, sometimes detaching the tendon from the bone. A torn rotator cuff due to an injury is usually best treated by immediate surgical. Rotator cuff repair therapy protocol page 1 of 6 bart eastwood d. 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. 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 pain assessment posture, scapulothoracichumeral position activepassive shoulder range of motion. For this reason the shoulder is the most mobile joint in the body. Surgery to repair a torn rotator cuff most often involves reattaching the tendon to the head of humerus upper arm bone. Size and location of tear degree of shoulder instabilitylaxity prior to surgery acute versus. Rotator cuff repair protocol south shore orthopedics. Rotator cuff strengthening internal and external rotation isometrics against a wall.
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. Three of the four rotator cuff muscles attach from the back of the shoulder blade to the arm bone. Rotator cuff tears can be classified in various ways. No resisted rotator cuff strengthening exercises until weeks patients this protocol should be used as a guide during your rehabilitation after surgery. Physical therapy standards of care brigham and womens. This protocol provides you with general guidelines for the conservative rehabilitation of the patient with a rotator cuff tear rct. A rotator cuff tear of greater than 5 cm is considered a massive tear. Tear size largemassive tear or 1 tendon repair difficult to. This means that many daily activities, like combing. Your surgeon will advise when you should start physiotherapy at your first followup appointment. Stretching the muscles that you strengthen is important for restoring range of motion and preventing injury. It is not intended to be a substitute for clinical decision. The rotator cuff is responsible for stabilization and active movement of the glenohumeral joint.
Rotator cuff tear has been a known entity for orthopaedic surgeons for more than two hundred years. Rehabilitation guidelines for type i and type ii rotator cuff. Rotator cuff tears one of the most common middleage complaints is shoulder pain. Exercises and physical therapy for rotator cuff tear. A physiotherapist should be consulted throughout to teach and individually modify the exercises. The intent of posting these standards of care and protocols is to provide clinicians and patients. The first classification is a partial thickness or a full thickness tear. Type ii rotator cuff repair protocol medical staff. 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. No arom exercise of the shoulder consistent use of sling unless otherwise instructed weaning starting at week 4 at earliest. Arthroscopic rotator cuff repair protocol medium to large. 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. Modifications to this guideline may be necessary dependent on physician specific instruction, size and location of tear, tendons involved, acute vs. The first classification is a partial thickness or.
Type ii rotator cuff repair protocol arthroscopic tears for large to massive tears 5 cm joseph r. A partial tear, however, may need only a trimming or smoothing procedure called a debridement. Rotator cuff tears are classified into one of 4 categories. Strengthening the muscles that support your shoulder will help keep your shoulder joint stable. The deltoid muscle is separated to expose the torn.
The rotator cuff is made up of four muscles supraspinatus, infraspinatus, subscapularis, and teres minor and their tendons. Rolf phase i immediate post surgical phase weeks 14. The right treatment can make you feel better, keep a small. The rotator cuff can also wear out as a result of degenerative changes. Keep the abductor pillow in for the 4 weeks as well.
The physician will make specific changes to the program as appropriate for an individual patient. Actively rotate your arm clockwise, complete reps, then counterclockwise, keeping your elbow straight. It usually happens over time from normal wear and tear, or if. Phase i immediate postoperative phase weeks 0 6 days 014 patient is seen 2 days postoperative to remove surgical dressings and pain catheter.
Patients over 50 years of age are more susceptible to sustaining a significant rotator cuff tear from trauma. Postoperative protocol this rehabilitation protocol has been developed for the patient following a rotator cuff surgical procedure. Rehab protocol for small protocol for rotator cuff repair this protocol is intended to guide clinicians and patients through the postoperative course of a rotator cuff repair. 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. Full thickness rotator cuff tears are rarely seen in those younger than 40 years of age.
Do not have the patient perform fullcan or emptycan supraspinatus exercises. A torn rotator cuff due to an injury is usually best treated by immediate surgical repair. As a result of prolonged overuse, wear and tear, trauma, or surgery the muscles arising from the shoulder blade and attaching to the top of your humerus arm bone, the rotator cuff muscles can become completely torn massive rotator cuff tear, see image 5. Rotator cuff tendonitis bursitis rehabilitation protocol. Rehabilitation protocol for small to moderate rotator cuff tear. Maintain integrity of repair diminish pain and inflammation prevent muscular inhibition independent with adls with modifications while maintaining the integrity of the. This process alone can lead to rotator cuff tears in older patients. Partial thickness tears start on one surface of the tendon, but do not progress through the depth of the tendon.
Size and location of tear degree of shoulder laxity prior to surgery. A frequent source of that pain is a torn rotator cuff. Strengthening of the rotator cuff is done within limits of pain. It should be stressed that this is only a protocol and. This article contains details about these and other surgical treatments commonly used for rotator cuff tears. Moderate evidence supports that higher bmi is correlated with higher retear rates after rotator cuff repair surgery. The shoulder is immediately weak and there is pain when trying to lift the arm.
The information contained in these standards of care or protocols is not intended in any way to be used as primary medical advice or to replace medical advice offered by physical, occupational, speech therapists or other health care professionals. Rotator cuff repair postoperative rehabilitation protocol. A rotator cuff tear may result suddenly from a single traumatic event or. Madison, wi 53718 surgical repair of a rotator cuff tear can be done arthroscopically or with a miniopen procedure. Showering is allowed once dressings and catheter is removed. 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. 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.
Postoperative rotator cuff repair rehabilitation protocol. The chronic nature of these tears along with poor underlying quality of the tissue often results in recurrent tears. Partialthickness tears do not completely sever the tendon where full thickness tears do. Rotator cuff repair protocol rotator cuff repair protocol this rehabilitation protocol has been developed for the patient following a rotator cuff surgical procedure. Supraspinatus open can patient stands with theraband under their foot while grasping theraband, bring shoulders back and down. 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. The rotator cuff is comprised of four muscles and tendons that surround the top of the upper arm bone humerus and functions to help rotate the arm and stabilize the shoulder joint. 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. 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. These tears are usually chronic in nature and often involve poor tissue quality with fatty infiltration and muscle atrophy. Rotator cuff tears may be partial or full thickness.
Although the exact pathogenesis is controversial, a combination of intrinsic factors proposed by. Rotator cuff sprain and strains university of california. Most rotator cuff tears can be repaired surgically by reattaching the torn tendons to the humerus. Rotator cuff repair protocol boston shoulder institute. Rotator cuff repair protocol northeast orthopedics and. Arthroscopic rotator cuff repair postoperative rehab protocol. Moderate evidence supports that higher bmi is correlated with higher re tear rates after rotator cuff repair surgery. Rotator cuff bursitis tendonitis rehabilitation protocol. 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 will vary in length and aggressiveness depending on factors such as. Circumduction reverse codmans lie on your back, use your uninvolved hand to assist your arm to a vertical position you upper arm pointed towards ceiling. 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 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. Keeping these muscles strong can relieve shoulder pain and prevent further injury.
Type two rotator cuff repair arthroscopic or miniopen medium to large tear greater than 1 cm and less than 5 cm i. Purpose of the abductor pillow is to keep tension off of the repair, avoid adduction. Therapy services patient information poole hospital. The socket portion of the joint is not naturally deep. Brace abduction bracesling, remove sling only to bathe and to complete exercises. 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 pain assessment posture, scapulothoracichumeral position.
A large size rotator cuff tear is defined as a tear 35cm, massive 5cm. Rotator cuff repair small to medium rehabilitation guideline. Rehabilitation guidelines for rotator cuff repair and isolated subscapularis repair 2 uwsportsmedicine. On the other hand, 25% of all individuals over the age of 60 have a rotator cuff tear. It is no means intended to be a substitute for ones.
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. The speed in which you progress through these phases of rehab may be altered depending upon the size of your tear and the quality of the tissue. 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. At a 30 degree angle in front of the body with thumb pointed up, slowly raise arm to shoulder height. The rotator cuff can tear as an acute injury such as when lifting a heavy weight or falling on the shoulder or elbow.
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