Toc rotator cuff rehabilitation protocol medium tear the toc rotator cuff repair rehabilitation program is an evidencebased and soft tissue healing dependant protocol compiled by george j. Accuracy of rotator cuff tear diagnosis via mri in patients undergoing total shoulder arthroplasty. Protect repair decrease paininflammation prevent adhesive capsulitis precautions. Mcgill kc, sershon ra, mathers r, sherman sl, verma nn, romeo aa. One of the primary conditions targeted in rehabilitation of the shoulder is rotator cuff injury. This protocol provides you with general guidelines for the rehabilitation of patients following a massive open andor arthroscopic rotator cuff repair. Intermediate phase 16 weeks postop at this point you should begin your formal physical therapy, the instructions that follow are to aid your therapist in maximizing the results of your surgery while still protecting the repair.
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. Arthroscopic shoulder surgery these rehabilitation protocols are based on current studies detailing healing time and the risk of stiffness after arthroscopic shoulder surgery. The rotator cuff is then repaired directly to the bone with a. Rush university medical center 23rd annual thesis day department of orthopaedics. Immediate postop phase first 57 days after surgery. Rotator cuff and slap patient info boston sports medicine. Rehabilitation protocol after arthroscopic rotator cuff repair. Boyle cryotherapy as needed for pain relief cryocuff or ice pack no pendulum. Rotator cuff repair rehabilitation protocol protocol for subscapularis repair rehabilitation prepared by dr boyle. Stage i 0 to 4 weeks wear sling continuously for 4 weeks.
Size and location of tear degree of shoulder instabilitylaxity prior to surgery acute versus. A large size rotator cuff tear is defined as a tear 35cm, massive 5cm. Shoulder abduction pillowimmobilizer to be worn at all times the first 4 weeks except for exercise and hygiene therapeutic exercise. However, a comprehensive approach aimed at identifying all possible. 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. 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 primary rotator cuff repairs in patients under the age of 45.
This protocol provides you with general guidelines for the conservative rehabilitation of the patient with a rotator cuff tear rct. Rotator cuff repair rehabilitation protocol matthew. Massive rotator cuff repair rehabitation protocol 3 cm. The intent of this protocol is to provide the clinician with a. At this point you should begin your formal physical therapy, the instructions that follow are to aid your. Conservative treatment of chronic rotator cuff tears rehabilitation protocol phase 1. Mar 23, 2017 and more confusing is the lack of consensus among surgeons regarding the optimal postoperative rehabilitation protocol following arthroscopic rotator cuff repair. Rotator cuff repair protocol boston shoulder institute. Effect of two rehabilitation protocols on range of motion. Rotator cuff repair rehab protocol the stone clinic. Keep the abductor pillow in for the 4 weeks as well.
Showering is allowed once dressings and catheter is removed. Pdf merge combine pdf files free tool to merge pdf online. Rotator cuff tendonitis or impingement rehabilitation protocol. There is currently no uniform postoperative protocol for the rehabilitation of rotator cuff repairs.
Rotator cuff repair protocol boston sports medicine. Arthroscopic rotator cuff repair protocol small to medium sized tears david j. The deltoid muscle is separated to expose the torn rotator cuff tendons. Rotator cuff repair protocol northeast orthopedics and. Weeks 04 restrictions avoid provocative maneuvers or exercises that cause dis comfort includes both offending rom exercises and strengthening exercises. Rotator cuff repair postoperative physical therapy protocol 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. Begins immediately after surgery to approximately 4 weeks postop. Rotator cuff repair protocol the following procedures were performed. David schneider, md arthroscopic rotator cuff repair rehabilitation protocol phase i 0 3 weeks. The deltoid is divided in line with the portal site with a small incision. The rotator cuff can tear as an acute injury such as when lifting a heavy weight or falling on the shoulder or elbow. Madison, wi 53718 rehabilitation guidelines for anterior shoulder reconstruction with open bankart repair the anatomic configuration of the shoulder joint glenohumeral joint is often compared to a golf ball on a tee figure 1. An evaluationbased approach abstract rotator cuff disease of the shoulder, a common condition, is often incapacitating. Sling for everyone with or without abduction pillow as directed by dr.
Omearas rotator cuff repair 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. Rotator cuff repair protocol rotator cuff repair protocol this rehabilitation protocol has been developed for the patient following a rotator cuff surgical procedure. Early incorporation of an evidencebased aquaticassisted. Conservative treatment of chronic rotator cuff tears. Rotator cuff repair a rotator cuff repair is designed to improve pain and function in cases of rotator cuff tears. Rotator cuff repair protocol south shore orthopedics. My procedures are generally an arthroscopic evaluation, subacromial bursectomy, or an acromioplasty with miniopen 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. Effect of two rehabilitation protocols on range of motion and healing rates after arthroscopic rotator cuff repair. Type ii rotator cuff repair protocol arthroscopic tears for large to massive tears 5 cm joseph r.
This protocol will vary in length and aggressiveness depending on factors such as. Toc rotator cuff rehabilitation protocol medium tear. And more confusing is the lack of consensus among surgeons regarding the optimal postoperative rehabilitation protocol following arthroscopic rotator cuff repair. Davies, dpt professor at armstrong atlantic state university. 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. Abduction bracesling, remove sling only to bathe and to complete exercises. This protocol is intended to guide clinicians and patients through the post operative course of a rotator cuff repair. Marsh brook rehabilitation service wentworthdouglass hospital durham. Purpose of the abductor pillow is to keep tension off of the repair, avoid adduction. Massive rotator cuff repair protocol sports and ortho. Shawn hennigan, md rotator cuff repair rehabilitation protocol the following document is an evidencebased protocol for arthroscopic rotator cuff repair rehabilitation. 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. David schneider, md arthroscopic rotator cuff repair rehabilitation protocol phase i 0 3 weeks goals.
The physician will make specific changes to the program as appropriate for an individual patient. Rotator cuff rehabilitation protocol orthopedics ne. You may note that these protocols are more conservative than you have seen in your experience or heard from friends. The rotator cuff tissue is not very strong and can retear before healing if you do not follow these guidelines. The level i and ii evidence for rotator cuff repair rehabilitation is exceedingly small. Size and location of tear degree of shoulder instabilitylaxity prior to surgery. Rotator cuff repair protocol1 northwestern medical center. Arthroscopic rotator cuff repair protocol brigham and womens. Rehabilitation protocol for rotator cuff repair massachusetts. Only a few protocols have been reported in the literature that mention the use of aquatics to augment rotator cuff rehabilitation, and most only provide a brief notation that it can be incorporated. The rotator cuff is responsible for stabilization and active movement of the glenohumeral joint. May remove sling for tabletop activities eating, brushing teeth, keyboardtyping if painfree.
Denards rehabilitation protocols arthroscopic shoulder. The protocol is both chronologically and criterion based for advancement through four postoperative phases. Jan 19, 20 one of the primary conditions targeted in rehabilitation of the shoulder is rotator cuff injury. Protocol for smallmed rotator cuff andreas sauerbrey, m. The intent of this protocol is to provide the therapist and patient with guidelines for the postoperative rehabilitation course after arthroscopic rotator cuff repair. Uw health sports rehabilitation 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. This rehabilitation protocol has been developed for the patient following a rotator cuff surgical procedure. Phase i immediate postoperative phase weeks 0 6 days 014 patient is seen 2 days postoperative to remove surgical dressings and pain catheter. 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 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. Most protocols are implemented under the pretense of treating areas local to the site of symptoms.
It is not intended to be a substitute for clinical decision. Type one rotator cuff repair arthroscopic or miniopen small tear less than 1 cm i. Rotator cuff tendonitisimpingement rehabilitation protocol. At three weeks postsurgery begin physical therapy for prom and modalities. The team at the stone clinic has been repairing rotator cuffs for over twenty years and has progressively improved the techniques. Clinical guidelines for cpm following rotator cuff repair. Whether nonsurgical or surgical, successful management of rotator cuff disease is dependent on appropriate rehabilitation. Specific changes in the program will be made by the physician as appropriate for an individual patient. 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 authors protocol of choice, used within a large sports medicine rehabilitation center, is presented and the rationale behind its implementation is discussed. 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. You may remove the sling for exercises as prescribed by the surgeontherapist, icing, dressing, and showering. Rotator cuff repair most rotator cuff tears can be repaired surgically by reattaching the torn tendons to the humerus.
Type three rotator cuff repair miniopen or neer approach large to massive tear greater than 5 cm i. 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. Soda pdf is the solution for users looking to merge multiple files into a single pdf document. It is technically demanding but allows for less pain, early rehabilitation and minimal scars and has equal tendon healing rates as open surgery. Multiple nonoperative rehabilitation protocols have been described for the treatment of the spectrum of rotator cuff injury. 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. If you have any questions regarding the progress of the patient, the physician should be. Arthroscopic rotator cuff repair protocol medium to large. Split pdf files into individual pages, delete or rotate pages, easily merge pdf. Nonoperative rotator cuff tear protocol acuteearly phase limited, painful arom, painful resisted testing subacutemid phase. Rehabilitation guidelines for type i and type ii rotator. Now also begin to perform rotator cuff strengthening exercises. This is because the articular surface of the round humeral head is approximately. The shoulder is immediately weak and there is pain when trying to lift the arm.
Arthroscopic or key hole surgery of the shoulder allows for excellent visualisation of the rotator cuff tear and its repair in a minimally invasive manner. A torn rotator cuff due to an injury is usually best treated by immediate surgical repair. Rotation medical patch rehabilitation protocol phase i. 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. A comprehensive approach to nonoperative rotator cuff. Sling immobilization with supporting abduction pillow to be worn at all times except for showering and rehab under guidance of pt.
Rehabilitation guidelines for type i and type ii rotator cuff. Rehabilitation guidelines for smallmedium rotator cuff tears. 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. Most rotator cuff tears can be repaired surgically by reattaching the torn tendons to the humerus.