Department of rehabilitation services physical therapy arthroscopic rotator cuff repair protocol. Sometimes, a tissue transfer or a tendon graft is used. Type ii rotator cuff repair protocol arthroscopic tears for large to massive tears 5 cm joseph r. Rotator cuff repair and rehabilitation surgical indications and considerations anatomical considerations. Disorders of the rotator cuff, including tears, are thought to be the most common cause of this shoulder pain. Showering is allowed once dressings and catheter is removed. This included data on small to large tears however massive tears. Once this bridge is reestablished and the connection between the tendon and the bone has thoroughly healed, the corresponding muscles can once. And more confusing is the lack of consensus among surgeons regarding the optimal postoperative rehabilitation protocol following arthroscopic rotator cuff repair.
Specific changes in the program will be made by the physician as appropriate for an individual patient. The intent of this protocol is to provide the clinician with a guideline to establish and progress a patient through post operative rehabilitation. 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. Phase 1 maximum protection phase 2 active range of motion. Rotator cuff repair is followed by a program consisted of four commonly used and accepted phases, beginning with the aim to protect mainly the repair in the immediate postoperative phase and gradually return to preoperative activity level 31 huberty dp, schoolfield jd, brady pc, et al.
Rotator cuff repair rehabilitation program largemassive 5cm. The rate of progression following rotator cuff repair surgery is often determined by the amount of retraction present prior to repair, with the more retracted tendon requiring a slower rehabilitation course because of a. Type ii rotator cuff repair protocol medical staff. 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. The rotator cuff complex is comprised of four tendons from four muscles. Rotator cuff repair large to massive 5cm rehabilitation. Rotator cuff repair postoperative rehabilitation protocol orthoindy. Protected rom 0 to 6 weeks after surgery patients may shower on postop day number 2. It is not intended to be a substitute for ones clinical decision making.
Abduction bracesling, remove sling only to bathe and to. Sutures will be removed by surgeon in 7 to 10 days. Initiate with submax painfree isometrics and arom as outlined in the protocol. Rehabilitation after rotator cuff repair springerlink. Then, the tendon repair must be protected to allow the tendons to heal. Weather ache for 1 2 years is common after rc repair 2. 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. However, there is no consensus concerning the rehabilitation protocol following surgery. Regain motion, avoid deconditioning, decrease pain 1 rest, immobilize to protect shoulder, decrease inflammation 2 sling at night, during day in unprotected situations 3 ice, nsaids, analgesics. This protocol provides you with general guidelines for the rehabilitation of patients following a standard open, mini open andor arthroscopic rotator cuff repair. 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.
These videos should not be used as a substitute for regular physical therapy visits and guidance from your physician. In the general population, the prevalence of rotator cuff. A miniopen repair that combines arthroscopy and a small incision can be used to treat fullthickness tears. Your shoulder is the most mobile joint in your body and is therefore dependent on strong muscles to move and stabilise it. 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 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. The primary purpose of the present study was to evaluate the tendon repair integrity and clinical outcomes for a cohort of patients following revision arthroscopic rotator cuff repair. The attachment site should be decorticated, although creation of a trough, which. In addition, few studies have evaluated the clinical results of contemporary revision arthroscopic rotator cuff repair15. Pdf rehabilitation after rotator cuff repair researchgate. There are several general precautions to be aware of. Discomfort will be moderate and may be severe for the first few days and will gradually get better in the first day or two after the surgery, it is better to give the pain medication regularly e. The first phase of therapy focuses on pain control, restoration of motion within specific guidelines while preserving the integrity of the repair.
Type i rotator cuff repair repair gradual return to full promaarom increase shoulder strength while respecting repair decrease pain weeks 0 3. Postoperative rehabilitation protocol rotator cuff repair. Rehabilitation guidelines for rotator cuff repair type i phase iii begin after meeting phase ii criteria, usually postop weeks 812 appointments if arom deficit is present with lag signs surgeon should be notified re. A gentle rehabilitation protocol with limits in range of motion and exercise times after arthroscopic rotator cuff repair would be better for tendon healing without taking any substantial risks.
Patient will wear an abduction pillow bracesling for 6 weeks postop. Rehabilitation protocol rotator cuff repair phase i. 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. Even when surgery and rehabilitation are successful, the repaired rotator cuff tendon is prone to reinjury up to 12 months following the procedure. A gentle rehabilitation protocol with limits in range of motion and exercise times after arthroscopic rotator cuff repair would be better for tendon healing without. Please remember, individual patients will progress differently and their post operative protocol will be dependent on both the size of the tear. Rotator cuff repair protocol is a rehabilitation protocol to provide patient with the guidelines following a rotator cuff surgical procedure. Rehabilitation of the shoulder after rotatorcuff repair. In most studies, contact between the tendon and bone was essential and healing proceeded chiefly from the bone, and in small measure from the bursa but not at all from the tendon. Rotator cuff repair protocol rotator cuff protocol. Standard open or arthroscopic rotator cuff repair protocol. Shawn hennigan, md rotator cuff repair rehabilitation protocol.
A close communication between the surgeon, the patient and the physical therapy team is important and should continue throughout the whole recovery. Guide to rotator cuff repair rehabilitation welcome to our rotator cuff repair rehabilitation video series. Rotator cuff repair represents the most common shoulder condition for which patients need postsurgical rehabilitation 1. Rehab rotator cuff repair surgery at queens university. 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 goal of these videos is to help maximize your recovery following rotator cuff surgery. If the repair is stressed too early, before healing. 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. But, while surgical technique has developed, rehabilitation, a critical component of the recovery process has not. Rotator cuff repair is then considered if the more conservative methods are not successful. A rotator cuff repair involves stitching the torn tendon back onto its attachment to the arm bone humerus.
Ice or cold flow systems encouraged for the first week at a minimum. Your shoulder will be quite stiff and sore for the first few days. Healing of the tendon to the bone at the attachment site is the goal of cuff repair. General time frames are given for reference to the average, but individual patients will progress at. Rotator cuff repair large to massive 5cm rehabilitation guideline. In more severe cases, open surgery is required to repair the injured rotator cuff. Ice or cold flow systems encouraged for the first week at a. Rotator cuff repair the following is a protocol for postoperative patients following rotator cuff repair. Take your arm out of the sling a couple of times a day and bend and straighten your elbow. Hagan rotator cuff repair rehabilitation protocol overview. 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. 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. Rotator cuff and shoulder rehabilitation exercises. If you have any questions regarding the progress of the patient, the.
Most rotator cuff tears will occur at the supraspinatous tendon that corresponds to a subacromial impingement. Rehabilitation of the shoulder following a rotator cuff repair is variable and is dependent not only on the quality of the repair, but also on the tear size and extent of medial retraction. Rehabilitation protocol after arthroscopic rotator cuff repair. 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. No arom exercise of the shoulder consistent use of sling unless otherwise instructed weaning starting at week 4 at earliest. The level i and ii evidence for rotator cuff repair rehabilitation is exceedingly small. Type three rotator cuff repair miniopen or neer approach large to massive tear greater than 5 cm i. Phase i immediate postoperative phase weeks 0 6 days 014 patient is seen 2 days postoperative to remove surgical dressings and pain catheter. Improvements in strength come slowly takes 1 year to end result 3. Distal rom with scapular retraction manual scapular manipulation with patient lying on nonoperative side supine passive ff in scapular plane to 120 supine passive er to 30 weeks 26. To repair a torn rotator cuff, the tendons must be freed up from scar tissue and then sutured back down to the bone where they were before the tear. Following arthroscopic rotator cuff repair huberty2009 arthroscopy 489arthroscopic rotator cuff repairs 24 patients 4.
Rotator cuff repair rehabilitation protocol the following document is an evidencebased protocol for arthroscopic rotator cuff repair rehabilitation. Arthroscopic rotator cuff repair shoulderdoc by prof. Many of the studies compare different surgical techniques and there is a lack of consistency in postoperative rehabilitation. Shawn hennigan, md rotator cuff repair rehabilitation. Rehabilitation following rotator cuff repair springerlink. Rotator cuff repair rehab protocol concord orthopaedics.
If the repair is stressed too early, before healing has taken place, the repair will fail. Two key factors for successful tendon healing and satisfactory functional outcome are a skillful surgical technique and a wellprogrammed rehabilitation protocol. Rotator cuff repair rehab protocol physical therapy referral peter g. This is because the articular surface of the round humeral head is approximately four times greater than that of the. Rotator cuff repair small to medium rehabilitation guideline. Specific interventions should be based on the needs of the individual and should consider exam findings and clinical decision making. Some of the most important muscles for this purpose are the rotator cuff muscles. The team at the stone clinic has been repairing rotator cuffs for over twenty years and has progressively improved the techniques. Rehabilitation protocol for rotator cuff repair this protocol is intended to guide clinicians and patients through the postoperative course of a rotator cuff repair. It is designed for rehabilitation following large to massive rotator cuff repairs.
Rotator cuff repair a rotator cuff repair is designed to improve pain and function in cases of rotator cuff tears. The primary goal of this protocol is to protect the repair while steadily progressing towards and ultimately achieving preinjury level of activity. James andrews, we have recently revised and expanded all of our protocols and made them completely online and downloadable. Incidence and treatment of postoperative stiffness. The procedure involves stitching the torn tendon back onto its attachment to the humerus. Surgical repair of the subscapularis along the anterior shoulder will require restrictions with internal rotation during the early stages of rehabilitation. Appointments should be 2 times per week until integrity has been determined and. Rotator cuff repair protocol boston shoulder institute. Return of strength is variable with massive tears 4. The primary aim of rotator cuff repair is to repair the connection between the damaged tendon and the bone. Complete ruptures usually require surgery if your goal is to return your shoulder to optimal function. Rehabilitation guidelines for type i and type ii rotator. Hagan rotator cuff repair rehabilitation protocol overview key.
Feb 28, 2017 a gentle rehabilitation protocol with limits in range of motion and exercise times after arthroscopic rotator cuff repair would be better for tendon healing without taking any substantial risks. It is designed for rehabilitation following small to medium rotator cuff repairs. Type one rotator cuff repair arthroscopic or miniopen small tear less than 1 cm i. This may be performed arthroscopically or through open surgery, using sutures and bone anchors. Rehabilitation guidelines for type i and type ii rotator cuff repair. This evidencebased large to massive rotator cuff repair physical therapy guideline is criterionbased. Rotator cuff repair rehabilitation framework phase 1 weeks 06 rc repair, deltoid takedown and repair, softtissue healing goals. Rehabilitation guidelines for type i and type ii rotator cuff. 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.
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