Rotator cuff rc disease is a frequent cause of shoulder pain and can result in weakness, alterations in glenohumeral kinematics, and shoulder instability in some circumstances. A torn rotator cuff due to an injury is usually best treated by immediate surgical repair. Rotator cuff physical therapy guidelines and protocol. Modifications to this guideline may be necessary dependent on physician specific. Clinical results of arthroscopic polyglycolic acid sheet patch graft for. Shawn hennigan, md rotator cuff repair rehabilitation protocol the following document is an evidencebased protocol for arthroscopic rotator cuff repair rehabilitation. Brace abduction bracesling, remove sling only to bathe and to complete exercises. Massive rotator cuff repair protocol sports and ortho. Rotator cuff repair protocol this rehabilitation protocol has been developed for the patient following a rotator cuff surgical procedure. The fix effect model was used to combine smds in the high homogeneity condition, and the. 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.
Rehabilitation guidelines for type i and type ii rotator. 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. It is designed for rehabilitation following small to medium rotator cuff repairs. It is prone to injury, but doing specific exercises can help prevent this. 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. Comparison of clinical outcomes in allarthroscopic versus mini. The four shoulder muscles that make up the rotator cuff can get worn or tear. Translation of the humeral head scale is associated with success of.
Success of repair depends on several factors that include patient age, tear size, type of fixation, smoking status, and. This rehabilitation protocol has been developed for the patient following a rotator cuff surgical procedure. Abduction bracesling, remove sling only to bathe and to complete exercises. The conservative approach may be associated with postoperative stiffness which can be managed once healing has occurred. The network metaanalysis could combine indirect and direct evidence to compare the relative advantages of multiple treatments and obtain the. The team at the stone clinic has been repairing rotator cuffs for over twenty years and has progressively improved the techniques. Shawn hennigan, md rotator cuff repair rehabilitation protocol.
Specific interventions should be based on the needs of the individual and should consider exam findings and clinical decision making. Mar 23, 2017 and more confusing is the lack of consensus among surgeons regarding the optimal postoperative rehabilitation protocol following arthroscopic rotator cuff repair. Preoperative rom exercises maximize shoulder strength of deltoid, intact rotator cuff muscles and scapular stabilizers. There are four tendons in the rotator cuff, and these tendons are attached individually to the following muscles. Improvements in strength come slowly takes 1 year to end result 3. The high retear rates after surgery for irreparable rotator cuff tears can be. The procedure involves stitching the torn tendon back onto its attachment to the humerus. Begin with 510 repetitions, advancing to 30 repetitions as able. This protocol is based on maintaining a range of movement in the first phase and then gradually building strength in the middle to the last phase. Highfrequency, lowmagnitude vibration has been demonstrated to promote new bone formation. Rotator cuff repair protocol south shore orthopedics. The average age of enrolled patients at the time of surgery was 53. Mo repair is an alternative surgery pattern to combine 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.
Clinical guidelines for cpm following rotator cuff repair. Arthroscopic rotator cuff repair is commonly performed and is generally a safe procedure. Rotator cuff surgery is the repair of inflammation or tears of the rotator cuff tendons in the shoulder. Type three rotator cuff repair miniopen or neer approach large to massive tear greater than 5 cm i. Avoid abductioner coupled motion for the first six 6 weeks postop. Two studies were excluded because the size of the tears were not reported26,56. 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. For this reason the shoulder is the most mobile joint in the body. 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. The conservative rehabilitation protocol allows sharpey fibers to form before stressing the repair with resistive exercises. Madison, wi 53718 surgical repair of a rotator cuff tear can be done arthroscopically or with a miniopen procedure.
Phase i immediate postoperative phase weeks 0 6 days 014 patient is seen 2 days postoperative to remove surgical dressings and pain catheter. Rehabilitation protocol after arthroscopic rotator cuff repair. Rotator cuff repair rehabilitation protocol kevin ko, md shoulder and elbow surgeon opa orthopedics seattle, wa phase i. 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. Distal rom with scapular retraction manual scapular manipulation with patient lying on nonoperative side. Protect repair decrease paininflammation prevent adhesive capsulitis precautions. Comparison of clinical outcomes in allarthroscopic versus miniopen. The remaining 108 patients 37 women and 71 men had a mean age of 65. Showering is allowed once dressings and catheter is removed. This may be performed arthroscopically or through open surgery, using sutures and bone anchors. Advancing age has been consistently held accountable as one of the major risk factor for the development of cuff tears in various studies. A comparison of rehabilitation methods after arthroscopic. Arthroscopic and open rotator cuff repair rehabilitation protocol week 1 2 shoulder sling and swathe full time day and night. 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 protocol is both chronologically and criterion based for advancement through four postoperative phases. Avoid biceps resistance exercise for eight 8 weeks postop. Protect the repair know what muscles were involved strengthen the repair only when it regains adequate strength to tolerate strengthening, usually 4. Rotator cuff repair is the surgery used to repair a tear in one of these tendons.
Physicians develop new technique for rotator cuff repair at the andrews institute. Rotator cuff pathology can contribute to shoulder pain, weakness, and limitations to both activities and work. All of the exercises should be performed with slow and controlled motion. Rotator cuff and shoulder rehabilitation exercises. Maximise shoulder strength of deltoid, intact cuff muscles and scapula stabilisers. Rotator cuff repair rehab protocol the stone clinic. Arthroscopic rotator cuff repair guys and st thomas. An evaluationbased approach abstract rotator cuff disease of the shoulder, a common condition, is often incapacitating. Rotator cuff repair revised august 2008 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 supported pendulum exercises. 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. Size and location of tear degree of shoulder instabilitylaxity prior to surgery acute versus chronic condition. A loadsharing ripstop fixation construct for arthroscopic rotator. Patients who ultimately undergo rotator cuff repair benefit from early range of.
Despite advancements in arthroscopic rotator cuff repair techniques. Rotator cuff repair postoperative rehabilitation protocol orthoindy. For this reason transosseous rotator cuff repair represents the gold standard. David schneider, md arthroscopic rotator cuff repair rehabilitation protocol phase i 0 3 weeks goals. Arthroscopic rotator cuff repair protocol medium to large. Rotator cuff repair protocol boston shoulder institute. Later, in an effort to combine the stronger biomechanical repair of the doublerow. Rehabilitation protocol for rotator cuff repair this protocol is intended to guide clinicians and patients through the postoperative course of a rotator cuff repair. Prom as instructed restrictionsexercise progression. Size and location of tear degree of shoulder instabilitylaxity prior to surgery. Physicians develop new technique for rotator cuff repair at. Rotator cuff repair protocol the following procedures were performed. Rotator cuff repair positions of significant length and tension penn shoulder and elbow service penn therapy and fitness presbyterian medical center retear and outcome n retear % surgery function fu tech tear size harryman, 1991 105 1t20 2t47 3t68 open yes us yes liu, 1994 35 34 mopen no mri yes klepps, 2004 32 1t26 2t38. Rotator cuff repair can require a long recovery period, especially if the tear was large.
The clinical effect of arthroscopic rotator cuff repair techniques. Exercises and physical therapy for rotator cuff tear. In fact, some rotator cuff tears will increase in size if. Surgical repair via open or arthroscopic techniques is associated with improved function and patient satisfaction. The american society of shoulder and elbow therapists. General time frames are given for reference to the average, but individual patients will progress at. Rotator cuff repair small to medium rehabilitation guideline. Sling x 6 weeks ultrasling x 46 weeks, larger tears may be in ultrasling x 6 weeks then. Rehabilitation of the shoulder after rotatorcuff repair. Surgery ends with subacromial decompression if necessary. To ensure that this program is safe and effective for you, it should be performed under your doctors supervision. Control pain, inflammation, and effusion regain normal upper extremity strength and endurance.
The socket portion of the joint is not naturally deep. A torn rotator cuff can cause significant pain and limit the movement of the shoulder and arm. Most rotator cuff tears can be repaired surgically by reattaching the torn tendons to the humerus. The intent of this protocol is to provide the clinician with a. Rotator cuff tears are a common cause of shoulder pain and dysfunction, with a prevalence of. Rotator cuff repair a rotator cuff repair is designed to improve pain and function in cases of rotator cuff tears. Shoulder abduction pillowimmobilizer to be worn at all times the first 4 weeks except for exercise and hygiene therapeutic exercise. 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. Postoperative rotator cuff repair rehabilitation protocol. Patients older than 60 were twice as likely to develop tear which were larger and more massive.
Whether nonsurgical or surgical, successful management of rotator cuff disease is dependent on appropriate rehabilitation. Victoria bc v8z 0b9 tel 250 940 4444 fax 250 385 9600 page 1 june 2017 v1s. International journal of sports physical therapy, 01 jun 2018, 3. 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. Weather ache for 1 2 years is common after rc repair 2. This protocol will vary in length and aggressiveness depending on factors such as. Rotator cuff repair postoperative rehabilitation protocol. Was the methods used to combine the findings of studies appropriate. Modified rehabilitation program after rotator cuff repair. Modified rehabilitation program after rotator cuff repair robert e. On the other hand, 25% of all individuals over the age of 60 have a rotator cuff tear. The american society of shoulder and elbow therapists consensus statement on rehabilitation following arthroscopic rotator cuff repair.
However, to make an informed decision and give your. Continued c canstick exercises for external rotation you can passively externally rotate your surgical shoulder and arm to the plane of your body. Rotator cuff tears do not heal, or repair themselves. When you can return to work or play sports depends on the surgery that was done. 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. Rotator cuff repair rehab protocol prescription patient name. Rehabilitation protocol following arthroscopic rotator cuff. Before suggesting the operation, your doctor will have considered that the benefits of the procedure outweigh any disadvantages. A small size rotator cuff tear is defined as a tear rotator cuff repair is performed, either arthroscopically or via miniopen procedure, by suturing the torn tendon to the. 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. Pdf rehabilitation of the patient with rotator cuff pathology requires a comprehensive. Full thickness rotator cuff tears are rarely seen in those younger than 40 years of age. Surgery to repair a torn rotator cuff most often involves reattaching the tendon to the humerus.
Rehabilitation after rotator cuff repair the open orthopaedics journal, 2017, volume 11 155 outpatient procedure and mainly enables secure fixation and sequentially early return to motion 3, 4. 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. 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. Multiple factors can impact the repair, including tissue quality, the age and size. The current literature on tissue engineering application for rotator cuff repair is scanty. 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. Learn about the causes, symptoms, and treatment options here. You will use your nonoperative arm as the motor, but do not bring your surgical arm past the plane of your. Arthroscopic transosseous rotator cuff repair ncbi. Cole,md,mba range of motion immobilizer exercises phase i 04 weeks 02 weeks. For patients who have undergone slap repair, use guidelines and timeframe for small cuff tear with good quality repair and tissue i. Remember the following as you engage in phase 3 rotator. Sling immobilization with supporting abduction pillow to be worn at all times except for showering and rehab under guidance of pt. This type of rotator cuff tear can usually be repaired but sometimes the tear may not need to be repaired and sometimes cannot be repaired.
Dissatisfied outcomes occurred in 15% of patients, who then transitioned to surgery. It should be stressed that this is only a protocol and. Rehabilitation guidelines for rotator cuff repair and isolated subscapularis repair 2 uwsportsmedicine. Rotator cuff repair and rehab i reported to the surgery center at 0600, surgery at 0730, recovery room at, discharged to go home around 1. Find out how physical therapy exercises and other treatment can help you feel better. Rotator cuff repair is a common method to treat rotator cuff tears. Romeo, md, and bernard bach, jr, md normal shoulder function requires a balanced relationship between glenohumeral mobility and glenohumeral stability.
The rotator cuff can also wear out as a result of degenerative changes. Talk to your doctor or physical therapist about which exercises will best help you meet your rehabilitation goals. Surgery to repair a torn rotator cuff is often successful in relieving pain in the shoulder. Immobilized at all times day and night off for hygiene and. Pictures courtesy of simpleset, used with permission. Pdf current concepts in rehabilitation of rotator cuff pathology.
Rotator cuff physical therapy guidelines and protocol general guidelines. Gumina et al on 586 patients with a history of arthroscopic tear repair reported a mean age of 59 years. Exercise therapy, fullthickness rotator cuff tear, nonoperative. The procedure may not always return strength to the shoulder. No arom exercise of the shoulder consistent use of sling unless otherwise instructed weaning starting at week 4 at earliest. 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. Comparison of aggressive and traditional postoperative. Return of strength is variable with massive tears 4.