Surgical repair of the rotator cuff is a valuable procedure to improve shoulder function and decrease pain. 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. The first phase of therapy focuses on pain control, restoration of motion within specific. 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. James andrews, we have recently revised and expanded all of our protocols and made them completely online and downloadable. However, there is no consensus concerning the rehabilitation protocol following surgery. Phase 1 sling 1 full time use for 6 weeks 2 sleep in sling until after week 6 3 discontinue only after week 6 weeks 06 1 passive motion only beginning first postoperative day. Phase i immediate postoperative phase weeks 0 6 days 014 patient is seen 2 days postoperative to remove surgical dressings and pain catheter. Rehabilitation following rotator cuff repair springerlink. Rotator cuff repair protocol rotator cuff protocol physical.
Whether nonsurgical or surgical, successful management of rotator cuff disease is dependent on appropriate rehabilitation. Patient will wear an abduction pillow bracesling for 6 weeks postop. Maximise shoulder strength of deltoid, intact cuff muscles and scapula stabilisers. There are several general precautions to be aware of.
Phase 1 sling 1 full time use for 6 weeks 2 sleep in sling until after week 6 3 discontinue only after week 6 weeks 06 1 passive motion only beginning first postoperative day forward elevation goal. I now have two anchors and a bunch of sutures that i will take to the grave. The intent of this protocol is to provide the clinician with a guideline of the post operative rehabilitation course of a patient that has undergone an arthroscopic assistedminiopen rotator cuff repair. Rehabilitation protocol after arthroscopic rotator cuff repair. 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. Deltoids, supraspinatus, infraspinatus, subscapularis equipment needed. Showering is allowed once dressings and catheter is removed. Rotator cuff repair rehabilitation protocol the following document is an evidencebased protocol for arthroscopic rotator cuff repair rehabilitation. Rehabilitation protocol for rotator cuff repair this protocol is intended to guide clinicians and patients through the postoperative course of a 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.
Rotator cuff physical therapy guidelines and protocol. Pulley with gentle passive flexion to approximately 90. 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 approach may be associated with postoperative stiffness which can be managed once healing has occurred. This evidencebased large to massive rotator cuff repair physical therapy guideline is criterionbased. Mar 21, 2009 click here to see more about how i rehabilitation rotator cuff repair patients and download free copy of my arthroscopic rotator cuff repair protocol. 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. Tears and lesions of the rotator cuff are a frequent cause of shoulder pain and disability.
Rehab rotator cuff repair department of surgery, queens. Sling x 6 weeks ultrasling x 46 weeks, larger tears may be in ultrasling x 6 weeks then. The first phase of therapy focuses on pain control, restoration of motion within specific guidelines while preserving the integrity of the repair. Rotator cuff repair protocol boston sports medicine. 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. Weather ache for 1 2 years is common after rc repair 2. Following rotator cuff repair surgery, a postoperative abduction pillow brace supporting the shoulder 30 abduction is used, for a minimum of 26 weeks, as there is documented evidence that there is less strain on the. 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. Arthroscopic rotator cuff repair guys and st thomas. Three of four rc tendons were torn full thickness, large tears.
In the general population, the prevalence of rotator cuff. Rotator cuff pathology can contribute to shoulder pain, weakness, and limitations to both activities and work. If the repair is stressed too early, before healing has taken place, the repair will fail. In addition, few studies have evaluated the clinical results of contemporary revision arthroscopic rotator cuff repair15. 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.
Pdf rehabilitation after rotator cuff repair researchgate. Prom as instructed restrictionsexercise progression. 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. Rehabilitation guidelines for type i and type ii rotator cuff repair.
Rotator cuff physical therapy guidelines and protocol general guidelines. How fast do you rehab your rotator cuff repair patients. Arthroscopic rotator cuff repair is commonly performed and is generally a safe procedure. Control pain, inflammation, and effusion regain normal upper extremity strength and endurance. This may be performed arthroscopically or through open surgery, using sutures and bone anchors. Sometimes, a tissue transfer or a tendon graft is used. Rehabilitation of the shoulder after rotatorcuff repair. Recovering from rotator cuff surgery usually takes 4 to 6 months, but a full recovery can take up to a year. A close communication between the surgeon, the patient and the physical therapy team is important and should continue throughout the whole recovery.
Type one rotator cuff repair arthroscopic or miniopen small tear less than 1 cm i. Occasionally, however, a true acute tear occurs, and in a younger person, this must be diagnosed early and. The more common injury in the young is avulsion of one of the tuberosities because the tendon is stronger than bone at this site. 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. 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.
Surgical repair via open or arthroscopic techniques is associated with improved function and patient satisfaction. Rotator cuff repair physical therapy protocol preoperative guidelines restore arom strengthen involved extremity in pain free rom, emphasize rotator cuff scapular stabilization musculature instruct in use of abduction pillow immobilizer, icing, hand gripping, elbow rom educate patient on postop protocol and importance of compliance for good. Rotator cuff repair the following is a protocol for postoperative patients following rotator cuff repair. Most rotator cuff tears will occur at the supraspinatous tendon that corresponds to a subacromial impingement. Rotator cuff repair a rotator cuff repair is designed to improve pain and function in cases of rotator cuff tears. Initiate with submax painfree isometrics and arom as outlined in the protocol. 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. 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. Rotator cuff repair with biceps releasetenodesis brian bjerke, md postoperative protocol phase i maximum protection week 0 to 6 goals. Rotator cuff repair rehab protocol in the early 1990s, dr. An evaluationbased approach abstract rotator cuff disease of the shoulder, a common condition, is often incapacitating. Rotator cuff repair postoperative rehabilitation protocol orthoindy. A miniopen repair that combines arthroscopy and a small incision can be used to treat fullthickness tears. The level i and ii evidence for rotator cuff repair rehabilitation is exceedingly small.
Take your arm out of the sling a couple of times a day and bend and straighten your elbow. Some of the most important muscles for this purpose are the rotator cuff muscles. Help and feedback was given from people who have had rotator cuff repair surgery. Rehabilitation guidelines for type i and type ii rotator. The conservative rehabilitation protocol allows sharpey fibers to form before stressing the repair with resistive exercises. Your shoulder is the most mobile joint in your body and is therefore dependent on strong muscles to move and stabilise it. Hagan rotator cuff repair rehabilitation protocol overview key.
Phase 1 maximum protection phase 2 active range of motion. 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. The procedure involves stitching the torn tendon back onto its attachment to the humerus. However, to make an informed decision and give your. Table slide for passive flexion and extension exercise. Success of repair depends on several factors that include patient age, tear size, type of fixation, smoking status, and. Rehabilitation guidelines for rotator cuff repair and isolated subscapularis repair 2 uwsportsmedicine. Shawn hennigan, md rotator cuff repair rehabilitation protocol. The protocol is both chronologically and criterion based for advancement through four postoperative phases.
Return of strength is variable with massive tears 4. Rotator cuff repair protocol rotator cuff protocol. If pain, weakness, and stiffness in your shoulder see figure in appendix are related to problems with your rotator cuff, a doctor will usually first recommend nonsurgical treatment. Rotator cuff repair large to massive 5cm rehabilitation guideline. Exercises you can do at home exercises are a very important part of treatment for a rotator cuff disorder. Abduction bracesling, remove sling only to bathe and to complete exercises. 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 rehab protocol concord orthopaedics. Shoulder rotator cuff repair oxford university hospitals. 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. The american society of shoulder and elbow therapists. Acute tears with early repair may become stiffer than when the surgery is delayed. The success of surgery to repair the rotator cuff depends upon the size of the tear and how long ago the tear occurred usually, a small tear has a good chance for full recovery. In more severe cases, open surgery is required to repair the injured rotator cuff. Then, the tendon repair must be protected to allow the tendons to heal. Acute tearing of the rotator cuff is a rarity in a younger person with good muscle. Specific interventions should be based on the needs of the individual and should consider exam findings and clinical decision making. Rotator cuff repair protocol is a rehabilitation protocol to provide patient with the guidelines following a rotator cuff surgical procedure.
The rotator cuff complex is comprised of four tendons from four muscles. Postoperative rehabilitation protocol rotator cuff repair. Whether nonsurgical or surgical, successful management of rotator cuff disease is dependent on appropriate. Type three rotator cuff repair miniopen or neer approach large to massive tear greater than 5 cm i. Rotator cuff repair is the surgery used to repair a tear in one of these tendons. Surgical repair of a rotator cuff tear can be done arthroscopically or with a miniopen procedure. Rotator cuff repair rehab protocol physical therapy referral peter g.
Before suggesting the operation, your doctor will have considered that the benefits of the procedure outweigh any disadvantages. Rotator cuff repair protocol boston shoulder institute. Contact dr kevin murphy at 9046340640 to know more. Protect the repair know what muscles were involved strengthen the repair only when it regains adequate strength to tolerate strengthening, usually 4. None stepbystep directions lean forward and place one hand on a counter or table for support. The primary goal of this protocol is to protect the repair while steadily progressing towards and ultimately achieving preinjury level of activity. The primary purpose of the present study was to evaluate the tendon repair integrity and clinical outcomes for a cohort of patients. A gentle rehabilitation protocol with limits in range of motion and exercise times after arthroscopic rotator cuff repair would be better for tendon. Rotator cuff repair and rehabilitation surgical indications and considerations anatomical considerations.
Rotator cuff repair physical therapy protocol preoperative guidelines restore arom strengthen involved extremity in pain free rom, emphasize rotator cuffscapular stabilization musculature instruct in use of abduction pillow immobilizer, icing, hand gripping, elbow rom educate patient on postop protocol and importance of compliance for good. Rotator cuff repair rehabilitation program largemassive 5cm. Madison, wi 53718 surgical repair of a rotator cuff tear can be done arthroscopically or with a miniopen procedure. 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. If the tear is large, the extent of recovery cannot be accurately predicted until the repair and rehabilitation is completed. Your shoulder will be quite stiff and sore for the first few days. Improvements in strength come slowly takes 1 year to end result 3.