Christopher L. Forthman, MD Orthopaedic and Hand Surgery HAND • WRIST • ELBOW • SHOULDER www.drforthman.com • www.chesapeakehand.com HAND • WRIST • ELBOW • SHOULDER Arthroscopic Rotator Cuff Repair Protocol: Massive Tear
Rehabilitation Protocol: Arthroscopic Rotator Cuff Repair ... o Elbow/Wrist/Hand Range of Motion and Grip Strengthening ... **IF BICEPS TENODESIS WAS PERFORMED ...
Michael Angeline, MD Department of Orthopedic Surgery-Sports Medicine Service Rehabilitation Protocol: Rotator Cuff Repair Weeks 1-2: Rest and Healing Sling Immobilizer: At all times except exercises
LARGE ROTATOR CUFF REPAIR PROTOCOL ... This is done with muscles in a shortened position. ... humeral head migration associated with high deltoid activity.
This procedure involves removing a bone spur and irregularities on the underside of the acromion (the roof of the shoulder) which can be a cause of rotator cuff irritation and tearing. The torn tendon is then reattached to the …
Arthroscopic Repair of Massive Contracted Rotator Cuff Tears: Aggressive Release with Anterior and Posterior Interval Slides Do Not Improve Cuff Healing and Integrity Sung-Jae Kim, MD, PhD, Sung-Hwan Kim, MD, Su-Keon Lee, MD, Jae-Wan Seo, MD, and Yon
Arthroscopic Rotator Cuff Phase 1 (0-4 weeks for small tears; 0-6 weeks for large tears) 1 Pendulums 2 Scaption 3 Scaption + external rotation to 30 degrees 4 Table slides in plane of scapula
If your biceps is damaged a biceps tenodesis is also performed where the ... Grasp the wrist of your operated arm. Bend and straighten your elbow by using your non-
Postoperative Rotator Cuff Repair Rehabilitation Protocol . Large and Massive Tears . Phase I: 0-6 weeks – exercise 4-5 times per days . Goals . 1. Patient education
ARTHROSCOPIC BANKART REPAIR PROTOCOL This rehabilitation protocol has been developed for the patient following an arthroscopic Bankart surgical pro-cedure.
Ryan C. Pate, MD Robert J. Dole VAMC 5500 E. Kellogg St. Wichita, KS 67218 316-685-2221 Fax: 316–681-5522
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. It should be stressed that this is only a protocol and should not be a substitute for clinical decision making regarding a patients progression. Actual progression should be individualized based upon your patient’s physical examination, individual progress and the presence of any postoperative complications. The rate limiting factor in arthroscopic rotator cuff repair is the biologic healing of the cuff tendon to the humerus, which is thought to be a minimum of 8-12 weeks. Progression of AROM against gravity and duration of sling use is predicated both on the size of tear and quality of tissue and should be guided by referring physician. Refer to initial therapy referral for any specific instructions.
Phase I: Immediate Post Surgical Phase (Weeks 0-6) Goals Maintain/protect integrity of repair Gradually increase PROM Diminish pain and inflammation Prevent muscular inhibition Independence in modified ADLs Precautions No active range of motion (AROM) of shoulder No lifting of objects, reaching behind back, excessive stretching or sudden movements Maintain arm in brace, sling – remove only for exercise Sling use for 6 weeks – medium to large tear size No support of body weight by hands Keep incisions clean and dry Day 1 to 6 Use of Abduction brace/sling (during sleep also) – remove only for exercise Passive pendulum exercises (3x/day minimum) Finger, wrist, and elbow AROM (3x/day minimum) Gripping exercises (putty, handball) Cervical spine AROM Passive shoulder (PROM) done supine for more patient relaxation Flexion to 110° ER/IR in scapular plane < 30° Educate patient on posture, joint protection, importance of brace/sling, pain medication use early, hygiene Cryotherapy for pain and inflammation Day 1-3: as much as possible (20 min/hour)
Day 4-7: post activity, or as needed for pain Days 7-42 Continue use of abduction sling/brace until the end of week 6. Pendulum exercises Begin PROM to tolerance (supine, and pain-free) May use heat prior to ROM Flexion to tolerance ER in scapular plane >/= 30° IR in scapular plane to body/chest Gentle scapular plane abduction: begin 0-30° and progress to 0-90° by end of week 7. Continue elbow, hand, forearm, wrist and finger AROM Begin resisted isometrics/isotonics for elbow, hand, forearm, wrist and fingers Begin scapula muscle isometrics/sets, AROM Cryotherapy as needed for pain control and inflammation May begin gentle general conditioning program (walking, stationary bike) with caution if unstable from pain medications No running/jogging No passive pulley exercise Aquatherapy may begin approximately 6 weeks post operative if wounds healed Criteria for progression to next phase (II) Passive forward flexion to >/= 125° Passive ER in scapular plane to >/= 60° (if uninvolved shoulder PROM > 80°) Passive IR in scapular plane to >/= 60° (if uninvolved shoulder PROM > 80°) Passive abduction in scapular plane to >/= 90°
Phase II: Protection and Protected Active Motion Phase (Weeks 7 to 12) Goals Allow healing of soft tissue Do not overstress healing soft tissue Gradually restore full passive ROM (~ week 8) Decrease pain and inflammation Precautions No lifting No supported full body weight with hands or arms No sudden jerking motions No excessive behind back motions No bike or upper extremity ergometer until week 8 Weeks 7-9 Continue with full time use of sling/brace until end of week 6 Gradually wean from brace starting several hours/day out progressing as tolerated Use brace sling for comfort only until full DC by end of week 7 Initiate AAROM shoulder flexion from supine position week 6-7 Progressive PROM until full PROM by week 8 (should be pain-free) May require use of heat prior to ROM exercises/joint mobilization Can begin passive pulley use May require gentle glenohumeral or scapular joint mobilization as indicated to obtain full unrestricted ROM
Initiate prone rowing to a neutral arm position Continue cryotherapy as needed post therapy/exercise Weeks 9-12 Continue AROM, AAROM, and stretching as needed Begin IR stretching, shoulder extension, and cross body, sleeper stretch to mobilize posterior capsule (if needed) Begin gentle rotator cuff submaximal isometrics (7-8 weeks) Begin glenohumeral submaximal rhythmic stabilization exercises in “balance position (90-100º of elevation) in supine position to initiate dynamic stabilization Continue periscapular exercises progressing to manual resistance to all planes Seated press-ups Initiate AROM exercises (flexion, scapular plane, abduction, ER, IR) (should be pain-free) low weight – initially only weight of arm Do not allow shrug during AROM exercises If shrug exists continue to work on cuff and do not reach/lift AROM over 90° elevation Initiate limited strengthening program *Remember RTC and scapular muscles small and need endurance more than pure strength ER and IR with exercise bands/sport cord/tubing ER isotonic exercises in side lying (low-weight, high-repetition) may simply start with weight of arm Elbow flexion and extension isotonics Criteria for progression to Phase III Full AROM
Phase III: Early Strengthening (Weeks 12-18) Goals Full AROM (weeks 12-14) Maintain full PROM Dynamic shoulder stability (GH and ST) Gradual restoration of GH and scapular strength, power and endurance Optimize neuromuscular control Gradual return to functional activities Precautions No lifting objects > 5 lbs, no sudden lifting or pushing Exercise should not be painful Week 12 Continue stretching, joint mobilization, and PROM exercises as needed Dynamic strengthening exercises Initiate strengthening program Continue exercises as above weeks 7-12 Scapular plane elevation to 90° (patient must be able to elevate arm without shoulder or scapular hiking before initiating isotonic exercises. If unable then continue cuff/scapular exercises) Full can (no empty can abduction exercises) Prone rowing Prone extension Prone horizontal abduction
Week 14 Continue all exercise listed above May begin BodyBlade, Flexbar, Boing below 45º Begin light isometrics in 90/90 or higher supine, PNF D2 flexion/extension patterns against light manual resistance Initiate light functional activities as tolerated Week 16 Continue all exercises listed above Progress to fundamental exercises (bench press, shoulder press) Initiate low level plyometrics (2-handed, below chest level – progressing to overhead and finally 1handed drills) Criteria for progression to Phase IV Ability to tolerate progression to low-level functional activities Demonstrate return of strength/dynamic shoulder stability Reestablishment of dynamic shoulder stability Demonstrated adequate strength and dynamic stability for progression to more demanding work and sportspecific activities
Phase IV: Advanced Strengthening Phases (Weeks 18-24) Goals Maintain full non-painful AROM Advanced conditioning exercise for enhanced functional and sports specific use Improve muscular strength, power and endurance Gradual return to all functional activities Week 18 Continue ROM and self-capsular stretching for ROM maintenance Continue progressive strengthening Advanced proprioceptive, neuromuscular activities Light isotonic strengthening in 90/90 position Initiation of light sports (golf chipping/putting, tennis ground strokes) if satisfactory clinical exam Week 24 Continue strengthening and stretching Continue joint mobilization and stretching if motion is tight Initiate interval sports program (eg, golf, doubles tennis) if appropriate