The patient may experience shoulder pain with specific motions, weakness, stiffness and loss of motion. Size and location of tear degree of shoulder instabilitylaxity prior to surgery acute versus chronic condition. This article contains details about these and other surgical treatments commonly used for rotator cuff tears. Move into available range, painfree and as tolerated at least 0 90. Arthroscopic rotator cuff repair guys and st thomas. This is because the articular surface of the round humeral head is approximately four times greater than that of the. Rotator cuff repair protocol south shore orthopedics. Oct 24, 2008 the patients characteristics and indications for surgery were not described in a majority of clinical outcome studies of rotator cuff repair.
These will let him see which parts of your rotator cuff are damaged and how best to fix them. Shoulder rotator cuff repair oxford university hospitals. It is evident that a successful outcome after surgical rotator cuff repair is as much dependent on surgical technique as it is on rehabilitation. Many surgeries are done without general anesthesia.
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. Paynes post operative instructions after arthroscopic rotator cuff repair. The ball, or head, of your upper arm bone fits into a shallow socket in your shoulder blade. Prevention and management of stiffness after arthroscopic rotator cuff repair. Double row fixation has been shown to better restore the normal rotator cuff footprint, maximize tendonbone contact, and minimize gapping with early. Rotator cuff repair a rotator cuff repair is designed to improve pain and function in cases of rotator cuff tears. 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. The 4 tendons come together to hold the end of the upper arm in the shoulder socket. In addition, few studies have evaluated the clinical results of contemporary revision arthroscopic rotator cuff repair15.
This protocol is designed for the patient following arthroscopic rotator cuff repair. This may be performed arthroscopically or through open surgery, using sutures and bone anchors. Our metaanalysis indicated that early motion after arthroscopic rotator cuff repair resulted in a significantly greater recovery of external rotation from preoperation to 3, 6, and 12 months. For this reason the shoulder is the most mobile joint in the body. It is important for these factors to be considered and reported because, without this information, the reasons for and results of rotator cuff repair are difficult to interpret. Arthroscopic rotator cuff repair results shoulderdoc by. Many different factors influence the postoperative rotator cuff repair rehabilitation outcome, including rotator cuff tear size, type of repair, tissue quality, number of. Rotator cuff repair greenlane rotator cuff tear shoulder. Rotator cuff repair is the surgery used to repair a tear in one of these tendons.
Progress to your normal diet as tolerated as long as you are not nauseated. Double row fixation has been shown to better restore the normal rotator cuff footprint, maximize tendonbone contact, and minimize gapping with early rom. Rotator cuff repair and rehabilitation surgical indications and considerations anatomical considerations. Patient to do home exercises given postop p endulums, elbow rom, wrist rom, grip. Arthroscopic repair is often used for patients with small to mediumsized tears about 3 cm or smaller. 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 information booklet has been produced to help you gain the maximum benefit after your operation. The rotator cuff is made up of the tendons of the 4 muscles of the rotator cuff. The ultrasling is to be worn for 6 weeks, following rotator cuff repair. Symptoms of rotator cuff injuries people of all ages injure their rotator cuffs. The rotator cuff is a group of 4 muscles that work together to move the shoulder. It is an outpatient procedure and the least invasive of the three rotator cuff repair options.
It should be stressed that this is only a protocol and should not be a substitute for clinical decision making regarding a patients progression. Rotator cuff repair protocol shoreline orthopaedics. Rotator cuff repair can require a long recovery period, especially if the tear was large. A rotator cuff repair involves stitching the torn tendon back onto its attachment to the arm bone humerus. You may resume clear liquids and light foods after surgery jello, soup, etc. The rotator cuff muscles are responsible for both motion of the shoulder and stabilising the ball in the socket joint during shoulder. Your shoulder will be quite stiff and sore for the first few days. Rotator cuff repair the following is a protocol for postoperative patients following rotator cuff repair. Rotator cuff repair protocol this rehabilitation protocol has been developed for the patient following a rotator cuff surgical procedure. Paff, do orthopaedic surgeon upper extremity specialist 370 n 120th ave holland, mi 49424 p 616. Type one rotator cuff repair arthroscopic or miniopen small tear less than 1 cm i. See decompression surgery for shoulder impingement.
The american society of shoulder and elbow therapists. The aim of this study was to audit the results of arthroscopic rotator cuff repair by the senior surgeon lennard funk and to analyse the results to ascertain whether there are any significant predictors of outcome of repair, such as age, sex, tear size, preoperative tissue quality and tendon retraction. Before suggesting the operation, your doctor will have considered that the benefits of the procedure outweigh any disadvantages. Rotator cuff repair what is the rotator cuff and what does it do. Shawn hennigan, md rotator cuff repair rehabilitation protocol. Phase i immediate postoperative phase weeks 0 6 days 014 patient is seen 2 days postoperative to remove surgical dressings and pain catheter. Those patients with poor rotator cuff tissue integrity, tear of 2. 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 812 weeks. The rotator cuff complex is comprised of four tendons from four muscles.
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. Alaia, md assistant professor of orthopaedics division of sports medicine tel. Arthroscopic rotator cuff repair protocol medium to large. Strengthening of rotator cuff at week 12 if full painfree arom this protocol provides the clinician with general guidelines for the rehabilitation of the patient undergoing arthroscopic, miniopen or open repair of a large or massive rotator cuff tear.
Arthroscopic rotator cuff repair shoulderdoc by prof. Rehabilitation program following rotator cuff repair 3 use of the ultrasling the ultrasling is designed to keep your operated shoulder in a comfortable position, away from your body, after your surgery. Standard open or arthroscopic rotator cuff repair protocol. Indications for surgery in clinical outcome studies of. This evidencebased large to massive rotator cuff repair physical therapy guideline is criterionbased.
Surgery to repair a torn rotator cuff is often successful in relieving pain in the shoulder. Rotator cuff isometrics submaximal initiate light strengthening for internal rotation, external rotation and extension when full arom is achieved modalities prn pool therapy prn 1216 weeks arom at 12 weeks for large tears initiate deltoid and supraspinatus strengthening, progress strengthening program. Those patients who have good rotator cuff tissue integrity, a one to two tendon repair, with a tear 3 centimeters or less will typically be progressed on the quicker end of these time frames. Rehabilitation protocol for rotator cuff repair massachusetts. Huges and others published s10 pattern and time phase of shoulder function and power recovery after arthroscopic rotator cuff repair find, read and cite all the. When you can return to work or play sports depends on the surgery that was done. This protocol will vary in length and aggressiveness depending on factors such as.
In order to diagnose impingement or a rotator cuff tear, dr. Arthroscopic rotator cuff repair is commonly performed and is generally a safe procedure. Most rotator cuff tears can be repaired surgically by reattaching the torn tendons to the humerus. Rotator cuff repair brisbane knee and shoulder clinic. 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. S10 pattern and time phase of shoulder function and power. Showering is allowed once dressings and catheter is removed. Rotator cuff repair adopted 298, revised 704, revised 1108 1 general principles. The socket portion of the joint is not naturally deep. Victoria bc v8z 0b9 tel 250 940 4444 fax 250 385 9600 page 1 june 2017 v1s. Specific changes in the program will be made by the physician as appropriate for an individual patient.
Arthroscopic large to massive rotator cuff repair postoperative protocol greater than 5 cm phase one maximum protection phase week 06 a week 04 1 brace or sling with activity and sleeping 2 pendulum exercises gentle 3 prom to tolerance in all shoulder motions shoulder flexion erir 4 elbow rom 5 hand gripping exercises. Arthroscopic rotator cuff repair protocol brigham and womens. Surgery to repair a torn rotator cuff most often involves reattaching the tendon to the head of humerus upper arm bone. Paynes post operative instructions after arthroscopic. The primary goal of this protocol is to protect the repair while steadily progressing towards and ultimately achieving preinjury level of activity. The procedure may not always return strength to the shoulder. If initial nonsurgical treatment of a rotator cuff tear fails, surgical repair is often the next line of treatment.
Shawn hennigan, md rotator cuff repair rehabilitation protocol the following document is an evidencebased protocol for arthroscopic rotator cuff repair rehabilitation. The procedure involves stitching the torn tendon back onto its attachment to the humerus. Rehabilitation guidelines for type i and type ii rotator cuff. A partial tear, however, may need only a trimming or smoothing procedure called a debridement. Complete ruptures usually require surgery if your goal is to return your shoulder to optimal function. These tendons surround and attach onto the ball humeral head of the ball and socket shoulder joint. If you have any questions regarding the progress of the patient, the physician should be contacted. Rotator cuff tear there are two main causes of rotator cuff tears chronic irritation and impingement discussed above, and acute trauma, such as an injury or a fall. 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. After making one or two very small cuts in your skin, a surgeon will insert a tiny camera called an arthroscope and special, thin tools into your shoulder. 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 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. The intent of this protocol is to provide the clinician with a guideline of the post operative rehabilitation course of a. Arthroscopic rotator cuff repair frequently asked questions. 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.
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