This is because the articular surface of the round humeral head is approximately four times greater than that of the. Clinical practice guidelines for the management of rotator cuff syndrome in the workplace the university of new south wales, medicine, rural clinical school, port macquarie campus 20 research team. Your doctor or physical therapist will tell you when you can start these exercises and which ones will work best for you. None stepbystep directions lean forward and place one hand on a counter or table for support. The rotator cuff is a group of muscles and tendons, which hold the glenohumeral joint together and help lift the arm overhead, such as throwing a ball or swimming. The rotator cuff is a combination of muscles and tendons that link your upper arm bone, the humerus, to your shoulder blades. The rotator cuff is made up of four muscles supraspinatus, infraspinatus, subscapularis, and teres minor and their tendons. One of the primary conditions targeted in rehabilitation of the shoulder is rotator cuff injury. Rotator cuff exercises are important to prevent and treat injuries. Rotator cuff strengthening with resistive bands start by placing a towel roll under the involved arm. Multiple nonoperative rehabilitation protocols have been described for the treatment of the spectrum of rotator cuff injury. This stage includes 57 weeks postsurgical of a rotator cuff repair.
Rehabilitation protocol for rotator cuff repair this protocol is intended to guide clinicians and patients through the postoperative course of a rotator cuff repair. Regarding therapist assisted manual prom in the scapular and sagittal planes. Rehabilitation introduction rotator cuff pathology is a common cause of shoulder pain, weakness, limitations to daily activity, and time off from work 1,2. Rotator cuff surgery arthroscopic recovery and rehabilitation protocol phase 1. Rotator cuff sprain and strains university of california. Brace abduction bracesling, remove sling only to bathe and to complete exercises. The level i and ii evidence for rotator cuff repair rehabilitation is exceedingly small. Shawn hennigan, md rotator cuff repair rehabilitation protocol the following document is an evidencebased protocol for arthroscopic rotator cuff repair rehabilitation. Rehabilitation of shoulder impingement syndrome and rotator. Rotator cuff tendonitisimpingement rehabilitation protocol. This evidencebased small to medium rotator cuff repair physical therapy guideline is criterionbased.
Rehabilitation, arthroscopic rotator cuff repair, shoulder, scientific. Whether nonsurgical or surgical, successful management of rotator cuff disease is dependent on appropriate rehabilitation. Jan 19, 20 one of the primary conditions targeted in rehabilitation of the shoulder is rotator cuff injury. The patient successfully underwent an arthroscopic rotator cuff repair using suture anchors. Rotator cuff and shoulder conditioning program orthoinfo aaos. Rehabilitation exercises for rotator cuff tears, tendonitis and impingement syndrome after an injury or surgery an exercise conditioning program will help you return to daily activities and enjoy a more active, healthy lifestyle. Rotator cuff and shoulder rehabilitation exercises. The rotator cuff is then repaired directly to the bone with a. Rotator cuff tearsurgery rehabilitation exercise program. The protocol is both chronologically and criterion based for advancement through four postoperative phases. Most rotator cuff tears can be repaired surgically by reattaching the torn tendons to the humerus. Deltoids, supraspinatus, infraspinatus, subscapularis equipment needed. Strengthen deltoid, rotator cuff and scapular stabilizers. Rehabilitation guidelines for type i and type ii rotator cuff.
Manual therapy and exercise for rotator cuff disease page, mj. No resisted rotator cuff strengthening exercises until weeks patients this protocol should be used as a guide during your rehabilitation after surgery. May 01, 2017 they help power and stabilize your arm and shoulder movements. Pdf background rotator cuff tears are a very common condition that is often.
Physical therapy and rehabilitation after rotator cuff repair. Protocol s3 accelerated physical therapy protocol for rotator. Kate hopman2, lee krahe1, sue lukersmith2, alexander mccoll1, kris vine1. The rotator cuff also holds your upper arm bone in place in your. It is not intended to be a substitute for clinical decision. It provides stability and strength for the shoulder joint, anchoring the humerus upper arm bone to the scapula shoulder blade so that movements of the arm can occur in a smooth and coordinated fashion.
The muscles attach at the shoulder blade scapula and extend out to form a cuff around the shoulder joint and insert at the upper. Failure of rehabilitation therapy is common in patients with massive anterior tears or tears involving at least three tendons. 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. If initial nonsurgical treatment of a rotator cuff tear fails, surgical repair is often the next line of treatment. The rotator cuff is made up of four muscles and their tendons. Postoperative rotator cuff repair rehabilitation protocol. Rehabilitation of shoulder impingement syndrome and rotator cuff injuries. The aetiology and pathophysiology are not fully understood.
The rotator cuff is a group of four muscles that stabilize the shoulder and allow it to move. Do these exercises while lying face down on an exercise table or. Whether nonsurgical or surgical, successful management of rotator cuff disease is dependent on appropriate. The term rotator cuff describes four muscletendon units that connect the upper bone of the arm to the shoulder blade. These tears are usually chronic in nature and often involve poor tissue quality with fatty infiltration and muscle atrophy. Rotator cuff repair rehab protocol the stone clinic. Rehabilitation of the shoulder after rotatorcuff repair. This evidencebased large to massive rotator cuff repair physical therapy guideline is criterionbased.
Physical therapist and founder of webpt heidi jannenga says you should visualize the head of the arm bone as a golf ball, and the area of the shoulder blade as a golf tee. 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. Pdf rehabilitation after rotator cuff repair researchgate. Postsurgical outcomes for patients having had rotator cuff repair can be. Establishing muscle speed and muscle power should be the focus of the middle stages of the rehab plan. The muscles attach at the shoulder blade scapula and extend out to form a cuff around the shoulder joint and insert at the upper portion of the arm humerus. Tears or ruptures of these muscles can be caused by trauma, such as a sports injury, a fall or a motor vehicle accident, but they can also be caused by other factors such as. No arom exercise of the shoulder consistent use of sling unless otherwise instructed weaning starting at week 4. Activation during early rehabilitation exercises for postop 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 tendons involved, the quality of tissue and. Accelerated physical therapy protocol for rotator cuff repair arthroscopic or miniopen technique recommended for mild.
Exercise therapy, shoulder pain, rotator cuff, tendinitis. No arom exercise of the shoulder consistent use of sling unless otherwise instructed weaning starting at week 4 at earliest. Sep 16, 2014 3 keys to rotator cuff rehabilitation. Romeo, md, and bernard bach, jr, md normal shoulder function requires a balanced relationship between glenohumeral mobility and glenohumeral stability. In anatomy, the rotator cuff is a group of muscles and their tendons that act to stabilize the. Jses,1994 30 cadavers split supraspinatus into bursal and articular sections histological and mechanical examination results bs tendon in strong longitudinal fibers, as. Regain full passive motion of operated shoulder by 6 weeks.
Arthroscopic rotator cuff repair protocol medium to large. Rom 1 codmanspendulum bend over chairtable, hang affected arm straight. My procedures are generally an arthroscopic evaluation, subacromial bursectomy, or an acromioplasty with miniopen rotator cuff repair. The team at the stone clinic has been repairing rotator cuffs for over twenty years and has progressively improved the techniques. This can cause pain, stiffness, weakness, and further damage. Division of physical therapy, university of new mexico health sciences. A rotator cuff tear of greater than 5 cm is considered a massive tear. Rotator cuff and shoulder conditioning program stretching exercises 1.
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. In my practice, i have had great success focusing on three things with rotator cuff rehabilitation, restore range of motion as close to normal as possible, improve muscle function, and putting the person in a position to succeed which is often the most critical. Treatment for a rotator cuff tear can include rest, ice, physical therapy, andor. 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. A comprehensive approach to nonoperative rotator cuff. Shoulder rotator cuff repair operative rehabilitative protocol. Outcomes of rehabilitation therapy in patients with irreparable massive rotator cuff tears and shoulder pseudoparalysis vary according to the site and number of the tears. Large rotator cuff repair protocol the intent of this protocol is to provide the clinician with instruction, direction, rehabilitative guidelines and functional goals for all rotator cuff repair procedures. The rotator cuff complex is comprised of four tendons from four muscles.
The recovery phase begins when the initial pain and inflammation have gone and most normal daily activities are painfree and the injured arm has at least 75% range of movement compared to the uninjured one. Pdf rotator cuff disease of the shoulder, a common condition. Jul 14, 2012 new yorkjuly 14, 2012 a new hospital for special surgery study suggests that the current rehabilitation used for patients undergoing tendonbone repairs such as rotator cuff surgery may be partially to blame for the high rates of failed healing after surgery. When this happens, you can have tendinitis or a tear in one or more of the tendons. Shawn hennigan, md rotator cuff repair rehabilitation protocol. However, a comprehensive approach aimed at identifying all possible. Patient guide to rotator cuff injuries what is the rotator cuff. 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. Talk to your doctor or physical therapist about which exercises will best help you meet your rehabilitation goals. Clinical practice guidelines for the management of rotator. The prevalence of full thickness tears in the general population is about 20% and markedly increased after the age of 50. Most protocols are implemented under the pretense of treating areas local to the site of symptoms. Rotator cuff repair postoperative rehabilitation protocol. An evaluationbased approach abstract rotator cuff disease of the shoulder, a common condition, is often incapacitating.
The deltoid muscle is separated to expose the torn rotator cuff tendons. Theories for tear evolvement are divided into intrinsic e. Pdf rotator cuff disease of the shoulder, a common condition, is often incapacitating. Is rehabilitation effective in massive rotator cuff tears. The rotator cuff is a sling of four shoulder muscles that act as a functional unit to move the arm and maintain the ball of the shoulder humeral head centered within the socket glenoid. The deltoid is divided in line with the portal site with a small incision. Conservative treatment for rotator cuff tears and other rotator cuff injuries includes treatment to help heal the injured rotator cuff muscle, pain management, education to avoid furtherreinjury, and exercises to restore normal movement to the shoulder and normal strength to both the affected and unaffected muscles of the shoulder and rotator. Shoulder rotator cuff repair operative rehabilitative protocol the physical therapy rehabilitation for rotator cuff repair will vary in length depending on the degree of instability, acute verses. Specific interventions should be based on the needs of the individual and should consider exam findings and clinical decision making.
New yorkjuly 14, 2012 a new hospital for special surgery study suggests that the current rehabilitation used for patients undergoing tendonbone repairs such as rotator cuff surgery may be partially to blame for the high rates of failed healing after surgery. Your surgeon will advise when you should start physiotherapy at your first followup appointment. Rotator cuff rehabilitation protocol scott orthopedic center. These muscles merge into tendons and this muscle structure allows the arm to be lifted and rotated. Rotator cuff bursitis tendonitis rehabilitation protocol.
Rehabilitation of the injured rotator cuff penn shoulder and elbow service penn therapy and fitness penn presbyterian medical center study nakajima et al. It is evident that a successful outcome after surgical rotator cuff repair is as much dependent on surgical technique as it is on rehabilitation. A physiotherapist should be consulted throughout to teach and individually modify the exercises. Study suggests changes in rotator cuff surgery rehabilitation. Exercises your kaiser permanente care instructions here are some examples of typical rehabilitation exercises for your condition. Rotator cuff repair and rehabilitation surgical indications and considerations anatomical considerations. The chronic nature of these tears along with poor underlying quality of the tissue often results in recurrent tears. Rotator cuff tendonitis rehabilitation protocol impingement is a chronic inflammatory process produced as the rotator cuff muscles supraspinatus, infraspinatus, teres major, and subscapularis and the subdeltoid bursa are pinched against the coracoacromial ligament and the anterior acromion when the arm is raised above 90 degrees. Shoulder strengthening exercises for rotator cuff phase ii shoulder strengthening exercises for rotator cuff phase ii the following is your personalized exercise program prescribed by your physical therapist. Management of rotator cuff disease often includes manual therapy and. Performing a formulated conditioning program will als.
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