Type ii rotator cuff repair protocol medical staff. The rotator cuff muscles are those muscles that surround the shoulder joint. Type ii rotator cuff repair protocol arthroscopic tears for large to massive tears 5 cm joseph r. These include age, gender, rangeofmotion, weakness in forward elevation, tear size, and workers.
It is evident that a successful outcome after surgical rotator cuff repair is as much dependent on surgical technique as it is on rehabilitation. While patients often benefit from rotator cuff repair, anatomic failure of the repair is not unusual. Evidence from two or more high quality studies with consistent findings for recommending. Keep the abductor pillow in for the 4 weeks as well. When you can return to work or play sports depends on the surgery that was done. 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. In fact, some rotator cuff tears will increase in size if. 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.
Indications for rotator cuff repair have been defined from the physicians perspective. Rotator cuff repair the physical therapy rehabilitation for rotator cuff repair will vary in length depending on degree of instability, acute versus chronic condition, strengthrom status, and activity demands. See decompression surgery for shoulder impingement. Rotator cuff tears are common causes of shoulder weakness and pain that can often be improved by expert shoulder surgery. Complete ruptures usually require surgery if your goal is to return your shoulder to optimal function.
It is an outpatient procedure and the least invasive of the three rotator cuff repair options. Rotator cuff repair rehab protocol concord orthopaedics. 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. Many different factors influence the postoperative rotator cuff repair rehabilitation outcome, including rotator cuff tear size, type of repair, tissue quality, number of. Rehabilitation guidelines for type i and type ii rotator cuff. Rotator cuff repair protocol boston shoulder institute. If initial nonsurgical treatment of a rotator cuff tear fails, surgical repair is often the next line of treatment. 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. Omearas rotator cuff repair rehabilitation protocol. Rotator cuff repair most rotator cuff tears can be repaired surgically by reattaching the torn tendons to the humerus. These muscles and tendons hold the arm in its ball and socket joint and are involved in essentially all shoulder motions. Patient notes rotator cuff repair you have elected to undergo an operation to repair the rotator cuff of your shoulder, which has a full thickness tear.
They attach from the shoulder blade onto the top of the arm bone. Arthroscopic rotator cuff repair guys and st thomas. Repair of rotator cuff tears uw orthopaedics and sports. The suturesanchors hold the tendons so they can heal back to the bone.
This protocol is designed for the patient following arthroscopic rotator cuff repair. In rotator cuff repair surgery one or more of these muscles are reattached to the bone using anchorssutures. Talk to your doctor or physical therapist about which exercises will. No arom exercise of the shoulder consistent use of sling unless otherwise instructed weaning starting at week 4 at earliest. Rotator cuff repair a rotator cuff repair is designed to improve pain and function in cases of rotator cuff tears. Arthroscopic rotator cuff repair with the elite shoulder system. Improvements in strength come slowly takes 1 year to end result 3. Once you are under a general anaesthetic the torn muscles are repaired using sutures or suture anchors depending on the type of damage. This is because the articular surface of the round humeral head is approximately four times greater than that of the. Most rotator cuff tears can be repaired surgically by reattaching the torn tendons to the humerus. With rapidly advancing surgical techniques and modes of fixation, optimal rehabilitation following rotator cuff surgical repair has become increasingly important. Jses 2004 84% vs 30% rehabilitation following rotator cuff repair introduction whats the concern about early. Rotator cuff repair what is the rotator cuff and what does it do.
The rotator cuff complex is comprised of four tendons from four muscles. Brace abduction bracesling, remove sling only to bathe and to complete exercises. Whether nonsurgical or surgical, successful management of. Rotator cuff repair rehab protocol physical therapy referral peter g. It is no means intended to be a substitute for ones. 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. Rotator cuff and shoulder rehabilitation exercises. Rehabilitation protocol for rotator cuff repair massachusetts. A rotator cuff repair involves stitching the torn tendon back onto its attachment to the arm bone humerus. Pdf rotator cuff tears are the most common musculoskeletal injury occurring in the shoulder. Full thickness rotator cuff tears are rarely seen in those younger than 40 years of age. 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.
Surgery to repair a torn rotator cuff most often involves reattaching the tendon to the humerus. It is not intended to be a substitute for clinical decision. Pdf background rotator cuff tears are a very common condition that is often incapacitating. To ensure that this program is safe and effective for you, it should be performed under your doctors supervision. There is a need for welldesigned level i and level ii trials to elucidate the optimal rotator cuff repair rehabilitation protocol.
Symptoms of rotator cuff injuries people of all ages injure their rotator cuffs. The procedure involves stitching the torn tendon back onto its attachment to the humerus. The ultrasling is to be worn for 6 weeks, following rotator cuff repair. Before suggesting the operation, your doctor will have considered that the benefits of the procedure outweigh any disadvantages. This article contains details about these and other surgical treatments commonly used for rotator cuff tears. It is prone to injury, but doing specific exercises can help prevent this. Specific interventions should be based on the needs of the individual and should.
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. These tears should be repaired if the patient has pain and weakness that interferes with their lifestyle. Rotator cuff repair adopted 298, revised 704, revised 1108 1 general principles. The rotator cuff is a group of muscles and tendons that form a cuff over the shoulder.
The ball, or head, of your upper arm bone fits into a shallow socket in your shoulder blade. 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. Specific interventions should be based on the needs of the individual and should consider exam findings and clinical decision making. Those patients with poor rotator cuff tissue integrity, tear of 2. Stiffness can occur after rotator cuff repair and can at times require further surgery in order to regain motion. This protocol was designed to provide the rehabilitation professional with a guideline of postoperative care. Distal rom with scapular retraction manual scapular manipulation with patient lying on nonoperative side supine passive ff in scapular plane to 90 supine passive er to 0. Pdf rotator cuff tear has been a known entity for orthopaedic surgeons for more than two hundred years. Rotator cuff repair and rehabilitation surgical indications and considerations anatomical considerations. Augmentation of rotator cuff repair with soft tissue scaffolds.
Rotator cuff repair the following is a protocol for postoperative patients following rotator cuff repair. Rehabilitation guidelines for type i and type ii rotator. Phase 1 initial 3 weeks postsurgery patient is immobilized for initial 3 weeks. Rotator cuff repair can require a long recovery period, especially if the tear was large. If you have any questions regarding the progress of the patient, the physician should be contacted. On the other hand, 25% of all individuals over the age of 60 have a rotator cuff tear. 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.
Arthroscopic rotator cuff repair is commonly performed and is generally a safe procedure. Sling usedriving do not attempt to lift the operative arm without assistance or use the muscles in the operative shoulder i. Infection after shoulder arthroscopy is rare but does occur. 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. 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. The socket portion of the joint is not naturally deep. A partial tear, however, may need only a trimming or smoothing procedure called a debridement. Small 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. Rotator cuff repair page 4 page 5 rotator cuff repair the rotator cuff the rotator cuff is a group of muscles closely wrapped around the shoulder. Unlike open repair, arthroscopic surgery involves small incisions, each about a centimeter long. If it happens, there is often a need for further surgery to eradicate the infection and it can require up to 6 weeks of iv antibiotics. 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. Surgery to repair a torn rotator cuff is often successful in relieving pain in the shoulder.
Jun 10, 2015 rotator cuff tears affect 30% to 50% of patients older than 50 years and are a common cause of functionlimiting pain and weakness of the shoulder. The principles, techniques, and instrumentation have evolved to the extent that all patterns and sizes of rotator cuff tear, including massive tears, can now be. 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. Purpose of the abductor pillow is to keep tension off of the repair, avoid adduction. Weather ache for 1 2 years is common after rc repair 2. Rehabilitation following rotator cuff repair keys to success rehabilitation following cuff repair maximizing tendon healing biomechanical factors biologic factors patient factors effect of smoking on rotator cuff repairs mallon et al. Specific changes in the program will be made by the physician as appropriate for an individual patient. Arthroscopic repair is often used for patients with small to mediumsized tears about 3 cm or smaller. A smoothing of the subacromial arch subacromial decompression is done at the same. Sling x 6 weeks ultrasling x 46 weeks, larger tears may be in ultrasling x 6 weeks then.
However, to make an informed decision and give your. 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. Arthroscopic and open rotator cuff repair rehabilitation protocol week 1 2 shoulder sling and swathe full time day and night. It should be stressed that this is only a protocol and should not be a substitute for clinical decision making regarding a patients progression. Arthroscopic rotator cuff repair shoulderdoc by prof. The shoulder is a wonderfully complex joint that is made up of the ball and socket connection. Exercises you can do at home exercises are a very important part of treatment for a rotator cuff disorder. Postoperative rotator cuff repair rehabilitation protocol. These muscles help keep the joint in the correct position and control shoulder movements. In order to diagnose impingement or a rotator cuff tear, dr. Their job is to provide the power to lift and rotate.
A surgeon experienced in shoulder surgery can repair a rotator cuff tear if there is enough good quality tendon tissue. A torn rotator cuff is a common injury that affects a persons ability to lift and rotate their arm. The rotator cuff can also wear out as a result of degenerative changes. This has been demonstrated by an arthrogram or an m. Open, miniopen, and allarthroscopic rotator cuff repair. To identify the published evidence on the factors associated with retears and with suboptimal clinical outcomes of rotator cuff repairs.
This is an enhanced pdf from the journal of bone and joint surgery. Rotator cuff repair brisbane knee and shoulder clinic. Victoria bc v8z 0b9 tel 250 940 4444 fax 250 385 9600 page 1 june 2017 v1s. Arthroscopic rotator cuff repair frequently asked questions. This may be performed arthroscopically or through open surgery, using sutures and bone anchors. The conservative approach may be associated with postoperative stiffness which can be managed once healing has occurred. According to the american academy of orthopaedic surgeons, an estimated 2 million people in. Rotator cuff repair postoperative rehabilitation protocol.
Pdf rehabilitation after rotator cuff repair researchgate. Return of strength is variable with massive tears 4. Rotator cuff tears do not heal, or repair themselves. The intent of this protocol is to provide the clinician with a guideline of the post operative rehabilitation course of a. Rotator cuff repair is the surgery used to repair a tear in one of these tendons. The operation aims to repair the damage to the torn muscles. If biceps tenodesis was performed no biceps strengthening until 8 weeks postop frequency. The primary goal of this protocol is to protect the repair while steadily progressing towards and ultimately achieving preinjury level of activity. The rotator cuff is an integral part of the anatomy of the shoulder.
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 procedure may not always return strength to the shoulder. The patient may experience shoulder pain with specific motions, weakness, stiffness and loss of motion. 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. For this reason the shoulder is the most mobile joint in the body.
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