Rehabilitation guidelines for type i and type ii rotator cuff. A small size rotator cuff tear is defined as a tear rotator. The rotator cuff is a group of tendons and muscles in your shoulder. The rotator cuff is an integral part of the anatomy of the shoulder. Clinical practice guidelines for the management of rotator. 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. Prolonged exercise rehabilitation and nonoperative treatment should be considered in patients with rotator cuff tendinopathies, partialthickness tears, and potentially small fullthickness tears, due to the limited risk for irreversible, chronic rotator cuff changes. It is essential that he or she follow this rehabilitation program very closely. The authors protocol of choice, used within a large sports medicine rehabilitation center, is presented and the rationale behind its implementation is discussed. A large size rotator cuff tear is defined as a tear 35cm, massive 5cm.
The intent of this protocol is to provide the clinician with a. For this reason the shoulder is the most mobile joint in the body. 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. 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. Verma or either physician assistant supersede the instructions below and should be followed. General time frames are given for reference to the average, but individual patients will progress at.
Whether nonsurgical or surgical, successful management of rotator cuff disease is dependent on appropriate rehabilitation. Rotator cuff repair postoperative rehabilitation protocol. Horizontal rows secure theraband around a stable object, like a pole patient can either kneel or stand. Rotator cuff repair protocol boston shoulder institute. 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. This process alone can lead to rotator cuff tears in older patients. The rotator cuff is made up of four muscles supraspinatus. The rotator cuff controls the shoulders movement and helps keep it stable.
A physiotherapist should be consulted throughout to teach and individually modify the exercises. Jan 19, 20 one of the primary conditions targeted in rehabilitation of the shoulder is rotator cuff injury. Abduction bracesling, remove sling only to bathe and to complete exercises. Rehabilitation of shoulder impingement syndrome and. The socket portion of the joint is not naturally deep. We have remained at the forefront of medicine by fostering a culture of collaboration, pushing the boundaries of medical research, educating the brightest medical minds and maintaining an unwavering commitment to the diverse communities we serve. Rotator cuff rc disease is a frequent cause of shoulder pain and can result in weakness, alterations in glenohumeral kinematics, and shoulder instability in some circumstances.
Quality of tissue and integrity of repair2 stronger tissue if rehabilitation for the patient with good or adequate tissue would be a. Exercises your kaiser permanente care instructions here are some examples of typical rehabilitation exercises for your condition. Rehabilitation of the shoulder following rotator cuff injury or surgery clive brewster, ms, rpt diane r. Rotator cuff repair large to massive 5cm rehabilitation. Moynes schwab, ms, rpt2 r otator cuff injuries oc cur because of mechan ical abrasion within a decreased glenohu meral joint space. How ever, the most frequent cause in an active young adult is. Rotator cuff and shoulder rehabilitation exercises. Rehabilitation protocol for small to moderate rotator cuff tear. However, a comprehensive approach aimed at identifying all possible. An acute or overuse injury may cause the rotator cuff to be injured and varying widths of tears may cause increased pain and dysfunction of the shoulder joint. The rotator cuff is a synthesis of the capsule of the glenohumeral joint with the ten dons of the subscapularis, supraspinatus, infraspinatus, and teres minor muscles fig. Rehabilitation protocol for rotator cuff repair this protocol is intended to guide clinicians and patients through the postoperative course of a rotator cuff repair. Talk to your doctor or physical therapist about which exercises will best help you meet your rehabilitation goals. Your surgeon will advise when you should start physiotherapy at your first followup appointment.
Rotator cuff and shoulder rehabilitation exercises orthoinfo aaos. No resisted rotator cuff strengthening exercises until weeks patients this protocol should be used as a guide during your rehabilitation after surgery. This shoulder rehabilitation program focuses on strengthening the muscles that support your shoulder to help keep your shoulder joint stable, relieve pain and. 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. An evaluationbased approach abstract rotator cuff disease of the shoulder, a common condition, is often incapacitating. Conservative rotator cuff tear protocol sports and ortho. The rotator cuff is comprised of four muscles and tendons that surround the top of the upper arm bone humerus and functions to help rotate the arm and stabilize the shoulder joint. Most protocols are implemented under the pretense of treating areas local to the site of symptoms. Eleven randomized, controlled trials level 1 and 2 evaluating the effect of exercise in the treatment of impingement were identified. Exercises you can do at home exercises are a very important part of treatment for a rotator cuff disorder. Brace abduction bracesling, remove sling only to bathe and to complete exercises.
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. Rehabilitation guidelines for type i and type ii rotator. Rotator cuff repair small to medium rehabilitation guideline this rehabilitation program is designed to return the individual to their activities as quickly and safely as possible. Avoid provocative maneuvers or exercises that cause discomfort o includes both offending rom exercises and strengthening exercises. Exercises and physical therapy for rotator cuff tear. Your doctor or physical therapist will tell you when you can start these exercises and which ones will work best for you. Patients over 50 years of age are more susceptible to sustaining a significant rotator cuff tear from trauma. Arthroscopic rotator cuff repair frequently asked questions. How ever, the most frequent cause in an active young adult is excessive ante. Rotator cuff repair large to massive 5cm rehabilitation guideline this rehabilitation program is designed to return the individual to their activities as quickly and safely as possible. Rotator cuff sprain and strains university of california.
The rotator cuff is responsible for stabilization and active movement of the glenohumeral joint. Strengthening all exercises painfree rom only 3xweek max. The rotator cuff is made up of muscles and tendons that support the shoulder joint. Summary table post op phasegoals range of motion therapeutic exercise precautions days 1 7 wear sling during the day and at night remove sling for showeringbathing remove sling 4 to 5 times per day for gentle elbow, forearm, wrist and finger exercises. Most rotator cuff tears can be repaired surgically by reattaching the torn tendons to the humerus. The rotator cuff is made up of four muscles supraspinatus, infraspinatus, subscapularis, and teres minor and their tendons. The conservative rehabilitation protocol allows sharpey fibers to form before stressing the repair with resistive exercises. If initial nonsurgical treatment of a rotator cuff tear fails, surgical repair is often the next line of treatment. This protocol is designed for the patient following arthroscopic rotator cuff repair. The rotator cuff is a group of four muscles that surround the shoulder joint, like a cuff, and work together to. Sling immobilization with supporting abduction pillow to be worn at all times except for showering and rehab under guidance of pt. Chloe wilson bsc hons physiotherapy rotator cuff injury exercises aim to restore strength and flexibility to the shoulder.
Clinical guidelines for cpm following rotator cuff repair. The best rotator cuff exercises and stretches medical news today. Rehabilitation of shoulder impingement syndrome and rotator cuff injuries. Modifications to this guideline may be necessary dependent on physician. The conservative approach may be associated with postoperative stiffness which can be managed once healing has occurred. The deltoid muscle is separated to expose the torn rotator cuff tendons. Arthroscopic and open rotator cuff repair rehabilitation protocol week 1 2 shoulder sling and swathe full time day and night.
Multiple nonoperative rehabilitation protocols have been described for the treatment of the spectrum of rotator cuff injury. Rehabilitation of the shoulder following rotator cuff injury. Victoria bc v8z 0b9 tel 250 940 4444 fax 250 385 9600 page 1 june 2017 v1s. All of the exercises should be performed with slow and controlled motion. Rotator cuff repair postoperative rehabilitation protocol orthoindy. Conservative rotator cuff tear protocol sports and orthopedic. 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. A rotator cuff tear may result suddenly from a single traumatic event or develop gradually over time. Begin with 510 repetitions, advancing to 30 repetitions as able. It is designed for rehabilitation following large to massive rotator cuff repairs. These exercises are intended for the initial strengthening of acute shoulder problems, andor longterm rehabilitation for massive rotator cuff tears and other conditions resulting in longterm severe weakness. It is designed for rehabilitation following small to medium rotator cuff repairs. Rotator cuff and shoulder conditioning program orthoinfo aaos.
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. Rotator cuff repair small to medium rehabilitation guideline. Rotator cuff repair protocol south shore orthopedics. Postoperative rehabilitation guidelines 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 consider exam findings and clinical decision making. Postoperative rehabilitation guidelines for rotator cuff tears please note that these instructions are general guidelines to be followed. Department of rehabilitation services physical therapy arthroscopic rotator cuff repair protocol. Synchronized or isolated protocol the primary goal of postsurgical rehabilitation following rotator cuff repair is to control pain, protect repaired tissue during the healing process, restore function, improve rangeofmotion, restore strength and prevent a.
Rotator cuff tears can be classified in various ways. Rom 1 codmanspendulum bend over chairtable, hang affected arm straight. Postoperative rotator cuff repair rehabilitation protocol. 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. Exercise in the treatment of rotator cuff impingement.
Those patients with poor rotator cuff tissue integrity, tear of 2. Start against gravity and gradually progress with weights. 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. This rehabilitation program has been distilled from seven level 1 or level 2 randomized controlled trials that demonstrate benefits from physical therapy for treating rotator cuff pain. 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 first classification is a partial thickness or. A comprehensive approach to nonoperative rotator cuff. Stretching and strengthening the muscles of the shoulder and scapula. The joint is a ball joint formed by the head of the humerus arm bone fitting into the socket of the scapula shoulder blade.
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