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. Arthroscopic rotator cuff repair for large cuff tear john cartledge, 2003. Rotator cuff sprain and strains university of california. Postoperative rotator cuff repair rehabilitation protocol. Exercises for rotator cuff repair performance health. Rotator cuff repair phase 1 seated scapular retraction reps. When i talk to patients about rehabilitation, regardless of the joint or procedure. Results of surgery and risks the success of surgery to repair the rotator cuff depends upon the size of the tear and how long ago the tear occurred. Strengthening and repair what are some rotator cuff exercises you can do.
It sets out the rehabilitation required to get an excellent result from your rotator cuff repair surgery with a safe but progressive program. Rotator cuff repair protocol this rehabilitation protocol has been developed for the patient following a rotator cuff surgical procedure. Continue the stretching exercises as needed t o regain or maintain a full range of motion in the shoulder. To ensure that this program is safe and effective for you, it should be performed under your doctors supervision. Are pulley exercises initiated 6 weeks after rotator cuff. The diagram on the right is a 34 side view of the rotator cuff musculature. Pull back so arms are at side of body while pulling your shoulder blades towards each other. After the warmup, do the stretching exercises shown on page 1 before moving on to the strengthening exercises. 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. Arthroscopic rotator cuff repair protocol brigham and womens. The primary goal of this protocol is to protect the repair while steadily progressing towards and ultimately achieving preinjury level of activity. It is essential that you wear the sling day and night for 26 weeks your physiotherapist will advise you. Rotator cuff repair protocol boston sports medicine. 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.
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. No arom exercise of the shoulder consistent use of sling unless otherwise instructed weaning starting at week 4. You should feel this exercise at the back of your shoulder and into your upper back equipment needed. 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. Now also begin to perform rotator cuff strengthening exercises. The rotator cuff is made up of four muscles supraspinatus, infraspinatus, subscapularis, and teres minor and their tendons. For this reason the shoulder is the most mobile joint in the body. Postoperative protocol this rehabilitation protocol has been developed for the patient following a rotator cuff surgical procedure. Due to his selfconfidence in the capability to repair the rotator cuff in a steady fashion, he has been comfortable pressing the rehabilitation program in ways that specifically protect the rotator cuff during the recovery period but allow range of motion and strengthening exercises to be carried out under the careful guidance of the knowledgeable rehab team at clinics. Exercises include pendulums, walkaways, scapular retraction, and more. Rotator cuff exercises strengthening workout stretches for.
Rotator cuff repair arthroscopic this protocol is based on maintaining range of movement in the first phase and then gradually building strength in the middle to the last phase. Generally, they should only be performed provided they do not cause or increase pain. These muscles help keep the joint in the correct position and control shoulder movements. Maximise shoulder strength of deltoid, intact cuff muscles and scapula stabilisers. A randomized controlled trial article in the american journal of sports medicine 44.
Rarely, a large pillow that holds your arm out to the side of your body is needed for 6 weeks if the tear is very large or difficult to repair. Principles of biomechanics, kinesiology, and electromyography will be explained and youll learn how to increase targeted muscle activation, improve scapular muscle activation sequencing, and challenge. When this happens, you can have tendinitis or a tear in one or more of the tendons. Most rotator cuff tears can be repaired surgically by reattaching the torn tendons to the humerus. 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. Do these exercises while lying face down on an exercise table or other sturdy surface where your arm can hang down. Matthew boess rotator cuff repair rehabilitation video series. 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. In november 2003, i injured my left shoulder when i slipped on wooden flooring. A physical therapy program will be initiated within a week after surgery and progress to exercises to strengthen the shoulder and restore motion.
It should be stressed that this is only a protocol and should not be a substitute for clinical decision making regarding a patients progression. Allan hunt phase i 04 weeks educate the patient on selfcarehygiene, supporting shoulder with slingabductor support, warning signs including fever, erythema and excessiveunrelenting pain, use of tens unit ice 35 times per day for 15 minutes each, especially after therapy. Their action is to increase circulation for healing and strengthening muscles with minimal joint irritation. This program outlines the stretches and exercises to undertake during your recovery from rotator cuff repair surgery. Brace abduction bracesling, remove sling only to bathe and to complete exercises. A torn rotator cuff due to an injury is usually best treated by immediate surgical repair. Bedi et al2 reported a recurrence rate of up to 94%. 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. Talk to your doctor or physical therapist if you have. Phase i immediate postoperative phase weeks 0 6 days 014 patient is seen 2 days postoperative to remove surgical dressings and pain catheter. 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 postoperative rehabilitation protocol. 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. Type one rotator cuff repair arthroscopic or miniopen small tear less than 1 cm i. 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. 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. 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. Rotator cuff repair postoperative rehabilitation protocol orthoindy. It is prone to injury, but doing specific exercises can help prevent this. Our goal is performing static holds that are direction specific for the individual rotator cuff muscles. The conservative rehabilitation protocol allows sharpey fibers to form before stressing the repair with resistive exercises. Rotator cuff repair protocol boston shoulder institute.
Your commitment to following the rehabilitation program given to you by your. If you have access to a fitness center, this exercise can also be performed on a weight machine. Rotator cuff exercises are important to prevent and treat injuries. If any of these exercises cause pain, stop performing them and contact our office.
The goal is to use the benefits of aquatic therapy to heal, stay conditioned, and then transition to landbased treatments. The team at the stone clinic has been repairing rotator cuffs for over twenty years and has progressively improved the techniques. A crash course in the anatomy of the rotator cuff will help you understand rotator cuff strengthening and rotator cuff exercises you can remember all the muscles of rotator cuff exercises with the acronym sits. Arthroscopic rotator cuff arc clinical trial rotator cuff home exercise program table of contents general instructions 1 passive motion exercises 2 active assisted range of motion exercises 3 active range of motion exercises 6 isometric exercises 8 resisted exercises 9 rotator cuff strengthening exercises 11 shoulder stretches. Movement gently squeeze your shoulder blades together, relax, and then repeat. You can remove the sling to carry out your exercises and for washing and dressing only. Tear size largemassive tear or 1 tendon repair difficult to achieve full rom, caution with arom and resisted exercises with chroniclarge tears. The following rotator cuff strengthening exercises are designed to improve the strength of the rotator cuff muscles figure 1. Specific interventions should be based on the needs of the individual and should consider exam findings and clinical decision making.
Over the next few weeks my shoulder ached particularly at night which affected my sleep. The intent of this protocol is to provide the clinician with a guideline to establish and progress a patient through post operative rehabilitation. 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. After a rotator cuff repair surgery, patients are required to wear a sling for four weeks. The physician reserves the right to either advance or delay this protocol as deemed necessary. Your doctor or physical therapist will tell you when you can start these exercises and which ones will work best for you. We will be demonstrating and explaining seven evidence based shoulder exercises. It is not intended to be a substitute for ones clinical decision making. When you have completed the strengthening exercises, repeat the stretching exercises to end the program. 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. Global rotator cuff protocol with and without subscapularis repair this protocol is intended to be a general outline only. Exercises your kaiser permanente care instructions here are some examples of typical rehabilitation exercises for your condition. Shoulder external rotation with anchored resistance. Loops ends of clx around hands with palms facing forward, away from body.
Rotator cuff strengthening internal and external rotation isometrics against a wall. Rotator cuff repair adopted 298, revised 704, revised 1108 1 general principles. Rotator cuff repair protocol south shore orthopedics. The rotator cuff is an integral part of the anatomy of the shoulder. Cover any incision that is open or still has a scab with tegoderm to help prevent infection when in the pool. Exercises you can do at home exercises are a very important part of treatment for a rotator cuff disorder. Rehabilitation protocol for small to moderate rotator cuff tear. This pain is usually the sign of a rotator cuff muscle that has been irritated or has succumbed to a slight tear. The intent of this protocol is to provide the therapist and patient with guidelines for the postoperative rehabilitation course after arthroscopic rotator cuff repair. This protocol was designed to provide the rehabilitation professional with a guideline of postoperative care. Isometric exercises are muscle tightening exercises performed with no joint movement. Talk to your doctor or physical therapist about which exercises will best help you meet your rehabilitation goals. This isnt your average rotator cuff and scapula article. Size and location of tear degree of shoulder instabilitylaxity prior to surgery acute versus chronic condition.
Rotator cuff strengthening exercises physioadvisor. The intent of this protocol is to provide the clinician with a. Rubber tubing may be purchased inexpensively at most physical therapy places. It is highly recommended to protect all surgical incisions from infection. 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. This can cause pain, stiffness, weakness, and further damage. Use an elastic stretch band of comfortable resistance. He recommends delaying strengthening until 3 to 4 months postoperatively.
The goal of our phase 3 program for rotator cuff rehabilitation is to start light reconditioning exercises for the rotator cuff muscles. All of the exercises should be performed with slow and controlled motion. This rotator cuff treatment plan includes a stepbystep hydrotherapy progression with exercises from initial evaluation through 26 weeks postop. If you strengthen this region, you can avoid surgery and months of physical therapy in the future. Tip make sure to maintain good posture during the exercise. Type three rotator cuff repair miniopen or neer approach large to massive tear greater than 5 cm i. This protocol will vary in length and aggressiveness depending on factors such as. The amount of time will depend on the size of the rotator cuff tear. View background material via the rc cpg eappendix 1 view data summaries via the rc cpg eappendix 2 6. Rotator cuff repair rehab protocol the stone clinic.
For all exercises, stand with good posture by pulling your shoulder blades slightly down and. The rotator cuff tendon needs to heal back into the bone rom goals. Rehabilitation guidelines for type i and type ii rotator cuff. As the exercise becomes easier to perform, progress to 3 sets of 12 repetitions. This video is designed to help maximize your recovery following rotator cuff repair surgery. Postoperative rehabilitation protocol rotator cuff repair. Rehabilitation protocol for rotator cuff repair massachusetts. Cole,md,mba range of motion immobilizer exercises phase i 04 weeks 02 weeks. They attach from the shoulder blade onto the top of the arm bone.
Rotator cuff repair protocol weeks full time in sling range of motion. Try to pick a point between the two pictures and hold is for 510 seconds for 35 repetitions. The socket portion of the joint is not naturally deep. Omearas rotator cuff repair rehabilitation protocol. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them.
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. Showering is allowed once dressings and catheter is removed. Are pulley exercises initiated 6 weeks after rotator cuff repair a safe and effective rehabilitative treatment. Start with holding these contractions within a pain free range. May 01, 2017 they help power and stabilize your arm and shoulder movements. Elbow therapists consensus statement on rehabilitation following arthroscopic rotator cuff repair. Rotator cuff exercises for strengthening and rehabilitation. These are called isometric holds, which are the most basic of our shoulder exercises. If initial nonsurgical treatment of a rotator cuff tear fails, surgical repair is often the next line of treatment.
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. Rotator cuff surgical repair return to sport protocol. It is no means intended to be a substitute for ones. It is evident that a successful outcome after surgical rotator cuff repair is as much dependent on surgical technique as it is on rehabilitation. Clinical guidelines for cpm following rotator cuff repair. Rotator cuff repair the following is a protocol for postoperative patients following 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. Initiate with submax, painfree isometrics and arom as outlined in the protocol. This is because the articular surface of the round humeral head is approximately four times greater than that of the. Rotator cuff and shoulder rehabilitation exercises. Rotator cuff exercises 5 essential workouts ace blog.
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