Rehabilitation Guidelines for Large Rotator Cuff Repair

Size: px
Start display at page:

Download "Rehabilitation Guidelines for Large Rotator Cuff Repair"

Transcription

1 Rehabilitation Guidelines for Large Rotator Cuff Repair The true shoulder joint is called the glenohumeral joint and consists humeral head and the glenoid. It is a ball and socket joint. Anatomy of the Shoulder The shoulder is made up of three bones: the scapula (shoulder blade), the humerus (upper arm bone) and the clavicle (collarbone). Ligaments and tendons connect the bones. The part of the scapula that makes up the roof of the shoulder is called the acromion. Impingement may be caused by the shape of the acromion causing irritation on the rotator cuff during motion. The joint where the acromion and the clavicle join together is known as the acromioclavicular (AC) joint. If this joint is injured during a fall, the ligaments stabilizing the joint may be injured. This is called a shoulder separation. If the joint wears out, it may become arthritic and painful with motion. The rotator cuff connects the humerus to the scapula. The rotator cuff is formed by the tendons of four muscles: the supraspinatus, infraspinatus, teres minor, and subscapularis. The stability and movement of the shoulder is controlled by the rotator cuff muscles, with assistance from the ligaments, labrum and capsule. Rotator cuff tears can occur from repeated stress or from trauma. Throwing activities, repetitive overhead movements, or falls onto an outstretched arm can cause trauma to the rotator cuff. Patients over the age of 50 are more susceptible to rotator cuff tearing from a fall. Rotator Cuff Anatomy Tears are classified in many ways, but most commonly they are referred to as partial or fullthickness. Partial tears can occur on the articular or bursal side of the joint. Bursal surface tears occur on the outer surface of the tendon and may be caused by repetitive impingement. Articular sided tears occur on the inner surface of the tendon, and are most often caused by internal impingement or tensile stresses related to overhead sports. Full thickness or complete tears extend from one surface of the tendon all the way through to the other surface of the tendon. Since a full-thickness tear is complete, there may be some retraction from the pull of the muscles against the torn tissue. The degree of retraction and dictate the extent of the repair. In general, the more retraction, the more difficult the repair and recovery. The most common tendons of the rotator cuff that are torn are the supraspinatus and infraspinatus. Less commonly injured are the subscapularis and the teres minor.

2 If rest and therapy cannot relieve the symptoms of the tear, surgery mau be warranted. The primary goal of a rotator cuff repair is to restore the normal anatomy by approximating the rotator cuff tendon back to its normal attachment site on the greater tuberosity of the humerus. This is done by passing sutures through the tendon and then tying the tendon down to suture anchors that have been placed in the humerus. The degree of success for tears that are repaired is related to various factors, including tear size, the number of tendons involved, patient age, associated injuries and post operative rehabilitation. Rehabilitation is vital to regaining motion, strength and function of the shoulder after arthroscopic surgery. Initially patients may use a sling for comfort. During this time, range of motion exercises are started to prevent the shoulder from getting stiff and losing mobility. The rehabilitation program will gradually progress to more strengthening and muscle-control exercises. General time frames are given for reference to the average, but individual patients will progress at different rates depending on their age, associated injuries, pre-injury health status, rehabilitation compliance and injury severity. Restrictions or precautions may also be given to protect healing. 2

3 PHASE I (usually surgery to 2 weeks after surgery) Rehabilitation appointments begin within 7 days after surgery Reduce pain and swelling in the post-surgical shoulder Maintain active range of motion of the elbow, wrist and neck Protect healing of repaired tissues Use sling continuously except while doing therapy Relative rest to reduce in ammation Elbow, wrist and neck active range of motion Ball squeezes Pendulum exercises Passive range of motion for shoulder flexion and abduction (between 0 and 50) Walking and/or stationary bike with sling on No treadmill Avoid running and jumping due to the forces that can occur at landing 2 weeks postop 3

4 PHASE II (begin after meeting Phase I criteria, usually 2 weeks after surgery) Rehabilitation appointments are 1-2 times per week Controlled restoration of passive and active assistive range of motion Activate shoulder and scapular stabilizers in a protected position of 0 to 30 of shoulder abduction Correct postural dysfunctions Continue use of the sling for the first 4 weeks Wean out of the sling slowly based on the safety of the environment - weeks 5/6 No active abduction for the first 8 weeks in order to protect the repair Passive and active assisted range of motion for the shoulder in all cardinal planes (shoulder abduction should be passive only) Begin active range of motion for shoulder flexion and rotation at 4 weeks Isometric internal and external rotator cuff strengthening in non-provocative positions with the shoulder in 0 to 45 of abduction Scapular strengthening with the arm in neutral - Sidelying scapular protraction/ retraction resistance Cervical spine and scapular active range of motion Core strengthening Walking and stationary bike No treadmill or stairmaster Avoid running and jumping until the athlete has full rotator cuff strength in a neutral position due to forces that can occur at landing The patient can progress to phase III when they have achieved full passive range of motion (equal to the uninvolved side) and normal (rated 5/5) strength for the shoulder internal rotators and external rotators at 0 of shoulder abduction 4

5 PHASE III (begin after meeting Phase II criteria, usually 6 weeks after surgery) Rehabilitation appointments are 1 time per week Full shoulder active range of motion in all planes Normal (rated 5/5) strength for shoulder internal rotators and external rotators with the shoulder in 0 of abduction Correct any postural dysfunction Ensure that exercises are pain free and do not include long lever arms that will significantly change the torque throughout the motion Begin active scapular strengthening exercises. Continue with sidelying manual scapular stabilization program to include retraction and depression Resistive exercise program with GH joint supported: biceps, triceps, wrists Begin submaximal rhythmic stabilization in supine position Shoulder internal rotation and external rotation with theraband or weights that begin at 0 of shoulder abduction - gradually increase shoulder abduction as strength improves Isotonic resistive exercises: sidelying ER, prone extension, prone abduction to 45 degrees, supine IR, flexion to 90 degrees Low resistance/ high repetition program Progress to full PROM and AROM in all planes HEP with RC strengthening and therabands Walking and stationary bike No treadmill, stairmaster or swimming Avoid running and jumping until the athlete has full rotator cuff strength in a neutral position due to forces that can occur at landing Full shoulder active range of motion (equal to the uninvolved shoulder) and normal (rated 5/5) strength for shoulder internal rotators and external rotators at 30 of shoulder abduction 5

6 PHASE IV (begin after meeting phase III criteria, usually 10 weeks after surgery) Rehabilitation appointments are 1 time every 2 to 3 weeks Normal (rated 5/5) rotator cuff strength and endurance at 90 of shoulder abduction Advance proprioceptive and dynamic neuromuscular control retraining Correct postural dysfunctions with work and sport specific tasks Develop strength and control for movements required for work or sport Post-rehabilitation soreness should alleviate within 12 hours of the activities No overhead work or sports Begin submaximal isokinetic program for IR/ER in neutral position. Begin with #2 weight or elastic tubing Resistance bands in external and internal rotation (concentric and eccentric). External rotation resistance in side-lying position. Lateral raises: side-lying abduction limited to 45 degrees allows strengthening with minimal risk of impingement. Prone rowing, extension and horizontal abduction. Build muscle endurance. Walking, stationary bike, and stairmaster. Jog only if 5/5 RTC strength. No treadmill or swimming Full shoulder active range of motion in all planes and multi-plane movements Normal (rated 5/5) strength at 90 of shoulder abduction Negative impingement signs 6

7 PHASE V (begin after meeting Phase IV criteria, usually weeks after surgery) Rehabilitation appointments are once every 2 to 3 weeks Normal (rated 5/5) rotator cuff strength at 90 of shoulder abduction Normal (rated 5/5) supraspinatus strength Advance proprioceptive and dynamic neuromuscular control retraining Correct postural dysfunctions with work and sport specific tasks Develop strength and control for movements required for work or sport Develop work capacity cardiovascular endurance for work and/or sport Post-rehabilitation soreness should alleviate within 12 hours of the activities Multi-plane shoulder active range of motion with a gradual increase in the velocity of movement while making sure to assess scapular rhythm Shoulder mobilizations as needed Rotator cuff strengthening in 90 of shoulder abduction as well as in provocative positions and work/sport specific positions, including eccentric strengthening, endurance and velocity specific exercises Scapular strengthening and dynamic neuromuscular control in overhead positions and work/sport specific positions Work and Sport specific strengthening Core and lower body strengthening Throwing program, swimming program or overhead racquet program as needed Design to use work or sport specific energy systems The patient may return to sport after receiving clearance from the orthopedic surgeon and the sports rehabilitation provider. Return to sport decisions are based on meeting the goals of this phase Sport Specific Recommendations: o Golf chipping/putting at 3 months o Golf wedge shots and tennis ground strokes 4 months o No throwing, tennis serves or freestyle swimming until 6 months Please be aware that this information is not intended to replace the care or advice given by your physician or health care provider. It is not intended to be a substitute for professional advice. Call your health provider immediately if you think you may have a medical emergency. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any question you may have regarding a medical condition. 7

Rehabilitation Guidelines for Shoulder Arthroscopy

Rehabilitation Guidelines for Shoulder Arthroscopy Rehabilitation Guidelines for Shoulder Arthroscopy The true shoulder joint is called the glenohumeral joint and consists humeral head and the glenoid. It is a ball and socket joint. Anatomy of the Shoulder

More information

Rehabilitation Guidelines for Labral/Bankert Repair

Rehabilitation Guidelines for Labral/Bankert Repair Rehabilitation Guidelines for Labral/Bankert Repair The true shoulder joint is called the glenohumeral joint and consists humeral head and the glenoid. It is a ball and socket joint. Anatomy of the Shoulder

More information

REHABILITATION GUIDELINES FOR ROTATOR CUFF REPAIR FOR TYPE II TEARS (MASSIVE)(+/- SUBACROMIAL DECOMPRESSION)

REHABILITATION GUIDELINES FOR ROTATOR CUFF REPAIR FOR TYPE II TEARS (MASSIVE)(+/- SUBACROMIAL DECOMPRESSION) REHABILITATION GUIDELINES FOR ROTATOR CUFF REPAIR FOR TYPE II TEARS (MASSIVE)(+/- SUBACROMIAL DECOMPRESSION) The rehabilitation guidelines are presented in a criterion based progression. General time frames

More information

REHABILITATION GUIDELINES FOR ROTATOR CUFF REPAIR FOR TYPE I TEARS (+/- SUBACROMINAL DECOMPRESSION)

REHABILITATION GUIDELINES FOR ROTATOR CUFF REPAIR FOR TYPE I TEARS (+/- SUBACROMINAL DECOMPRESSION) REHABILITATION GUIDELINES FOR ROTATOR CUFF REPAIR FOR TYPE I TEARS (+/- SUBACROMINAL DECOMPRESSION) The rehabilitation guidelines are presented in a criterion based progression. General time frames are

More information

REHABILITATION GUIDELINES FOR SUBSCAPULARIS (+/- SUBACROMIAL DECOMPRESSION) Dr. Carson

REHABILITATION GUIDELINES FOR SUBSCAPULARIS (+/- SUBACROMIAL DECOMPRESSION) Dr. Carson REHABILITATION GUIDELINES FOR SUBSCAPULARIS (+/- SUBACROMIAL DECOMPRESSION) Dr. Carson The rehabilitation guidelines are presented in a criterion based progression. General time frames are given for reference

More information

Rehabilitation Guidelines for Shoulder Arthroscopy

Rehabilitation Guidelines for Shoulder Arthroscopy UW HEALTH SPORTS REHABILITATION Rehabilitation Guidelines for Shoulder Arthroscopy Front View Acromion Supraspinatus Back View Supraspinatus Long head of bicep Type I Infraspinatus Short head of bicep

More information

Rehabilitation Guidelines for Arthroscopic Capsular Shift

Rehabilitation Guidelines for Arthroscopic Capsular Shift UW HEALTH SPORTS REHABILITATION Rehabilitation Guidelines for Arthroscopic Capsular Shift The anatomic configuration of the shoulder joint (glenohumeral joint) is often compared to a golf ball on a tee.

More information

REHABILITATION GUIDELINES FOR ARTHROSCOPIC CAPSULAR SHIFT

REHABILITATION GUIDELINES FOR ARTHROSCOPIC CAPSULAR SHIFT REHABILITATION GUIDELINES FOR ARTHROSCOPIC CAPSULAR SHIFT The rehabilitation guidelines are presented in a criterion based progression. General time frames are given for reference to the average, but individual

More information

PHASE I (Begin PT 3-5 days post-op) DOS:

PHASE I (Begin PT 3-5 days post-op) DOS: REHABILITATION GUIDELINES FOR POSTERIOR SHOULDER RECONSTRUCTION +/- LABRAL REPAIRS The rehabilitation guidelines are presented in a criterion based progression. General time frames are given for reference

More information

REHABILITATION GUIDELINES FOR ANTERIOR SHOULDER RECONSTRUCTION WITH BANKART REPAIR

REHABILITATION GUIDELINES FOR ANTERIOR SHOULDER RECONSTRUCTION WITH BANKART REPAIR REHABILITATION GUIDELINES FOR ANTERIOR SHOULDER RECONSTRUCTION WITH BANKART REPAIR The rehabilitation guidelines are presented in a criterion based progression. General time frames are given for reference

More information

Rehabilitation Guidelines for Anterior Shoulder Reconstruction with Arthroscopic Bankart Repair

Rehabilitation Guidelines for Anterior Shoulder Reconstruction with Arthroscopic Bankart Repair UW HEALTH SPORTS REHABILITATION Rehabilitation Guidelines for Anterior Shoulder Reconstruction with Arthroscopic Bankart Repair The anatomic configuration of the shoulder joint (glenohumeral joint) is

More information

Phase I : Immediate Postoperative Phase- Protected Motion. (0-2 Weeks)

Phase I : Immediate Postoperative Phase- Protected Motion. (0-2 Weeks) Phase I : Immediate Postoperative Phase- Protected Motion (0-2 Weeks) Appointments Progression Criteria 2 weeks after surgery Rehabilitation appointments begin within 7-10 days of surgery, continue 1-2

More information

Rotator Cuff Repair Protocol

Rotator Cuff Repair Protocol Rotator Cuff Repair Protocol Applicability: Physician Practices Date Effective: 11/2016 Department: Rehabilitation Services Supersedes: Rotator Cuff Repair (Beattie) Date Last Reviewed / or Date Last Revision:

More information

Rehabilitation Guidelines for Anterior Shoulder Reconstruction with Open Bankart Repair

Rehabilitation Guidelines for Anterior Shoulder Reconstruction with Open Bankart Repair UW HEALTH SPORTS REHABILITATION Rehabilitation Guidelines for Anterior Shoulder Reconstruction with Open Bankart Repair The anatomic configuration of the shoulder joint (glenohumeral joint) is often compared

More information

Rotator Cuff Repair Protocol

Rotator Cuff Repair Protocol Rotator Cuff Repair Protocol Applicability: Physician Practices Date Effective: 11/2016 Department: Rehabilitation Services Supersedes: Rotator Cuff Repair (Beattie) Date Last Reviewed / or Date Last Revision:

More information

Rehabilitation Guidelines for Biceps Tenodesis with Hardware Fixation

Rehabilitation Guidelines for Biceps Tenodesis with Hardware Fixation UW HEALTH SPORTS REHABILITATION Rehabilitation Guidelines for Biceps Tenodesis with Hardware Fixation The shoulder has two primary joints. One part of the shoulder blade, called the glenoid fossa forms

More information

SHOULDER ARTHROSCOPY WITH ANTERIOR STABILIZATION / CAPSULORRHAPHY REHABILITATION PROTOCOL

SHOULDER ARTHROSCOPY WITH ANTERIOR STABILIZATION / CAPSULORRHAPHY REHABILITATION PROTOCOL General Notes As tolerated should be understood to include with safety for the surgical procedure; a sudden increase in pain, swelling, or other undesirable factors are indicators that you are doing too

More information

Shoulder Arthroscopy with Rotator Cuff Repair Rehabilitation Protocol

Shoulder Arthroscopy with Rotator Cuff Repair Rehabilitation Protocol General Notes: As tolerated should be understood to include with safety for the surgical procedure; a sudden increase in pain, swelling, or other undesirable factors are indicators that you are doing too

More information

Rehabilitation Guidelines for Type I and Type II Rotator Cuff Repair and Isolated Subscapularis Repair

Rehabilitation Guidelines for Type I and Type II Rotator Cuff Repair and Isolated Subscapularis Repair UW HEALTH SPORTS REHABILITATION Rehabilitation Guidelines for Type I and Type II Rotator Cuff Repair and Isolated Subscapularis Repair The anatomic configuration of the shoulder joint (glenohumeral joint)

More information

Arthroscopic Rotator Cuff Repair Protocol:

Arthroscopic Rotator Cuff Repair Protocol: Arthroscopic Rotator Cuff Repair Protocol: The intent of this protocol is to provide the therapist and patient with guidelines for the post-operative rehabilitation course after arthroscopic SLAP repair.

More information

Rehabilitation Guidelines for Open Latarjet Anterior Shoulder Stabilization

Rehabilitation Guidelines for Open Latarjet Anterior Shoulder Stabilization UW HEALTH SPORTS REHABILITATION Rehabilitation Guidelines for Open Latarjet Anterior Shoulder Stabilization The anatomic configuration of the shoulder joint (glenohumeral joint) is often compared to a

More information

Rotator Cuff Repair Protocol for tear involving Subscapularis Tendon with or without Pectoralis Major Tendon Transfer

Rotator Cuff Repair Protocol for tear involving Subscapularis Tendon with or without Pectoralis Major Tendon Transfer Rotator Cuff Repair Protocol for tear involving Subscapularis Tendon with or without Pectoralis Major Tendon Transfer D. WATTS, MD Precautions: BASIS Tendon healing back to bone is a slow process that

More information

Latarjet Repair Rehabilitation Protocol

Latarjet Repair Rehabilitation Protocol General Notes: As tolerated should be understood to include with safety for the reconstruction/repair; a sudden increase in pain, swelling, or other undesirable factors are indicators that you are doing

More information

UHealth Sports Medicine

UHealth Sports Medicine UHealth Sports Medicine Rehabilitation Guidelines for Arthroscopic Rotator Cuff Repair Type 2 Repairs (+/- subacromial decompression) The rehabilitation guidelines are presented in a criterion based progression.

More information

Shoulder Arthroscopy with Posterior Labral Repair Rehabilitation Protocol

Shoulder Arthroscopy with Posterior Labral Repair Rehabilitation Protocol General Notes: As tolerated should be understood to include with safety for the surgical procedure; a sudden increase in pain, swelling, or other undesirable factors are indicators that you are doing too

More information

The Four Phases of Healing During Rehabilitation Following Rotator Cuff Surgery. Phase 1: Immediate postoperative period (weeks 0-6) Goals

The Four Phases of Healing During Rehabilitation Following Rotator Cuff Surgery. Phase 1: Immediate postoperative period (weeks 0-6) Goals The Four Phases of Healing During Rehabilitation Following Rotator Cuff Surgery Phase 1: Immediate postoperative period (weeks 0-6) Maintain/protect integrity of repair Gradually increase PROM Diminish

More information

Ms. Ruth A. Delaney, MB BCh BAO, MMedSc, MRCS

Ms. Ruth A. Delaney, MB BCh BAO, MMedSc, MRCS Ms. Ruth A. Delaney, MB BCh BAO, MMedSc, MRCS Consultant Orthopaedic Surgeon, Shoulder Specialist. +353 1 5262335 ruthdelaney@sportssurgeryclinic.com Modified from the protocol developed at Boston Shoulder

More information

Biceps Tenodesis Protocol

Biceps Tenodesis Protocol Biceps Tenodesis Protocol A biceps tenodesis procedure involves cutting of the long head of the biceps just prior to its insertion on the superior labrum and then anchoring the tendon along its anatomical

More information

Rehabilitation Protocol: Arthroscopic Anterior Capsulolabral Repair of the Shoulder - Bankart Repair Rehabilitation Guidelines

Rehabilitation Protocol: Arthroscopic Anterior Capsulolabral Repair of the Shoulder - Bankart Repair Rehabilitation Guidelines Rehabilitation Protocol: Arthroscopic Anterior Capsulolabral Repair of the Shoulder - Bankart Repair Rehabilitation Guidelines Department of Orthopaedic Surgery Lahey Hospital & Medical Center, Burlington

More information

Type II SLAP lesions are created when the biceps anchor has pulled away from the glenoid attachment.

Type II SLAP lesions are created when the biceps anchor has pulled away from the glenoid attachment. Arthroscopic Superior Labral (SLAP) Repair Protocol-Type II, IV, and Complex Tears The intent of this protocol is to provide the clinician with a guideline of the post-operative rehabilitation course of

More information

TALLGRASS ORTHOPEDIC & SPORTS MEDICINE. Phase I Immediate Post-Surgical Phase (Weeks 0-2) Date: Maintain/protect integrity of the repair

TALLGRASS ORTHOPEDIC & SPORTS MEDICINE. Phase I Immediate Post-Surgical Phase (Weeks 0-2) Date: Maintain/protect integrity of the repair TALLGRASS ORTHOPEDIC & SPORTS MEDICINE Name: Date of Surgery: Patient Flow Sheet Arthroscopic Rotator Cuff Repair Small to Medium Tears Benedict Figuerres, MD Phase I Immediate Post-Surgical Phase (Weeks

More information

Dr. Denard s Rehabilitation Protocols Arthroscopic Shoulder Surgery

Dr. Denard s Rehabilitation Protocols Arthroscopic Shoulder Surgery 2780 E. Barnett Rd Medford, OR 97530 541-779-6250 Dr. Denard s Rehabilitation Protocols Arthroscopic Shoulder Surgery These rehabilitation protocols are based on current studies detailing healing time

More information

Arthroscopic Labral Repair Protocol-Type II, IV, and Complex Tears:

Arthroscopic Labral Repair Protocol-Type II, IV, and Complex Tears: Arthroscopic Labral Repair Protocol-Type II, IV, and Complex Tears: The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that

More information

Rehabilitation Protocol: Massive Rotator Cuff Tear Repair

Rehabilitation Protocol: Massive Rotator Cuff Tear Repair Rehabilitation Protocol: Massive Rotator Cuff Tear Repair Department of Orthopaedic Surgery Lahey Hospital & Medical Center, Burlington 781-744-8650 Lahey Outpatient Center, Lexington 781-372-7020 Lahey

More information

UHealth Sports Medicine

UHealth Sports Medicine UHealth Sports Medicine Rehabilitation Guidelines for Arthroscopic Rotator Cuff Repair Type 1 Repairs (+/- subacromial decompression) The rehabilitation guidelines are presented in a criterion based progression.

More information

Rotator Cuff Repair. What to Expect. Alta View Sports Medicine. Dr. James R. Meadows, MD

Rotator Cuff Repair. What to Expect. Alta View Sports Medicine. Dr. James R. Meadows, MD Alta View Sports Medicine Dr. James R. Meadows, MD Orthopedic Surgery & Sports Medicine 74 Kimballs Ln Ste 230, Draper, UT 84020 9844 S. 1300 E. Ste 100, Sandy, UT 84094 (801) 571-9433 www.meadowsmd.com

More information

Shoulder Impingement Rehabilitation Recommendations

Shoulder Impingement Rehabilitation Recommendations Shoulder Impingement Rehabilitation Recommendations The following protocol can be utilized for conservative care of shoulder impingement as well as post- operative subacromial decompression (SAD) surgery.

More information

Reverse Total Shoulder Arthroplasty Protocol Shawn Hennigan, MD

Reverse Total Shoulder Arthroplasty Protocol Shawn Hennigan, MD General Information: Reverse Total Shoulder Arthroplasty Protocol Shawn Hennigan, MD Reverse or Inverse Total Shoulder Arthroplasty (rtsa) is designed specifically for the treatment of glenohumeral (GH)

More information

Bradley C. Carofino, M.D. Shoulder Specialist 230 Clearfield Avenue, Suite 124 Virginia Beach, Virginia Phone

Bradley C. Carofino, M.D. Shoulder Specialist 230 Clearfield Avenue, Suite 124 Virginia Beach, Virginia Phone Rehabilitation following Arthroscopic Rotator Cuff Repair: Medium Tears Phase I: Immediate Postsurgical Phase (Days 10-14) Precautions: No lifting of objects; No excessive arm motions; No excessive external

More information

Bradley C. Carofino, M.D. Shoulder Specialist 230 Clearfield Avenue, Suite 124 Virginia Beach, Virginia Phone

Bradley C. Carofino, M.D. Shoulder Specialist 230 Clearfield Avenue, Suite 124 Virginia Beach, Virginia Phone Subpectoral Bicep Tenodesis Protocol (Spreadsheet) Weeks 1-2 Modalities Treatment Restrictions Goals No active elbow flexion (6weeks) Full PROM shoulder and elbow PROM: Shoulder, elbow, forearm No active

More information

Anterior Stabilization of the Shoulder: Distal Tibial Allograft

Anterior Stabilization of the Shoulder: Distal Tibial Allograft Anterior Stabilization of the Shoulder: Distal Tibial Allograft Name: Diagnosis: Date: Date of Surgery: Phase I Immediate Post Surgical Phase (approximately Weeks 1-3) Minimize shoulder pain and inflammatory

More information

Ms. Ruth A. Delaney, MB BCh BAO, MMedSc, MRCS

Ms. Ruth A. Delaney, MB BCh BAO, MMedSc, MRCS Ms. Ruth A. Delaney, MB BCh BAO, MMedSc, MRCS Consultant Orthopaedic Surgeon, Shoulder Specialist. +353 1 5262335 ruthdelaney@sportssurgeryclinic.com Modified from the protocol developed at Boston Shoulder

More information

Shoulder Labral Tear and Shoulder Dislocation

Shoulder Labral Tear and Shoulder Dislocation Shoulder Labral Tear and Shoulder Dislocation The shoulder joint is a ball and socket joint with tremendous flexibility and range of motion. The ball is the humeral head while the socket is the glenoid.

More information

Biceps Tenodesis Protocol

Biceps Tenodesis Protocol Robert K. Fullick, MD 6400 Fannin Street, Suite 1700 Houston, Texas 77030 Ph.: 713-486-7543 / Fx.: 713-486-5549 Biceps Tenodesis Protocol The intent of this protocol is to provide the clinician with a

More information

Anterior Stabilization of the Shoulder: Latarjet Protocol

Anterior Stabilization of the Shoulder: Latarjet Protocol Robert K. Fullick, MD 6400 Fannin Street, Suite 1700 Houston, Texas 77030 Ph.: 713-486-7543 / Fx.: 713-486-5549 Anterior Stabilization of the Shoulder: Latarjet Protocol The intent of this protocol is

More information

Charlotte Shoulder Institute

Charlotte Shoulder Institute Charlotte Shoulder Institute Patient Centered. Research Driven. Outcome Maximized. James R. Romanowski, M.D. Novant Health Perry & Cook Orthopedics and Sports Medicine 2826 Randolph Rd. Charlotte, NC 28211

More information

Core deconditioning Smoking Outpatient Phase 1 ROM Other

Core deconditioning Smoking Outpatient Phase 1 ROM Other whereby the ball does not stay properly centered in the shoulder socket during shoulder movement. This condition may be associated with impingement of the rotator cuff on the acromion bone and coracoacromial

More information

Biceps Tenotomy Protocol

Biceps Tenotomy Protocol Biceps Tenotomy Protocol A biceps tenotomy procedure involves cutting of the long head of the biceps just prior to its insertion on the superior labrum. A biceps tenotomy is typically done when there is

More information

Latissimus dorsi tendon transfer protocol

Latissimus dorsi tendon transfer protocol Department of Rehabilitation Services Physical Therapy The intent of this protocol is to provide the physical therapist with a guideline/treatment protocol for the postoperative rehabilitation management

More information

Large/Massive Rotator Cuff Repair

Large/Massive Rotator Cuff Repair Large/Massive Rotator Cuff Repair 1. Defined a. Suturing of tears within the rotator cuff (most commonly supraspinatus muscle). Massive RCR usually involve more than the supraspinatus. b. May be done arthroscopically

More information

AC reconstruction Protocol: Dr. Rolf

AC reconstruction Protocol: Dr. Rolf AC reconstruction Protocol: Dr. Rolf The intent of this protocol is to provide the clinician with a guideline of the post-operative rehabilitation course of a patient that has undergone a AC reconstruction

More information

Small Rotator Cuff Repair

Small Rotator Cuff Repair Small Rotator Cuff Repair 1. Defined a. Surgical repair of the rotator cuff (most commonly supraspinatus muscle) utilizing sutures b. May be done arthroscopically or open. c. May be done in conjunction

More information

SLAP LESION REPAIR PROTOCOL

SLAP LESION REPAIR PROTOCOL SLAP LESION REPAIR PROTOCOL Clarkstown Division This rehabilitation protocol has been developed for the patient following a SLAP (Superior Labrum Anterior Posterior) repair. It is extremely important to

More information

Biceps Tenotomy Protocol

Biceps Tenotomy Protocol Department of Rehabilitation Services Physical Therapy The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone

More information

Mini Open Rotator Cuff Repair Large (3 5 cm)

Mini Open Rotator Cuff Repair Large (3 5 cm) Mini Open Rotator Cuff Repair Large (3 5 cm) Size: small = < 1 cm, medium = 1 3 cm, large 3 5 cm, massive = > 5 cm **It is the treating therapist s responsibility along with the referring physician s guidance

More information

Appendix A: The American Society Of Shoulder And Elbow Therapists Arthroscopic Rotator Cuff Repair Rehabilitation Guide Phase 1 (POD 1 to ~ POW 6) GOALS: Maintain integrity of repair Minimize pain and

More information

OrthoCarolina. Arthroscopic SLAP Lesion (Type II) Repair Protocol

OrthoCarolina. Arthroscopic SLAP Lesion (Type II) Repair Protocol OrthoCarolina Arthroscopic SLAP Lesion (Type II) Repair Protocol Surgical Overview: SLAP, which stands for superior labrum anterior to posterior, lesions are labral detachments that originate posterior

More information

Rotator Cuff Repair Protocol

Rotator Cuff Repair Protocol Rotator Cuff Repair Protocol Overview a. Begin passive shoulder ROM after surgery (beginning week 1) b. Active assist ROM beginning week 7 after surgery (weeks 7-8) c. Active ROM beginning week 9 after

More information

TOTAL SHOULDER ARTHROPLASTY / HEMIARTHROPLASTY

TOTAL SHOULDER ARTHROPLASTY / HEMIARTHROPLASTY Teodoro P. Nissen, M.D., Q.M.E. Fellowship Trained Board Certified Joseph M. Centeno, M.D. Fellowship Trained Board Certified TOTAL SHOULDER ARTHROPLASTY / HEMIARTHROPLASTY Protocol: The intent of this

More information

PROM is not stretching!

PROM is not stretching! Dx: o Right o Left Shoulder Replacement/Hemiarthroplasty Rehab Date of Surgery: Patient Name: PT/OT: Please evaluate and treat. Follow attached protocol. 2-3 x per week x 6 weeks. Signature/Date: The intent

More information

SMALL-MEDIUM ROTATOR CUFF REPAIR GUIDELINE

SMALL-MEDIUM ROTATOR CUFF REPAIR GUIDELINE SMALL-MEDIUM ROTATOR CUFF REPAIR GUIDELINE The rotator cuff is responsible for stabilization and active movement of the glenohumeral joint. An acute or overuse injury may cause the rotator cuff to be injured

More information

Post-Operative Instructions Glenoid Reconstruction using Fresh Distal Tibial Allograft

Post-Operative Instructions Glenoid Reconstruction using Fresh Distal Tibial Allograft Day of Surgery Post-Operative Instructions Glenoid Reconstruction using Fresh Distal Tibial Allograft A. Relax. Diet as tolerated. B. Icing is important for the first 5-7 days post-op. While the post-op

More information

Jennifer L. Cook, MD Stephen A. Hanff, MD. Rotator Cuff Type I Repair (Small Large Tear)

Jennifer L. Cook, MD Stephen A. Hanff, MD. Rotator Cuff Type I Repair (Small Large Tear) Jennifer L. Cook, MD Stephen A. Hanff, MD Florida Joint Care Institute 2165 Little Road, Trinity, Florida 34655 PH: (727) 372 6637 FAX: (727) 375 5044 Rotator Cuff Type I Repair (Small Large Tear) This

More information

Charlotte Shoulder Institute

Charlotte Shoulder Institute Charlotte Shoulder Institute Patient Centered. Research Driven. Outcome Maximized. James R. Romanowski, M.D. Novant Health Perry & Cook Orthopedics and Sports Medicine 2826 Randolph Rd. Charlotte, NC 28211

More information

SLAP LESION REPAIR PROTOCOL Dr. Steven Flores

SLAP LESION REPAIR PROTOCOL Dr. Steven Flores SLAP LESION REPAIR PROTOCOL Dr. Steven Flores This rehabilitation protocol has been developed for the patient following a SLAP (Superior Labrum Anterior Posterior) repair. It is extremely important to

More information

Total Shoulder Arthroplasty / Hemiarthroplasty Protocol

Total Shoulder Arthroplasty / Hemiarthroplasty Protocol Adam N. Whatley, M.D. 6550 Main St., STE. 2300 Zachary, LA 70791 Phone(225)658-1808 Fax(225)658-5299 Total Shoulder Arthroplasty / Hemiarthroplasty Protocol The intent of this protocol is to provide the

More information

Rotator Cuff Repair +/- Acromioplasty/Mumford. Phase I: 0 to 2 weeks after surgery

Rotator Cuff Repair +/- Acromioplasty/Mumford. Phase I: 0 to 2 weeks after surgery Rotator Cuff Repair +/- Acromioplasty/Mumford 2. Ensure wound healing Phase I: 0 to 2 weeks after surgery 1. Sling: Use your sling all of the time. 2. Use of the affected arm: You may use your hand on

More information

Total Shoulder Arthroplasty / Hemiarthroplasty Therapy Protocol

Total Shoulder Arthroplasty / Hemiarthroplasty Therapy Protocol Total Shoulder Arthroplasty / Hemiarthroplasty Therapy Protocol The intent of this protocol is to provide the therapist with a guideline of the postoperative rehabilitation course of a patient that has

More information

Anatomy Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).

Anatomy Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle). Shoulder Impingement/Rotator Cuff Tendinitis One of the most common physical complaints is shoulder pain. Your shoulder is made up of several joints combined with tendons and muscles that allow a great

More information

Arthroscopic Shoulder Surgery /Meniscectomy Recovery

Arthroscopic Shoulder Surgery /Meniscectomy Recovery Arthroscopic Shoulder Surgery /Meniscectomy Recovery Arthroscopic Shoulder Surgery (Acromioplasty) Recovery Arthroscopic subacromial decompression (ASAD) is a surgical procedure with the goal of relieving

More information

Charlotte Shoulder Institute

Charlotte Shoulder Institute Charlotte Shoulder Institute Patient Centered. Research Driven. Outcome Maximized. James R. Romanowski, M.D. Novant Health Perry & Cook Orthopedics and Sports Medicine 2826 Randolph Rd. Charlotte, NC 28211

More information

Progression to the next phase based on Clinic Criteria and or Time Frames as Appropriate

Progression to the next phase based on Clinic Criteria and or Time Frames as Appropriate Bicep Tenodesis D. WATTS, M.D. Progression to the next phase based on Clinic Criteria and or Time Frames as Appropriate PHASE I PASSIVE RANG OF MOTION PHASE (STARTS APPROXIMATELY POST OP WEEKS 1-2) Minimize

More information

Phase I: 0 to 3 weeks after surgery

Phase I: 0 to 3 weeks after surgery Dx: Right Left RTC (Massive) Repair Date of Surgery: Patient Name: PT/OT: Please evaluate and treat. Follow attached protocol. 2-3 x per week x 6 weeks. Signature/Date: 2. Ensure wound healing Phase I:

More information

SUPERIOR LABRAL REPAIRS

SUPERIOR LABRAL REPAIRS LOURDES MEDICAL ASSOCIATES Sean Mc Millan, DO Director of Orthopaedic Sports Medicine & Arthroscopy 2103 Burlington-Mount Holly Rd Burlington, NJ 08016 (609) 747-9200 (office) (609) 747-1408 (fax) http://orthodoc.aaos.org/drmcmillan

More information

Anterior Labrum Repair Protocol

Anterior Labrum Repair Protocol Anterior Labrum Repair Protocol Stage I (0-4 weeks): Key Goals: Protect the newly repaired shoulder. Allow for decreased inflammation and healing. Maintain elbow, wrist and hand function. Maintain scapular

More information

Reverse Total Shoulder Arthroplasty Protocol

Reverse Total Shoulder Arthroplasty Protocol General Information: Reverse Total Shoulder Arthroplasty Protocol Reverse or Inverse Total Shoulder Arthroplasty (rtsa) is designed specifically for the treatment of glenohumeral (GH) arthritis when it

More information

Rotator Cuff Repair Protocol

Rotator Cuff Repair Protocol Protocol This rehabilitation protocol has been developed for the patient following a rotator cuff surgical procedure. This protocol will vary in length and aggressiveness depending on factors such as:

More information

Labral Tears. Fig 1: Intact labrum and biceps tendon

Labral Tears. Fig 1: Intact labrum and biceps tendon Labral Tears What is it? The shoulder joint is a ball and socket joint, with the humeral head (upper arm bone) as the ball and the glenoid as the socket. The glenoid (socket) is a shallow bone that is

More information

Rehabilitation Guidelines for UCL Repair

Rehabilitation Guidelines for UCL Repair UW HEALTH SPORTS REHABILITATION Rehabilitation Guidelines for UCL Repair The elbow is a complex system of three joints formed from three bones; the humerus (the upper arm bone), the ulna (the larger bone

More information

ROTATOR CUFF REPAIR REHAB PROTOCOL

ROTATOR CUFF REPAIR REHAB PROTOCOL Jayesh K. Patel, M.D. Trinity Clinic Orthopaedic and Sports Medicine 1327 Troup Hwy Tyler, TX 75701 (903) 510-8840 ROTATOR CUFF REPAIR REHAB PROTOCOL This rehabilitation protocol has been developed for

More information

Rehab protocol. Phase I: Immediate Post-Surgical Phase: Typically 0-4 weeks; 2 PT visits. Goals:

Rehab protocol. Phase I: Immediate Post-Surgical Phase: Typically 0-4 weeks; 2 PT visits. Goals: Reverse Total shoulder arthroplasty Rehab protocol Phase I: Immediate Post-Surgical Phase: Typically 0-4 weeks; 2 PT visits Allow healing of soft tissue Maintain integrity of replaced joint Gradually increase

More information

Charlotte Shoulder Institute

Charlotte Shoulder Institute Charlotte Shoulder Institute Patient Centered. Research Driven. Outcome Maximized. James R. Romanowski, M.D. Gill Orthopaedic Midtown Medical Plaza 1918 Randolph Rd., Suite 700 Charlotte, NC 28211 704-342-3544

More information

Rotator Cuff Repair Anterior Open Approach Large Tear < 3 cm

Rotator Cuff Repair Anterior Open Approach Large Tear < 3 cm Rotator Cuff Repair Anterior Open Approach Large Tear < 3 cm ** It is the treating therapist s responsibility along with the referring physician s guidance to determine the actual progression of the patient

More information

BANKART REPAIR PROTOCOL

BANKART REPAIR PROTOCOL BANKART REPAIR PROTOCOL Clarkstown Division This rehabilitation protocol has been developed for the patient following Bankart surgical procedure for anterior shoulder instability. The protocol is divided

More information

Shoulder Instability. Fig 1: Intact labrum and biceps tendon

Shoulder Instability. Fig 1: Intact labrum and biceps tendon Shoulder Instability What is it? The shoulder joint is a ball and socket joint, with the humeral head (upper arm bone) as the ball and the glenoid as the socket. The glenoid (socket) is a shallow bone

More information

Arthroscopic Bankart Repair Rehabilitation Protocol Dr. Mark Adickes

Arthroscopic Bankart Repair Rehabilitation Protocol Dr. Mark Adickes Arthroscopic Bankart Repair Rehabilitation Protocol Dr. Mark Adickes Introduction: This rehabilitation protocol has been developed for the patient following an arthroscopic Bankart (anteroinferior labral

More information

ARTHROSCOPIC SLAP LESION REPAIR (TYPE II) WITH THERMAL CAPSULAR SHRINKAGE

ARTHROSCOPIC SLAP LESION REPAIR (TYPE II) WITH THERMAL CAPSULAR SHRINKAGE ARTHROSCOPIC SLAP LESION REPAIR (TYPE II) WITH THERMAL CAPSULAR SHRINKAGE I. Phase I Immediate Postoperative Phase Restrictive Motion (Day 1 to Week 6) Goals: Protect the anatomic repair Prevent negative

More information

Harold Schock III, MD Rotator Cuff Repair Rehabilitation Protocol

Harold Schock III, MD Rotator Cuff Repair Rehabilitation Protocol Harold Schock III, MD Rotator Cuff Repair Rehabilitation Protocol The following document is an evidence-based protocol for arthroscopic rotator cuff repair rehabilitation. The protocol is both chronologically

More information

Theodore B. Shybut, M.D. Orthopedics and Sports Medicine 7200 Cambridge St. #10A Houston, Texas Phone: Fax:

Theodore B. Shybut, M.D. Orthopedics and Sports Medicine 7200 Cambridge St. #10A Houston, Texas Phone: Fax: Theodore B. Shybut, M.D. Orthopedics and Sports Medicine 7200 Cambridge St. #10A Houston, Texas 77030 Phone: 713-986-5590 Fax: 713-986-5521 ROTATOR CUFF REPAIR PROTOCOL This rehabilitation protocol has

More information

Mini Open Rotator Cuff Repair Small Tears < 1 cm

Mini Open Rotator Cuff Repair Small Tears < 1 cm Mini Open Rotator Cuff Repair Small Tears < 1 cm **It is the treating therapist s responsibility along with the referring physician s guidance to determine the actual progression of the patient within

More information

Arthroscopic SLAP Lesion Repair Rehabilitation Guideline

Arthroscopic SLAP Lesion Repair Rehabilitation Guideline Arthroscopic SLAP Lesion Repair Rehabilitation Guideline This rehabilitation program is designed to return the individual to their activities as quickly and safely as possible. It is designed for rehabilitation

More information

Diagnosis: ( LEFT / RIGHT ) Shoulder Instability / SLAP Tear

Diagnosis: ( LEFT / RIGHT ) Shoulder Instability / SLAP Tear UCLA OUTPATIENT REHABILITATION SERVICES! SANTA MONICA! WESTWOOD 1000 Veteran Ave., A level Phone: (310) 794-1323 Fax: (310) 794-1457 1260 15 th St, Ste. 900 Phone: (310) 319-4646 Fax: (310) 319-2269 FOR

More information

THERMAL - ASSISTED CAPSULORRAPHY With or without SLAP Repair

THERMAL - ASSISTED CAPSULORRAPHY With or without SLAP Repair THERMAL - ASSISTED CAPSULORRAPHY With or without SLAP Repair **It is important for the clinician to determine the capsular response to the heat probe. Patients that have excessive ROM early in the rehab

More information

The Cryo/Cuff provides two functions: 1. Compression - to keep swelling down. 2. Ice Therapy - to keep swelling down and to help minimize pain. Patien

The Cryo/Cuff provides two functions: 1. Compression - to keep swelling down. 2. Ice Therapy - to keep swelling down and to help minimize pain. Patien The Cryo/Cuff provides two functions: 1. Compression - to keep swelling down. 2. Ice Therapy - to keep swelling down and to help minimize pain. Patients, for the most part, experience less pain and/or

More information

Arthroscopic Labrum Repair of the Shoulder (SLAP)

Arthroscopic Labrum Repair of the Shoulder (SLAP) Anatomy Arthroscopic Labrum Repair of the Shoulder (SLAP) The shoulder joint involves three bones: the scapula (shoulder blade), the clavicle (collarbone) and the humerus (upper arm bone). The humeral

More information

SLAP Lesion Type II Repair Rehabilitation Program

SLAP Lesion Type II Repair Rehabilitation Program SLAP Lesion Type II Repair Rehabilitation Program The GLSM SLAP Type II Repair Rehabilitation Program is an evidence-based and soft tissue healing dependent program allowing patients to progress to vocational

More information

ULNAR COLLATERAL LIGAMENT (UCL) RECONSTRUCTION REHABILITATION PROTOCOL

ULNAR COLLATERAL LIGAMENT (UCL) RECONSTRUCTION REHABILITATION PROTOCOL General Notes As tolerated should be understood to include with safety for the surgical procedure; a sudden increase in pain, swelling, or other undesirable factors are indicators that you are doing too

More information