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

Transcription

1 Rehabilitatin fllwing Arthrscpic Rtatr Cuff Repair: Large Tear Phase I: Immediate Pstsurgical/Prtectin Phase (Days 1 6weeks) Precautins: N lifting f bjects; N excessive arm mtins; N excessive external rtatin (ER) r internal rtatin (IR) mtins; N excessive shulder extensin; N excessive stretching r sudden mvements; N supprting f bdy weight by hands Keep incisin clean and dry. Precautins islated supraspinatus repair. Cautin with excessive* (>25-35 ) passive and active IR range f mtin (ROM) fr 4 weeks. Precautins cmbined supraspinatus and infraspinatus repair. Cautin with excessive* (>25-35 ) passive and active IR ROM fr 4 weeks. Precautins islated/cmbined subscapularis repair. N ER AROM fr 4 weeks; Avid excessive* (>25-35 ) ER PROM N IR AROM fr 6 weeks. Prgress ER slwly frm 4 weeks until 6 weeks. Precautins if patient had Bicep Tendesis prcedure. Please refer t BT rehab packet fr guidelines. Maintain integrity f the repair Prmte tissue healing Gradually increase passive ROM Diminish pain and inflammatin Prevent muscular inhibitin Day 1 6 weeks Elbw/hand gripping and ROM exercises: perfrm 4-6 times per day (bicep tendesis precautins if applicable) Crytherapy fr pain and inflammatin Ice min apprximately 4-6 times daily Sleeping Sleep in pillw brace until instructed t discntinue. (Typically until 6weeks) Wear sling 24/7 except t shwer and dress Weeks abductin pillw brace Prgressive Table Slides t 90 (pain-free/slide t tlerance) PROM Flexin t 90 (pain-free ROM) ER/IR in scapular plane at 45 f abductin (pain-free ROM, use twel rlls r therapist assisted hld fr supprt) * Limit ER and IR ROM t ; See precautins abve Submaximal pain-free ismetrics (initiate week 6) Flexin with elbw bent t 90 ER IR Elbw flexrs 1

2 Weeks 6 8 Discntinue use f pillw brace prgressively (6-8weeks pst-surgery) Table Slide (ther clsed chain PROM exercises) (increase frm 90 t full PROM) Prgress PROM t tlerance (pain-free ROM) Flexin ER in scapular plane at 45 abductin t 50 + IR in scapular plane at 45 abductin t 45 + (pain-free ROM, use twel rlls r manual hld fr supprt) * Cntinue elbw/hand AROM and gripping exercises (bicep tendesis?) Cntinue ismetrics (submaximal and sub-painful) * AAROM exercises (L-Bar) at 7-8weeks ER/IR in scapular plane at 45 abductin Flexin using L-bar t tlerance* Sub-painful/sub-maximal, gentle and cntrlled AAROM*** * May apply electrical muscle stimulatin t shulder external rtatrs fr muscle reeducatin; initiate at 8weeks pstperatively. Flexin with bent elbw Extensin with bent elbw Abductin with bent elbw ER/IR with arm in scapular plane Elbw flexin Initiate rhythmic stabilizatin (gentle, sub-painful) ER/IR at 45 abductin Cntinue use f ice fr pain cntrl Use ice at least 6-7 times daily* Sleeping discntinue use f sling if cmfrtable in this time perid Phase II: Prtectin/Intermediate Phase (Weeks 8-12) Precautins: N heavy lifting f bjects; N carrying heavy bjects; N excessive behind the back mvements; N supprting f bdy weight by hands and arms; N sudden jerking mtins Allw healing f sft tissue D nt verstress healing tissue Gradually restre full passive ROM (week 6-8) Re-establish dynamic shulder stability Decrease pain and inflammatin Weeks 8 10 Cntinue prgressive PROM t full (Table Slides) Flexin Full ER at abductin t 60 + IR at abductin t

3 AAROM exercises (L-Bar) weeks 9 10 ER/IR in scapular plane at 45 abductin Flexin t tlerance* Rhythmic stabilizatin drills (minimal frce) ER/IR in scapular plane Flexin/extensin at 100 and 125 flexin Cntinue all ismetric cntractins Initiate scapular ismetrics (minimal; pain-free) Cntinue use f crytherapy as needed Cntinue all precautins N lifting N excessive mtin Weeks Bradley C. Carfin, M.D. Cntinue all exercises listed abve but prgressive if tlerated Initiate ER/IR strengthening using exercise tubing at 0 f abductin (use twel rll, minimal) Initiate manual resistance ER supine in scapular plane (light resistance) Initiate prne rwing with arm at 30 abductin (twel rll) t neutral arm psitin Initiate prne shulder extensin with elbw flexed t 90 Initiate istnic elbw flexin (biceps tendesis?) Cntinue use f ice as needed May use heat prir t ROM exercises May use pl fr light active ROM exercises Rhythmic stabilizatin exercises (flexin at 45, 90, 125 and ER/IR at multiple angles) Cntinue AAROM and stretching exercises Especially fr mvements that are nt full - Shulder flexin stpping at 90 in side-lying (gravity eliminated psitin) - ER at 90 abductin (by week 12) Shulder flexin in scapular plane in side-lying at week 10 (n weight) Shulder abductin at week 11 (if n substitutin pattern r pain is present) Prgress istnic strengthening exercise prgram ER tubing Side-lying ER Prne rwing Prne hrizntal abductin (bent elbw) Biceps curls (istnics) very light weight (Bicep tendesis?) Phase III: Intermediate Phase/Early Strengthening phase (Weeks 12-16) Full AROM (weeks 12 14) Maintain full PROM Dynamic shulder stability Gradual restratin f shulder strength Gradual return t ADL s and light functinal activity 3

4 Weeks Cntinue stretching fr passive ROM (as needed t maintain full ROM) Cntinue dynamic stabilizatin drills Prgress active ROM light strengthening prgram ER/IR tubing ER side-lying Lateral raises t 90 f abductin* Full can in scapular plane t 90 f flexin* Prne rwing Prne hrizntal abductin Prne extensin Elbw flexin Elbw extensin * Patient must be able t elevate arm withut shulder r scapular hiking befre initiating istnics. If unable, cntinue glenhumeral jint stabilizatin drills and exercises Cntinue all exercises listed abve If physician permits, may initiate light functinal activities Week 14 Cntinue all exercises listed abve Prgress t fundamental shulder exercises Therapist may initiate istnic resistance (0.5-kg weight) during flexin and abductin* If nn-painful nrmal mtin is exhibited and n substitutin pattern is present Weeks Prgress all exercises Cntinue ROM and flexibility exercises Prgress strengthening prgram (increase 0.5 kg/10 days if nn-painful) * Be sure when prgressing patient, n residual pain is present fllwing exercises Phase IV: Early Strengthening/Advanced Strengthening Phase (Weeks 16-26) Maintain full nn-painful ROM Maintain integrity f repair Enhance functinal use f upper extremity Imprve muscular strength and pwer Gradual return t functinal activities Weeks Cntinue ROM and stretching t maintain full ROM Self-capsular stretches Prgress shulder strengthening exercises Fundamental shulder exercises Initiate interval glf prgram (if apprpriate) week 24 4

5 Weeks Cntinue all exercises listed abve Gradually increase resistance but patient shuld exhibit n pain during r after exercise and n substitutin pattern Phase V: Return t Activity Phase (Weeks 26-36) Gradual return t strenuus wrk activities Gradual return t recreatinal sprt activities Week 26 Cntinue fundamental shulder exercise prgram (at least 4 times weekly) * Prgress glf prgram t playing glf (if apprpriate) Initiate interval tennis prgram (if apprpriate) May initiate light swimming (if apprpriate), weeks Cntinue stretching if mtin is tight Cntinue prgressin t sprt r wrk activity Shuld cntinue fundamental shulder exercise prgram until 12 m. fllwing surgery r until instructed t discntinue 5