Mini Open Rotator Cuff Repair Small Tears < 1 cm

Transcription

1 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 the protocol guidelines. For example tendon to bone healing requires 12 weeks of healing and strengthening may need to be postponed. Size: small = < 1 cm, medium = 1 3 cm, large = 3 5 cm, massive = > 5 cm Always note if biceps tenodesis or repair has been performed obtain surgical report. Note which rotator cuff muscle was repaired. Muscle actions: Supraspinatusabduction assists external rotation with shoulder abduction, internal rotation with shoulder flexion. It is also a stabilizer. Subscapularis internal rotation. Teres Minorexternal rotation, transverse abduction and transverse extension. Infraspinatusexternal rotation, transverse abduction, transverse extension. Phase I Immediate Post Surgical Phase (Days 1 10) Maintain Integrity of the Repair Gradually Increase Passive Range of Motion Diminish Pain and Inflammation Prevent Muscular Inhibition Precautions: No lifting of objects No excessive shoulder motion behind the back No excessive stretching or sudden movements No supporting of body weight by the hands Keep incision clean and dry Page 1 of 6

2 Days 1 6: Sling or Abduction pillow brace Pendulum Exercises Passive ROM Flexion to tolerance ER/IR in Scapular Plane (pain free ROM) limit ER and IR to degrees Abduction to 45 Elbow/Wrist/Hand Gripping & ROM Exercises (no AROM elbow flexion if biceps tenodesis or biceps repair for 4 weeks) Ice minutes 4 6x a day Sleep in sling or pillow brace Days 7 10: Pendulum Exercises Progress Passive ROM guidelines Flexion to 115 ER in Scapular Plane to IR in Scapular Plane to Abduction to 90 (pain free) Continue Elbow/Hand ROM & Gripping Exercises Continue Use of Ice for Pain Control Continue Sleeping in Brace/sling until Physician Instructs Phase II Protection Phase (Day 11 Week 5) Allow Healing of Soft Tissue Do Not Overstress Healing Tissue Gradually Restore Full Passive ROM (Week 4 5) Re Establish Dynamic Shoulder Stability Decrease Pain & Inflammation Precautions: No sudden jerking motions No supporting of body weight through hands or arms No lifting/carrying heavy objects Page 2 of 6

3 Days 11 14: Passive Range of Motion guidelines o Flexion to o ER in scapular plane o IR in scapular plane o Abduction to 90 Active Assisted ROM o ER/IR in Scapular Plane as per above guidelines Initiate scapular isometrics Submaximal pain free isometrics Flexion with elbow bent to 90 o External rotation o Internal rotation o Elbow flexors (not with biceps tenodesis/repair) Continue all precautions no lifting or excessive motion Continue Use of Cryotherapy as needed Weeks 3 4: Initiate active assistive exercise (week 4) o Forward flexion with therapist assist o External /internal rotation in scapular plane Initiate AROM in external rotation in scapular plane week 4 if pain free Initiate scapular muscular strengthening program Initiate isotonic elbow flexion (not with biceps tenodesis/repair) Week 5: Patient should be nearing full passive ROM Continue active assisted ROM and stretching exercises Progress to AROM scaption as tolerated (do not progress if hiking/substituting) Continue AROM in external rotation Page 3 of 6

4 Phase III Intermediate Phase (Weeks 6 11) Full Active ROM (Week 8 10) Maintain Full Passive ROM Dynamic Shoulder Stability Gradual Restoration of Shoulder Strength Gradual Return to Functional Activities Weeks 6 9: Progress AROM flexion and scaption Continue stretching and passive ROM (as needed to maintain full ROM) Dynamic stabilization drills Begin gentle internal rotation behind the back at week 8 Progress from AROM to isotonic/band strengthening program o Side lying external rotation o ER/IR tubing o Prone extension o Prone rowing o Prone horizontal abduction o Elbow flexion o Elbow Extension *Patient must be able to elevate arm without shoulder or scapular hiking before initiating isotonics; if unable, continue dynamic rhythmic stabilization gleno humeral joint exercises If physician permits, may initiate light functional activities Week 10: Therapist may initiate isotonic resistance during flexion *If non painful normal motion is exhibited and no substitution patterns Phase IV Advanced Strengthening Phase (Weeks 12 19) Maintain Full Non Painful ROM Enhance Functional Use of UE Improve Muscular Strength & Power Gradual Return to Functional Activities Page 4 of 6

5 Week 12: Continue ROM & stretching to maintain full ROM Self assisted capsular stretches Progress shoulder strengthening exercises Initiate swimming or tennis program (if appropriate) Week 15: Progress golf program to playing golf (if appropriate) Phase V Return to Activity Phase (Weeks 20 26) Gradual Return to Strenuous Work Activities Gradual Return to Recreational Sport Activities Week 24: Continue progression to sport and /or work activity References: Handbook of Orthopaedic Rehabilitation Brotzman, B and Wilk, K Cardiff and Vale University Health Board Physiotherapy protocols for shoulder Surgery Page 5 of 6

6 Returning to Functional Activities (Guidelines only) Driving: Driving can usually be resumed at 6 8 weeks once AROM is WNL s. MD/therapist will guide you. Return to work: This will be dependent upon the patient s occupation and the demands that their work will pose on their operated arm. In all cases the physician and/or physical therapist should guide the patient. Those in sedentary work may return 6 8 weeks. Those returning to light duties may resume work at 8 10 weeks. Those in physically demanding/ manual jobs may return at 4 months Return to Leisure Activities: Swimming breast stroke 8 10 weeks other strokes weeks except overhead stroke (with caution) Golf 3 4 months Contact/impact sports including football, martial arts 4 6 months Initiation of Active ROM exercises based on size of tear: Surgical Procedure Small Tear < 1 Medium Tear1 3 Large Tear 3 5 cm cm Mini Repair 4 5 wks 6 wks 7 8 wks Arthroscopic Repair 5 wks 6wks Large 7 8 wks Massive 8 12 wks Open Procedure 6 wks 6 8 wks Large 6 12 wks Massive 8 12 Discontinuation of the sling: (AROM limitations still persist even is the sling is discontinued) MD may remove sling earlier. Surgical Procedure Small Tear Medium Tear Large Tear Mini Repair 4 wks 4 5 wks 6 wks Arthroscopic Repair 4 wks 4 5wks Large 6 wks Massive 6 8 wks Open Procedure 6 wks 6 wks Large 6 wks Massive 6 8 wks Last revised: 10/14 Page 6 of 6