Surgical Explanations
Rehabilitation Protocols
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Rotator Cuff
Surgical repair of the rotator cuff involves reattaching tendinous tissue to the surface of the bone about the shoulder. After surgery, plan to rest at home, sleep in a semi-sitting position, and accept the fact that pain medicines may need to be taken on an almost regular basis. After surgery, feel free to take your arm out of the djOrtho Ultra Sling II and move it in small circles. Don’t hesitate to flex and extend your elbow and work the muscles of your forearm.
Physical therapy will be initiated within the first week as they assist you in gaining passive shoulder motion. You may use your arm in the “mid-range” area. Do NOT lift your elbow above your shoulder or place your hand behind your head.
CONSIDERATIONS:
size of the tear (Below are 3 different protocols based on the size of the tear. An operative report is an appropriate guide to the sizing of the tear and subsequent repair technique.)
patient’s age
how long the tear has been present
quality of the tissue
surgical technique employed (mini-open approach , arthroscopic)
acute or chronic tear
co-morbidities (biceps, labral, capsular tears)
medications
overall health of the patient
SMALL ROTATOR CUFF REPAIR
1st 6 WEEKS POST-OP SMALL ROTATOR CUFF TEAR
PROM
Flexion/Scaption (thumb in neutral)
Progress as tolerated by pt to 150 degrees
ER (scaption)
Progress as tolerated by pt to 75 degrees
ABER (to 80 degrees Abd)
Progress ER as tolerated to 45 degrees
IR (scaption)
Progress as tolerated
AAROM
Initiate at 3-4 weeks post-op, not to exceed PROM limits
Strengthening
Isometric submax ER/IR
Initiate at 4 weeks post-op
Scapular retraction
Initiate in sling at 2 weeks post-op
Shrugs
Initiate 2 weeks post-op unresisted
Seated/Standing Row
Initiate at 4 weeks post-op unresisted
Prone Row (saw)
Initiate 2-3 weeks post-op, arm to be raised no higher than parallel to chest, weight of arm only
Other Exercises
Pendulums
Initiate during 1st week post-op
Putty Squeeze
Initiate during 1st week post-op
Wrist/Hand AROM
Initiate during 1st week post-op w/ arm supported on table
Elbow Flex/Ext
Initiate during 1st week post-op w/ arm at side and shoulder in IR
6-12 WEEKS POST-OP SMALL ROTATOR CUFF REPAIR
PROM
Flexion
Full ROM by 10-12 weeks post-op
ER (scaption)
Full ROM by 10-12 weeks post-op
ABER
Full ROM by 10-12 weeks post-op
IR (scaption)
Full ROM by 10-12 weeks post-op
AROM
Initiate at 4-6 weeks post-op or when pt is released from sling, full ROM all planes by 10-12 weeks
Strengthening
Isotonic ER/IR
Neutral or scaption @ 6 weeks post-op progressing to 90/90 position @ 8 weeks post-op
Shrugs
Add resistance at 6 weeks post-op
Rows
Add resistance at 6 weeks post-op
Prone T and Y
Initiate at 8 weeks post-op progressing from unilateral prone on table to bilateral prone on table to bilateral prone over ball
Prone extension w/ ER
Initiate at 6 weeks post-op
Bent row or prone row
Add resistance at 6 weeks post-op
Horizontal abduction
Initiate at 6 weeks post-op
Scaption to 90 degrees
Initiate at 6 weeks post-op
Flexion to 90 degrees
Initiate at 6 weeks post-op
Bicep curls/tricep ext
Add resistance at 6 weeks post-op
Push up progression
Initiate at 6 weeks post-op, progress wall --> table --> knees -->floor
Neuromuscular Re-ed
Rhythmic stabilization
Initiate at 6 weeks post-op
Diagonals
Initiate at 6 weeks post-op, progress from supine to standing and unresisted to resisted
MEDIUM SIZED ROTATOR CUFF REPAIR
1st 6 WEEKS POST-OP MEDIUM SIZED ROTATOR CUFF TEAR
PROM
Flexion/Scaption (thumb in neutral)
Progress as tolerated by pt to 120 degrees
ER (scaption)
Progress as tolerated by pt to 60 degrees
ABER (to 80 degrees Abd)
Hold until 6 weeks post-op
IR (scaption)
Progress as tolerated
AAROM
Wand ER ONLY in scaption plane, gravity assisted progressing to gravity neutral
Strengthening
Isometric submax ER/IR
Initiate at 6 weeks post-op
Scapular retraction
Initiate in sling at 2-3 weeks post-op
Shrugs
Initiate at 3 weeks post-op unresisted
Seated/Standing Row
Hold until 6 weeks post-op
Prone Row (saw)
Initiate at 4 weeks post-op, arm to be raised no higher than parallel to chest, weight of arm only
Other Exercises
Pendulums
Initiate during 1st week post-op
Putty Squeeze
Initiate during 1st week post-op
Wrist/Hand AROM
Initiate during 1st week post-op w/ arm supported on table or in sling
Elbow Flex/Ext
Initiate during 1st week post-op w/ arm in pendulum position
6-12 WEEKS POST-OP MEDIUM SIZED ROTATOR CUFF TEAR
PROM
Flexion
Full ROM by 10-12 weeks post-op
ER (scaption)
Full ROM by 10-12 weeks post-op
ABER
Initiate after 6 weeks post-op and progress as tolerated, full ROM by 10-12 weeks post-op
IR (scaption)
Full ROM by 10-12 weeks post-op
AROM
Hold until 6 weeks post-op, full ROM all planes by 10-12 weeks
Strengthening
Isotonic ER/IR
Neutral or scaption @ 6 weeks post-op progressing to 90/90 position @ 8-10 weeks post-op
Shrugs
Add resistance after 6 weeks post-op
Rows
Initiate at 6 weeks post-op
Prone T and Y
Initiate at 8-10 weeks post-op progressing from unilateral prone on table to bilateral prone on table to bilateral prone over ball
Prone extension w/ ER
Initiate at 6 weeks post-op
Bent row or prone row
Add resistance after 6 weeks post-op
Horizontal abduction
Initiate at 6 weeks post-op
Scaption to 90 degrees
Initiate at 6-8 weeks post-op
Flexion to 90 degrees
Initiate at 6-8 weeks post-op
Bicep curls/tricep ext
Add resistance at 6 weeks post-op
Push up progression
Initiate at 8 weeks post-op, progress wall --> table --> knees -->floor
Neuromuscular Re-ed
Rhythmic stabilization
Initiate at 6-8 weeks post-op
Diagonals
Initiate at 6 weeks post-op, progress from supine to standing and unresisted to resisted
LARGE ROTATOR CUFF REPAIR
1st 8 WEEKS POST-OP LARGE ROTATOR CUFF TEAR
PROM
Flexion/Scaption (thumb in neutral)
Progress as tolerated by pt to 90 degrees
ER (scaption)
Progress as tolerated by pt to 45 degrees
ABER (to 80 degrees Abd)
Hold until 8 weeks post-op
IR (scaption)
Progress as tolerated
AAROM
No AAROM until after 6 weeks post-op (no pulley or wand)
Strengthening
Isometric submax ER/IR
Hold until 8 weeks post-op
Scapular retraction
Initiate in sling at 4-5 weeks post-op
Shrugs
Initiate at 4 weeks post-op unresisted
Seated/Standing Row
Hold until 8 weeks post-op
Prone Row (saw)
Initiate at 6 weeks post-op, arm to be raised no higher than parallel to chest, weight of arm only
Other Exercises
Pendulums
Hold if pt has CPM, show pt pendulum position for dressing/grooming during 1st week post-op
Putty Squeeze
Initiate during 1st week post-op
Wrist/Hand AROM
Initiate during 1st week post-op w/ arm in sling
Elbow Flex/Ext
Initiate during 1st week post-op w/ arm in pendulum position, ensure pt maintains a passive shoulder
6-14 WEEKS POST-OP LARGE ROTATOR CUFF TEAR
PROM
Flexion
Full ROM by 12-14 weeks post-op
ER (scaption)
Full ROM by 12-14 weeks post-op
ABER
Initiate after 8 weeks post-op and progress as tolerated, full ROM by 12-14 weeks post-op
IR (scaption)
Full ROM by 10-12 weeks post-op
AROM
Hold until 8 weeks post-op, full ROM all planes by 12-14 weeks
Strengthening
Isotonic ER/IR
Neutral or scaption @ 8-10 weeks post-op progressing to 90/90 position @ 12 weeks post-op
Shrugs
Add resistance after 8 weeks post-op
Rows
Initiate at 8 weeks post-op
Prone T and Y
Initiate at 10-12 weeks post-op progressing from unilateral prone on table to bilateral prone on table to bilateral prone over ball
Prone extension w/ ER
Initiate at 8 weeks post-op
Bent row or prone row
Add resistance after 8 weeks post-op
Horizontal abduction
Initiate at 10-12 weeks post-op
Scaption to 90 degrees
Initiate at 8-10 weeks post-op
Flexion to 90 degrees
Initiate at 10-12 weeks post-op
Bicep curls/tricep ext
Add resistance at 6 weeks post-op
Push up progression
Initiate at 10 weeks post-op, progress wall --> table --> knees -->floor
Neuromuscular Re-ed
Rhythmic stabilization
Initiate at 8 weeks post-op
Diagonals
Initiate at 8-10 weeks post-op, progress from supine to standing and unresisted to resisted |
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