Rotator Cuff Repair

<H1>Rotator Cuff Repair</H1> <H2>Post-Operative Physical Therapy Protocol</H2> GENERAL CONSIDERATIONS •    This protocol is a guideline only; actual progression will be based on clinical      presentation •    Early passive range of motion of the glenohumeral joint to prevent capsular      adhesions is essential •    This early ROM is done in a manner that shortens the involved muscle:  i.e., for      supraspinatus avoid adduction past midline and external rotation •    DO NOT elevate surgical arm above 70 degrees in any plane for the first 4 weeks      post-op •    DO NOT lift any objects over 5 pounds with the surgical arm for the first 6 weeks •    AVOID EXCESSIVE reaching and external/internal rotation for the first 6 weeks •    Ice shoulder 3-5 times (15 minutes each time) per day to control swelling and      inflammation   •    An arm sling is used for 4 weeks post-op.  Sling wear during sleep is optional      depending on comfort •    Maintain good upright shoulder girdle posture at all times--especially during sling use •    M.D. follow-up visits at Day 1, Day 8-10, Month 1, Month 3 and Year 1 post-op Weeks 0-2: •    M.D. visit day 1 post-op to change dressing and review home program •    Suture removal at day 8-10 post-op •    Exercises (3x per day): 1) pendulum exercises, 2) squeeze ball, 3) triceps and      biceps training with Theraband, 4) pulley passive flexion and scaption (scapular      plane)  0-60 degrees, 5) isometric shoulder abduction, adduction, extension and      flexion with arm at side, 6) scapular pinches every hour, 7) neck stretches for comfort Weeks 2 - 4: •    M.D. visit at 8-10 days for suture removal and check-up •    Use of strapping tape for secondary AC compression and support (optional) •    Soft tissue treatments for associated shoulder and neck musculature for comfort Weeks 4 - 8: •    M.D. visit at Week 4 post-op and will usually be progressed to a more aggressive      ROM and strength program •    At Week 4: start mid-range of motion (ROM) rotator cuff external and internal      rotations active and light resistance exercises (through 75% of ROM as patient's      symptoms permit) without shoulder elevation and avoiding extreme end ROM •    Strive for progressive gains to 90 degrees of shoulder flexion and abduction Weeks 8 - 12: •    Seek gentle full shoulder ROM in all planes-- especially with flexion, abduction,      external rotation and internal rotation •    Increase mobilizations of soft tissue as well as glenohumeral and scapulothoracic      joints for ROM •    Exercises: wand exercises, ROM shoulder pulleys, scapular training (rows,      protractions, lower trapezius work, etc), PNF •    No overhead lifting Weeks 12 and beyond: •    Start a more aggressive rotator cuff program as tolerated •    Start progressive resistance exercises with weights as tolerated •    Continue to seek full shoulder range of motion in all planes •    Increase the intensity of strength and functional training for gradual return to      activities and sports •    Return to specific sports is determined by the physical therapist through functional      testing specific to the targeted sport