Rotator Cuff Repair Protocol - Medium to Large
Rotator Cuff Repair Protocol - Medium to Large
Day 1 post-op to 2 weeks
- Change dressings day 1 post-op. Keep portal sites or incision clean and dry. Remove sutures at 7-10 days post-op. Patient then allowed to get area wet.
- Stay in sling except for exercises
- Therapeutic exercise
- Pendulums
- Table slides into flexion, external rotation, and abduction (in scapular plane)
- Supine opposite arm assist flexion
- Supine wand for ER at 45 degrees abduction
- Posterior shoulder rolls or scapular squeezes
- Cervical active range of motion
- Elbow active range of motion
- Hand squeezes
- Manual
- Passive range of motion (ROM) into all ranges to patient tolerance; be careful on internal rotation
- Grade I-II joint mobs to glenohumeral joint with emphasis on posterior and inferior directions
- Scapular manual resistive exercises (MRE)
- In side-lying (contralateral side), resist scapular protraction and retraction with depression
- Ice every 1 to 2 hours for first 72 hours, then 3-4 x/day
- Precautions
- No active use of shoulder
- No putting weight through shoulder
- No reaching behind back
Weeks 2-3
- Goals
- Protect the repair while gaining ROM
- Maintain ROM and strength of distal and proximal joints
- Reduce pain and inflammation
- Stay in sling when up and moving around. Patient can take it off when just sitting and when doing exercises
- Therapeutic exercise
- Continue exercises as above
- Gentle submaximal isometrics at 2-3 weeks for flexion, external rotation, internal rotation, and extension with bent elbow
- Manual
- Passive ROM in all directions to patient tolerance. Patient brought up to 90 degrees abduction for external rotation
- Gentle submaximal isometrics at 2-3 weeks
- Gentle rhythmic stabilization in balance point (100 degrees flexion, 10 degrees horizontal abduction) and neutral rotation with arm by side at 3-4 weeks
- Continue scapular MRE's
- Precautions
- Continue above precautions
Weeks 4-5
- Discharge sling at physician's discretion
- Goals
- Full passive ROM by end of week 4
- Do not overstress healing tissue
- Start to regain dynamic stability
- Therapeutic exercise
- Continue those above
- Supine active assist wand flexion
- Flexion wall crawl with opposite arm assist
- Standing wand extension
- Theraband internal rotation, external rotation, extension
- Side-lying external rotation
- Blackburns 1 (prone horizontal abduction in neutral) and 5 (prone extension with external rotation)
- Manual
- Continue same as above.
- Full passive ROM by 3-4 weeks post op
- MRE for IR/ER and extension
Weeks 6-7
- Therapeutic exercise
- Continue with those as above
- Standing wand flexion (start with bent elbow) progressing to active ROM
- Full active ROM by end of week 7
- Flexion wall crawl without help from other arm
- Horizontal adduction stretch at week 7
- Towel internal rotation stretch at week 7
- Manual
- Continue with those above
Weeks 8-14
- Therapeutic exercise
- Blackburn 3 (prone horizontal abduction with external rotation)
- Add weight to side-lying external rotation and Blackburn 5
- Progress with band color, reps and sets
- Theraband IR/ER at 90 degrees abduction at 9 weeks
- Full can at 9 weeks
- Manual
- Continue as above
- Rhythmic stabilization performed in multiple body positions and ROM
Weeks 15 to 21
- Therapeutic exercise
- Progress with all above exercises
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