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ARTHROSCOPIC ROTATOR CUFF REPAIR REHABILITATION PROTOCOL BY TENDAYI MUTSOPOTSI

ARTHROSCOPIC ROTATOR CUFF REPAIR REHABILITATION PROTOCOL BY TENDAYI MUTSOPOTSI

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The purpose of this protocol is to provide the physiotherapist with a guideline for the post- operative rehabilitation course of a patient that has undergone an Arthroscopic Rotator cuff Repair. It is not intended to be a substitute for appropriate clinical decision-making regarding the progression of a patient’s post-operative course. The actual post surgical physiotherapy management must be based on the surgical approach, physical examination/findings, individual progress, and/or the presence of post-operative complications. If a physiotherapist requires assistance in the progression of a post-operative patient they should consult with Mr. Andrew Sankey (Shoulder Consultant) or Mr. Tendayi Mutsopotsi (Specialist Shoulder Therapist)
The purpose of this protocol is to provide the physiotherapist with a guideline for the post- operative rehabilitation course of a patient that has undergone an Arthroscopic Rotator cuff Repair. It is not intended to be a substitute for appropriate clinical decision-making regarding the progression of a patient’s post-operative course. The actual post surgical physiotherapy management must be based on the surgical approach, physical examination/findings, individual progress, and/or the presence of post-operative complications. If a physiotherapist requires assistance in the progression of a post-operative patient they should consult with Mr. Andrew Sankey (Shoulder Consultant) or Mr. Tendayi Mutsopotsi (Specialist Shoulder Therapist)

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Published by: Physiotherapy Care Specialists on Nov 07, 2012
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12/04/2012

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 Arthroscopic Rotator Cuff Repair Protocol: Tendayi Mutsopotsi (Specialist Shoulder Therapist)
ARTHROSCOPICROTATORCUFFREPAIRPROTOCOL
PHYSIOTHERAPYLEDPOSTOPERATIVESHOULDERCLINIC
COMPILEDBY:TENDAYIMUTSOPOTSIBSc.HPT(Hons)MSc.ORTHO-MEDMCSPMSOM
APPROVEDBY:MRANDREWSANKEYORTHOPAEDICCONSULTANTSURGEON
 
 Arthroscopic Rotator Cuff Repair Protocol: Tendayi Mutsopotsi (Specialist Shoulder Therapist)
 ArthroscopicRotatorCuffRepair
The purpose of this protocol is to provide the physiotherapist with a guideline for the post- operativerehabilitation course of a patient that has undergone an Arthroscopic Rotator cuff Repair. It is not intended to bea substitute for appropriate clinical decision-making regarding the progression of a patient’s post-operativecourse. The actual post surgical physiotherapy management must be based on the surgical approach, physicalexamination/findings, individual progress, and/or the presence of post-operative complications. If a physiotherapist requires assistance in the progression of a post-operative patient they should consult with Mr.Andrew Sankey (Shoulder Consultant) or Mr. Tendayi Mutsopotsi (Specialist Shoulder Therapist)
Please Note:
Recovery takes 6-12 months.The protocol is divided into phases. Each phase is adaptable based on the individual and special circumstances.Immediately post-operatively, exercises must be modified so as not to place unnecessary stress to the repairedrotator cuff of the shoulder.Early passive range of motion is highly beneficial to enhance circulation within the joint to promote healing. The
overall goals
of the surgical procedure and rehabilitation are to:
 
Control pain and inflammation
 
Regain normal upper extremity strength and endurance
 
Regain normal shoulder range of motion
 
Achieve the level of function based on the orthopedic and patient goalsThe physical therapy should be initiated within the first week and one half to two weeks post-op. The supervisedrehabilitation program is to be supplemented by a home exercise program where the patient performs the givenexercises at home or at a gym facility.
Important post-operative signs
to monitor include:
Swelling of the shoulder and surrounding soft tissue
Abnormal pain response, hypersensitive-an increase in night pain
Severe range of motion limitations
Weakness in the upper extremity musculature
Return to activity
requires both time and clinical evaluation. To most safely and efficiently return to normal or high level of functional activity, the patient requires adequate strength, flexibility, and endurance. Functionalevaluation including strength and range of motion testing is one method of evaluating a patient’s readiness toreturn to activity. Return to intense activities following an arthroscopic rotator repair requires both a gradedstrengthening and range of motion program along with a period of time to allow for tissue healing.
 
ProgressiontothenextphasebasedonClinicalCriteriaand/orTimeFramesasAppropriate.
 
 Arthroscopic Rotator Cuff Repair Protocol: Tendayi Mutsopotsi (Specialist Shoulder Therapist)
PhaseI:ImmediatePostSurgical(Weeks1-6):Goals:
Maintain/protectintegrityofrepairPreventmuscularinhibitionGraduallyincreasepassiverangeofmotion(PROM)BecomeindependentwithactivitiesofdailylivingwithmodificationsDiminishpainandinflammation
Precautions:
Maintainarminpolysling/abductionsling,removeonlyforexerciseNoliftingofbodyweightbyhandsNosupportingofanyweightKeepincisioncleananddryNoshouldermotionbehindbackNoexcessivestretchingorsuddenmovementsNoactiverangeofmotion(AROM)ofshoulderNoliftingofobjectsCriteriaforprogressiontothenextphase(II):Passiveforwardflexiontoatleast125degreesPassiveexternalrotation(ER)inscapularplanetoatleast75degreesPassiveinternalrotation(IR)inscapularplanetoatleast75degreesPassiveAbductiontoatleast90degreesinthescapularplane
DAYS1TO6:
Abductionbrace/polyslingSleepinginslingBeginscapulaisometricsPENDULUM,cervical,finger,wrist,andelbowAROMexercisesPatientEducation:posture,jointprotection,positioning,hygiene,etc.CryotherapyforpainandinflammationDay1-2:asmuchaspossible(20minutes/everyhour)andDay3-6:postactivity,orforpain
DAYS7TO28:
Continueuseofabductionsling/braceandPendulumexercisesBeginpassiveROMtotolerance(theseshouldbedonesupineandshouldbepainfree)-Flexionto90degreesandIRtobody/chestERinscapulaplaneupto35(EXCEPTSUBSCAPREPAIR)ContinueElbow,wrist,andfingerAROM/resistedCryotherapyasneededforpaincontrolandinflammationMayresumegeneralconditioningprogram–walking,stationarybicycle,etc.
Aquatherapy/pooltherapymaybeginat3weekspost-op

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