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ROTATOR CUFF REPAIR Flipbook PDF
ROTATOR CUFF REPAIR - Rehabilitation Protocol Thomas J. Kovack, DO Phase II: Wks 4-6 POC • Continue immobilizer; may be
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ROTATOR CUFF REPAIR Rehabilitation Protocol
Thomas J. Kovack, DO Orthopaedic Specialists of Central Ohio 3663 Ridge Mill Drive Hilliard, Ohio 43026 (614) 544-1401
ROTATOR CUFF REPAIR Rehabilitation Protocol
Thomas J. Kovack, DO
Orthopaedic Specialists of Central Ohio PHYSICAL THERAPY: To evaluate/admit patient within 24 hours of discharge.
Phase I : Weeks 1-3 • Position
•
Evaluation (EVAL) & Exercises
• • •
• • • Frequency of exercises
1. 2. 3. 4. 5. 6. 7. 8. 9.
• •
Protocol (POC) Immobilizer on at all times, except during exercise and while showering. Supine with upper extremity slightly abducted. Place a small pillow or towel behind/under distal humerus. No shoulder ROM Active circumduction performed in pendulum position. Circles not larger than a basketball. AROM: Hand, wrist, forearm and elbow: All motions. When initially performing elbow flexion keep fingertips in contact with body. Well body exercise. Pain management: Instruction in use of ice and positioning. Pendulum position for hygiene. Instruction/Education: Bathing, dressing, donning and doffing immobilizer and precautions. Transfer and gait training as indicated. Exercises performed 2-3 times per day at 10-15 repetitions each session.
Phase I Goals Independent emergency evacuation (enter and exit residence). Independent home exercise program. Independent sit to stand. Independent bed transfer. Minimal assistance donning and doffing immobilizer. Minimal assistance bathing. Minimal assistance dressing. Demonstrate knowledge of precautions. Pain Management 0-4/10
ROTATOR CUFF REPAIR - Rehabilitation Protocol Thomas J. Kovack, DO
Phase II: Wks 4-6
POC •
Continue immobilizer; may be removed for showering and exercise.
Position
•
Supine with upper extremity slightly abducted. Place a small pillow or towel behind/under distal humerus.
Continue
• • • •
AROM: Continue Phase I PRN Education/ADL’s: Continue Phase I PRN Transfer/Gait training: Continue Phase I PRN Pain Management: Continue Phase I PRN
Add
•
PROM and AAROM in supine : Shoulder Gentle external rotation not to exceed 20° Gentle scaption not to exceed 120° Diagonal patterns with a limit of 20° of external rotation and 120° of scaption. Begin: Wand flexion, scaption and external rotation.
Closed kinetic chain
• •
Initiate use of UE for sit to stand. Initiate UE weight shift.
Frequency of exercises
•
Exercises performed 1-3 times per day at 10-15 repetitions each session.
Phase II Goals 1. 2. 3. 4. 5. 6. 7. 8.
Independent car transfer. Independent shower transfer. Independent modified bathing. Independent modified dressing. Independent HEP. Pain Management 0-2/10 AAROM not to exceed 0-120°elevation 20° ER Make recommendations re: outpatient P.T. at 6-7 weeks.
Rotator Cuff Repair - Rehabilitation Protocol Thomas J. Kovack, DO
Phase III: Wks 7-9 Exercises
POC • •
• • Closed Chain
•
Frequency of exercises
•
May discontinue immobilizer. AROM: Initiate AROM exercises in supine/prone increasing elevation gradually within patient’s tolerance. o External rotation not to exceed 35° o Scaption not to exceed 135° o D1 and D2 patterns, triceps, serratus lift in supine, extension. o Sidelying: external rotation. AROM and AAROM: Continue as above RROM: Initiate gentle isometrics. Internal rotation, external rotation, flexion, extension. Progression from Phase II continued. Add resistance and challenge. ROM exercises performed 2-3 times per day until maximum ROM achieved, then performed daily for 3 months, then performed 3 times per week.
Phase III Goals 1. Independent home exercise program. 2. AAROM in supine not to exceed: 0-135° elevation or 0-35°
Phase IV:Wk 10-12 Exercises
POC • •
• • • • Frequency of exercises
•
AROM: Continue Phase I, II, and III PRN. Begin AROM performed in standing: Elevation/Scaption in the plane of the scapula and diagonal patterns. AAROM: Continue as above. Increase ROM as tolerated by patient. RROM: Continue gentle isometrics. ADL’s: Military press in diagonal patterns, grooming, and dressing. Skill activities: Toss light ball with elbows and hands within view for reaction and timing. ROM exercises performed 2 times per day until maximum ROM is achieved, then performed daily for 3 months, then performed 3 times per week. Strengthening exercises performed 3 times per week.
Rotator Cuff Repair - Rehabilitation Protocol Thomas J. Kovack, DO
Phase IV Goals 1. Independent home exercise program. 2. AROM in supine: with UE 45° in scapular plane. Elevation/scaption: 135°, external rotation 35° as tolerated, progress in pain free ROM. 3. AROM in standing: 0-90° elevation.
Phase V: Wk 13 Exercises
POC • • • •
• •
Frequency of exercises
1. 2. 3. 4.
•
A & AAROM: Continue as above. Increase ROM as tolerated by patient. Begin AROM in standing: Elevation/Scaption in the plane of the scapula and diagonal patterns. AAROM: Continue as above. Increase ROM as tolerated by patient. RROM: Initiate gentle strengthening with theraband/tubing in small arcs of motion: internal rotation, external rotation, elevation, abduction, extension to 30 degrees. Progressive strengthening of the shoulder girdle and well body. ADL’s: Military press in diagonal patterns, grooming and dressing. Skill activities: Toss light ball with elbows and hands within view for reaction and timing.
Rom exercises performed 2 times per day until maximum ROM is achieved, the performed daily for 3 months then performed 3 times per week. Strengthening exercises performed 3 times per week. Phase V Goals
Independent exercise program Pain free ADL’s AROM in supine: Elevation/scaption to tolerance Catch light object (demonstrate good reaction and timing.)