Rotator cuff repair rehab has changed dramatically in the past several years due to improved surgical techniques, emphasis on immediate motion, early strengthening and functional activities. There are many factors that determine the speed of recovery. Of critical importance is the type of surgery performed.
The “deltoid split” is currently the least invasive procedure. Rehabilitation may begin immediately, with earlier return to functional activities. Rehabilitation following a “deltoid resection” typically does not begin until 4-6 weeks following surgery. Other factors influencing the pace of rehabilitation are: Tear size, integrity of surrounding soft and osseous tissues, mechanism of failure, the patient’s age, health and home exercise program compliance.
Early movement facilitates healing and assists in preventing adhesions. Passive and active assisted movements are done in a pain free and tolerable range, with careful attention to avoid forceful external rotation. Early strengthening is equally important as the compressive forces of the rotator cuff muscles (supraspinatus, infraspinatus, teres minor and subscapularis) center the humeral head with active movements. Submaximal (gentle) isometrics are initiated at pain free intensity. Strengthening and proprioceptive activities are gradually progressed to restore the muscle balance of the rotator cuff and scapular muscles. A deficit in external rotation strength results in the ability to raise the arm or a prominent shoulder shrug with active movements. This shrug or “Codman Hitch” is normal but should resolve by 10 weeks post-op.
PURPOSE:
To restore functional mobility and stability of the glenohumeral joint after surgery.
TREATMENT GOALS:
- Maintain repair integrity
- Diminish pain and inflammation
- Restore functional mobility
1. Full passive ROM by 7-8 weeks
2. Full pain free active ROM by 10 weeks
- Restore functional stability of the shoulder joint:
1. Normalize dynamic humeral head Control, via emphasis of posterior cuff strength, proprioception and endurance
2. Enhance scapular strength, proprioception and endurance
- Gradual return to functional activities
PRECAUTIONS:
- TMJ dysfunctions
- Cancer
- Elderly/ minors
- Bone spurs
- No increase pain should be felt
- Make sure patient is not experiencing symptoms of dizziness or nausea after treatment.
COMMENTS:
- Moist heat used to increase muscle relaxation
- Patient positioned supine/ prone and patient’s comfort determines choice of position
- Lumbar traction usually started fifty percent patient’s body weight unless indicated other wise
- Cervical traction usually started at twelve to fifteen pounds unless indicated other wise
