Rehab Protocol for Small (< 2 cm) Rotator Cuff Repair - PDF Document

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  1. Rehab Protocol for Small (< 2 cm) Rotator Cuff Repair Rehab Progression Summary 0-2 weeks Sling/immobilization 0-4 weeks Passive ROM (Phase I) 3-6 weeks Active-assisted ROM (Phase II) 4-8 weeks Active ROM (Phase III) 8+ weeks Strengthening (Phase IV) Immobilization •Sling/abduction pillow is worn for 2 weeks during the day and night •Remove sling for light activity and home exercise program as indicated by therapist Phase I – PROM: 1st post-op visit / 0-3 weeks Goals for Treatment: •Decrease pain and swelling •Increase nutrition and healing response •Infection prevention PROM: •Begin passive ROM exercises in clinic •Pendulum exercise without weight: clockwise, counterclockwise, side-to- side, front-back •PROM: ER, IR, flexion, extension •Table slides •Therapist: grade I, II joint mobilizations •Scapular retractions •Wrist/elbow exercises; grip exercises Patient Education: •Wound inspection •Begin active assisted ROM at 3 weeks •No active motion for 4 weeks, all planes •No weights/PRE for 8 weeks •No active external rotation for 2 weeks •Limit external rotation to neutral for 2 weeks •Sling use as indicated by repair •Icing 3x/day for 20 minutes Other: •Ice •Modalities - PRN 1

  2. Phase II - Assisted-AROM: 3 weeks post-op AROM: •Pendulum exercises with light weight •AAROM with cane & pulleys, to patient tolerance (flexion, abduction - ER to neutral) •Body Blade - opposite hand, straight plane •Shoulder shrugs - light weight/high reps Progress with: •Wall climbing/finger ladder •Scar mobility •J oint mobilizations - grade I/II •Quadruped rhythmic stabilization •Body Blade - opposite hand diagonals with trunk rotation •Biceps curls •Shoulder extension with Theraband •Shoulder shrugs •UBE - active assist only Other: •Ice •Modalities - PRN Phase III – AROM: 4 weeks post-op Progression dependent on quality of repair/tissue AROM: •Continue with Phase II A-AROM •AAROM exercises with cane •AROM - all planes •UBE - forward/reverse •Scapular retraction •Prone extension •Supine “holds” at 90° flexion; progress to small circles •Side-lying “holds” at 90° abduction; progress to small circles •Isometrics <50% effort, no pain (flexion, extension, abduction, ER) •Biceps curls/triceps extensions with light resistances, elbow at side Other: •Ice •Modalities - PRN 2

  3. Phase III – AROM: 6 weeks post-op Progression dependent on quality of repair/tissue Goal: Should have full PROM AROM: •Continue with Phase III exercises, no weight •Low-weight exercise (begin at 90° and increase to full ROM): oflexion/extension oabduction orows oscaption •Wall push-ups, wall push-ups plus •Shoulder IR/ER with low resistance •Scapular protraction (“serratus punch”) •Prone fly Other: •Ice •Modalities - PRN Phase IV – Strength: 8 weeks post-op Goal: Should have full AROM, if not, begin passive stretch to achieve full ROM Strength: •Body Blade, involved extremity: oone-handed grip, abduction to 90° otwo-handed grip, flexion to 90° •Kneeling push-ups, kneeling push-ups plus •Step-ups in kneeling push-up position •UBE with increased resistance •StairMaster in quadruped at level 12-15 •Treadmill in quadruped at 1.0 mph •Plyoball: ocircles, CW & CCW, 1 minute each direction osquares, CW & CCW, 1 minute each direction Other: •Ice •Modalities - PRN 3

  4. Return to Sport-Specific Training: 12-16+ weeks post-op •Continue with Phase IV Strength, increasing reps and resistance as tolerated •Isokinetic testing as directed by physician •Functional testing as directed by physician •Push-ups, push-ups plus •Step-ups in push-up position •Sport-specific exercises as directed by physician and therapist Other: •Ice •Modalities - PRN Courtesy of Vanderbilt Sports Medicine Adapted from MedSport: Ann Arbor, Michigan & Vanderbilt Sports Medicine, Nashville, TN 4