Presentation Transcript

  1. Shane Seroyer, MD Sports Medicine / Arthroscopy Joint Replacement Keith Meister, MD Sports Medicine / Arthroscopy Head Team Physician Texas Rangers ROTATOR CUFF TENDONITIS/IMPINGEMENT PROTOCOL Goals: •Reduce pain and inflammation •Maximize ROM/flexibility of glenohumeral and scapulothoracic joints •Maximize strength/endurance of rotator cuff and scapular musculature •Educate client in short –term use of sling for protection and active-rest if necessary •Educate client in home exercise program and self-management techniques •Return client to ADL’s/recreational/occupational and sport activities Phase I – Maximal Protection Phase •Pain-free AAROM: •Pendulum exercises •Pulley •T-Bar to tolerance •Flexion/extension •Abduction/adduction •ER/IR (start at 0 degrees abduction, progress to 45 degrees and then 90 degrees abduction) •Strengthening exercises: •Isometrics (all planes at sub-maximal, pain-free level) Tubing ER/IR at side in late phase • Pain/inflammation modalities Phase II – Moderate Protection Phase • Continue ROM exercise and initiate self-capsular stretches: Anterior capsule/pectoralis major and minor stretch (corner stretch) Inferior capsule stretch Posterior capsule stretch (standing, sideling IR) • Initiate therapist assisted mobilizations and stretching as needed • Progress strengthening exercises (dumbbell and T-band for RTC and scapular muscles) Flexion/Scaption Sideling ER Prone horizontal abduction Prone rows •Initiate upper extremity cycle for endurance •Initiate neuromuscular control exercises: Rhythmic stabilization (2 arms → 1 arm → eyes open → eyes closed) Ball on wall circles, ABC’s etc •Continue pain control modalities as needed Home to the Texas Rangers MD Ph 817-419-0303 PT Ph 972-623-2629 PT FAX 972-623-2661 3533 Matlock Road, Arlington, Texas, 76015 MD FAX 817-468-5963

  2. Phase III – Minimal Protection/Dynamic Strengthening Phase •Continue ROM/mobilizations/capsular stretching exercises •Strengthening: •Continue dumbbell strengthening •Continue T-band program for endurance •Initiate isokinetic strengthening in neutral with high speeds/high reps •Initiate latissimus, pectoralis, and deltoid strengthening with shoulder precautions •Continue neuromuscular control activities: Initiate plyometrics (2 handed → 1 handed) •Continue pain/inflammation control modalities prn Phase IV – Return to Activity Phase •Continue strengthening program •Continue ROM/flexibility program •Continue neuromuscular control program •Initiate interval sport program Criteria for return to play: •Physician approval •Satisfactory ROM •Satisfactory strength test •Satisfactory clinical exam •Satisfactory completion of interval sport program 2