Procedure: Rotator Cuff Repair (large) - PDF Document

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  1. Procedure: Rotator Cuff Repair (large) PHASE: HOSPITAL STAY POST-OP 1.NO AROM, AAROM, RROM OF THE SHOULDER JOINT 2.Pre-op passive Codman’s pendulum flexion with cautious body rocking. 3.AA/AROM elbow with sling on arm to relax biceps, gentle hand squeeze. 4.OK to perform PROM by therapist in post –op if patient stays overnight. Limits per phase I. 5.Cryotherapy x 15 minutes every hour. 6.Hand gentle grip squeezes. 7.Advise on dressing: likely using a button down shirt starting with surgical arm. 8.Immobilizer on all the time except for therapy and sponge bathing. 9.Patient should be independent with safe ambulation with/without assistive device, icing to shoulder, and aware of no active shoulder movement. Issued HEP and “do’s and don’ts” handout. “DO NOT…” •Remove arm from sling or brace except for cautious exercises given to you by the therapists and for bathing when the doctor says it is okay to bathe. •Actively move or use your shoulder or upper arm for 6 weeks. This could damage the surgical repair and cause your shoulder to lose function. •Be too “brave.” Please use the pain medication and ice and call the doctor if the pain is not tolerable. There will be some “pain” or “discomfort”. •Lift objects, make sudden movements, or support your body weight through the hand or elbow. Do not reach behind back. •Be late for Physical Therapy ☺!!! Please call us if you are late, need to cancel, or reschedule. “DO…” •Follow doctor’s instructions. Call him/her if you need to. •Ice 15-20 minutes every hour for pain and swelling for the first 5-10 days. •Continue icing 4-6 times/day for 10-14 days, then use ice as needed (especially after exercise). Your therapist can tell you when a hot pack is good to use. •Wear your sling at all times. •Sleep in sling. •Wear sling over a shirt, keep armpit clean and dry. Wash armpit by leaning forward and toward the surgery arm. A dry washcloth can be worn under the arm to protect the skin from rashes. •It is okay to move fingers and wrist, but not forcefully. The therapist will show you other exercises. •Remove the wrist from the sling to allow elbow to straighten and relax. •Place a pillow under the elbow when sitting and relax the shoulder and muscles between the neck and shoulder. •Plan on bringing a spouse, family member, or friend to therapy whom could possibly learn to perform some “passive” shoulder movement for you at home. This may take 1-2 appointments to learn and would likely occur in the first 1-2 weeks. Call PT with questions or concerns: 608-637-4385

  2. Procedure: Rotator Cuff Repair (large) Phase I (0-6wks) Issues Requiring Urgent Ortho Consult: Phone # (608) 637-4704 1)Significant, uncontrolled pain 2)Non-healing incisions or draining wounds 3)Failure to comply with restrictions/immobilizer use Activity Recommendations: 1) 2 wks begin submaximal, pain free isometrics in 0° GH position 2) 6 wks begin AAROM in gravity eliminate positions within ROM guidelines 3) Perform hand, wrist, elbow, and neck AROM exercises. ROM Restrictions: No AROM, Resisted ROM Weeks post op 0-2wks Flexion Unlimited Abduction 0-90° ER (0° abd.- mod. neutral) ER 90° None IR To chest 2-4wks Unlimited 0-120° if ER to 45° 0-45° 4-6wks Unlimited 0-180° 0-60° 0-30° None 0°-mod neutral to chest Neutral Neutral 0-90° 0-45° GH Extension Horizontal Adduction Neutral Neutral 0-30° 0-30° Activity Restriction: 1)Arm in an immobilizer at all times except for PROM and sponge bathing(in Codman’s position) 2)No aggressive or end range mobilizations 3)No W/B thru UE with transfers 4)No pushing or pulling through UE with transfers Home Instructions: 1)Caregiver PROM to limits above (if capable) 2)Icing 5X/day 3)Elbow flexion/extension, forearm pronation/supination, wrist all planes AROM PT Goals: Impairment Based: 1)PROM and AROM to limits above 2)Muscle activation of rotator cuff without joint motion/shoulder muscles in all planes 3)Elbow, wrist, c-spine ROM WNL Function Based: 1) 100% compliant with use of immobilizer and HEP/activity restrictions

  3. Procedure: Rotator Cuff Repair (large) Phase II (6-12 wks) Issues Requiring Urgent Ortho Consult: Phone # (608) 637-4704 1) Signs of repair failure/re-tear Activity Recommendations: 1)Aggressive end ROM stretching 2)Joint mobilization (I-V ok) 3)Resisted biceps/triceps ok with supported shoulder 4)UBE for ROM/increase endurance ok: no resistance ROM Restrictions: PROM full; AROM full against gravity Activity Restrictions: 1)No rotator cuff resistance exercises until 12 wks post op. 2)No resisted UBE 3)Job/work restrictions per MD guidelines (pt. specific) Home Instructions: Per PT discretion to achieve Phase 2 specific goals PT Goals: Impairment Based: 1)AROM to 80% of WFL 2)MMT strength grades to 3/5 by 12 wks 3)Improve GH joint mobility to normal 4)Improve rotator cuff muscle endurance to 10 reps against gravity without substitution/compensation Function Based: 1)Independent dressing, bathing, grooming, and use of involved UE 2)Driving independently and safely 3)Retrieve object up to 1 lbs from shoulder height (cup, plate, magazine) and place at waist height (counter top)

  4. Procedure: Rotator Cuff Repair (large) Phase III (12+wks) Issues Requiring Urgent Ortho Consult: Phone # (608) 637-4704 1) Signs of rotator cuff failure/re-tear Activity Recommendations: 1)May begin multi-speed isokinetic strengthening 2)UBE with resistance 3)Isotonic thru full ROM 4)Begin CKC exercises as tolerated 5)Plyometrics at 16+wks if strength is 80% of uninvolved UE ROM Restrictions: None Activity Restrictions: 1)No lifting ≥ 3-5 pounds away from the body until strength is 80% on Isokinetic evaluator or 4/5 MMT of rotator cuff 2)No lifting ≥ 15-20 pounds with biceps 3)No repetitive overhead work until strength 80% isokinetic or 4/5 MMT Home Instructions: Per PT discretion to achieve below goals PT D/C Goals: Impairment Based: 1)Isokinetic 80% strength eval or 4/5 MMT 2)Maximize AROM in all planes to 100% of uninvolved UE with good form Function Based: 1)Pt. specific based on ADL, work, sport, recreational activities 2)Unrestricted at 6 months