Balazs Galdi, M.D. - PDF Document

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  1. Balazs Galdi, M.D. 140 Bergen Street, ACC D1610 Newark, NJ 07103 Tel: (973) 972-8240 Fax: (973) 972-9367 ARTHROSCOPIC SMALL/MEDIUM ROTATOR CUFF TEAR REPAIR POST-OPERATIVE PHYSICAL THERAPY PROTOCOL RECOMMENDATIONS: No driving until 6 weeks post-surgery Encourage passive ROM at home daily by family member Wean from sling during daytime after 2 weeks; nighttime between 4-6 weeks PHASE I (0-2 Weeks Post-Op) Precautions: ER to 40 degrees at 0 degrees elevation in the scapular plane Elevation to 140 degrees; IT with thumb tip to L1 (avoid extension) Sling for days 1 to 14 then discourage except as visible sign of vulnerability in uncontrolled environment Sleep in sling No lifting heavy objects No shoulder motion behind body Keep incision clean and dry Physical Therapy: Grade I-II glenohumeral joint mobilizations; scapulothoracic joint mobilizations PROM within precautionary ROM (emphasize isolated GH elevation) Minimal manual resistance for isometric ER/IR at 45-60 degrees scapular plane elevation (supported) in supine after POD 7 Minimal manual resistance for rhythmic stabilization of GH joint at 90 degrees elevation after POD 7 Elbow/hand ROM and gripping exercises Home Exercise Program: Scapular elevation, depression, protraction, retractions (“scapular clocks”) Pendulums with emphasis on “relaxed” shoulder and using trunk as prime moving force Supine passive ER and elevation in scapular plane with cane

  2. Closed chain isometric ER and humeral head depression with arm in scapular plane and supported at 90 degrees of elevation Cryotherapy (ice) 6 to 7 times daily PHASE II (2-6 Weeks Post-Op) Goals: Allow healing of soft tissue Avoid over stress of healing tissue Reestablish dynamic shoulder stability Decrease pain and inflammation Gradually restore fully passive ROM (target to achieve FROM by 8 weeks) Precautions: No supporting body weight by arms and hands No lifting heavy objects Physical Therapy: Grade I-IV glenohumeral mobilizations and scapulothoracic mobilizations Passive ROM with target of normal ROM by 8 weeks Minimal manual resistance for isometric ER and IR and rhythmic stabilization (flexion, extension, horizontal abduction/adduction) at 45, 90, and 120 degrees elevation in the scapular plane as patient gains control of upper extremity AAROM progressing to minimal manual resistance for PNF patterns Aquatic therapy: increase speed of movement and resistance as tolerated, progress to using hand as a “paddle” and then to webbed gloves; also add periscapular strengthening Begin active ROM without weights Add light resistance as patient gains control of movement with good biomechanics. Exercises should include: oElevation in scapular plane (supine initially, progress to inclined, then upright) oSidelying ER; prone rowing; supine serratus “punches” oProgress to IR on light pulleys or Theraband (after 6 weeks post-op only) oProgress to upper body ergometer (UBE) at low resistance Home Exercise Program: As in Phase I, progress PROM as to FROM Add shoulder pulley

  3. PHASE III (6-12 Weeks Post-Op) Goals: Primary goal is to restore full PROM by 6-12 weeks Active ROM and strength should be within functional limits prior to discharge Precautions: Refer to physician for advice regarding activity restrictions Physical Therapy: Glenohumeral joint mobilizations and PROM when indicated Progress exercises in Phase II with increased weight based on 3 sets of 10 reps Gradually add following exercises and progress weights: oPeriscapular strengthening oManually-resisted PNF patterns oER, IR, and PNF patterns on pulleys oER, IR at 90 degrees abduction o“Empty can” exercise Begin functional progression for sports and activity specific tasks Begin isokinetics for ER and IR at 12 weeks post-op; begin in modified abduction and progress to supine or sitting 90 degrees abduction position Home Exercise Program: Maintain PROM Light Theraband for ER, IR, elevation, and “empty can” on non-op PT days Progress to independence with strengthening program prior to discharge PHASE IV (12-20 Weeks Post-Op) Goals: Advanced strengthening Gradual return to functional activities and sport