brigham and women's rotator cuff repair protocol

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GOALS: 1. As a full committee member, University of Medicine and Dentistry of New Jersey in Newark. J Shoulder Elbow Surg. Phase I: Days 1 to 28 Days 1 to 6 . Shoulder Motion. 2 Post-Op Debridement without Chondroplasty, Osteoplasty or Microfracture: Gait: WBAT with crutches-may advance off crutches if no pain and normal gait pattern Dressing: Removed at first PT visit, cleansed and band-aids applied Exercise Recommendations: Avoid supine straight leg raise, trunk curls with hip flex, Bony Mallet Fracture CRPP. Day 1 - 3 weeks. It is not a big operation to repair a torn rotator cuff, but the rehabilitation time can be long depending on the size of the tear and the quality of the tendons/muscles. It was postulated that this patient should progress well with a treatment program that focused on reducing rotator cuff inflammation, regaining rotator cuff strength, and restoring normal shoulder func-tion. It's one of the most important parts of the shoulder. Advance hinged elbow brace to 15-110. Most rotator cuff tears can be repaired surgically by reattaching the torn tendon(s) to the humerus. Mastersling with body . Carpal Tunnel Release. 55 11 99270-9895 sac@kidsfashionwear.com.br Rua Jorge Rizzo, 89 - Pinheiros - SP CEP 05424-060 - So Paulo 3. An injury to the rotator cuff, such as a tear, may happen suddenly when falling on an outstretched hand or develop over time due to repetitive activities. Specific interventions should be based on the needs of the individual and should consider exam findings and clinical decision making. o Prone T's and Y's o Begin supine, low intensity rhythmic stabilization at 110-120 flexion for rotator cuff and deltoid co-contraction. Elizabeth Matzkin, MD, is Board Certified and fellowship trained Orthopaedic Surgeon specializing in Sports Medicine at Brigham and Women's Hospital. Week 2: Progress above exercises, begin sub-maximal and pain-free wrist, elbow flexion and elbow extension isometrics. Throwing a baseball can create up Light active scapular strengthening . These muscles originate on the shoulder blade and attach to the humeral head. Open in a separate window. ROTATOR CUFF REPAIR Most rotator cuff tears can be repaired surgically by reattaching the torn tendon (s) to the humerus. It is by no means intended to be Normalize motion and activities of daily living during this period. Failure rates of up to 90% have been reported for rotator cuff repair (RCR) of large, multi-tendon tears.2 Most larger tears are degenerative, often with an acute trauma . , 4.6 out of 5. (70 Ratings, 12 Comments) About Our Process. Rotator cuff strengthening with light Theraband - ER and IR with arm at side and pillow or towel roll under arm - Flexion to 60 degrees - Abduction to 60 degrees - Scaption to 60 degrees - Extension to 30 degrees Standing rows with Theraband Prone scapular retraction exercises (with light weight) Ball on wall (arcs, alphabet) When overused or injured, tendons in the rotator cuff can tear and may require surgery to repair. More Courses View Course Rehabilitation Protocol for Rotator Cuff Repair-Small to Medium Sized Tears This protocol is intended to guide clinicians and patients through the post-operative course of a rotator cuff repair. DEVELOPED: 4/2008 . 1 OF 4 . Protocol Delays: o The start of this protocol will be delayed 3-4 weeks following rTSR for a revision or in the presence of poor bone stock based on the surgeon's assessment of the integrity of the surgical repair. COPYRIGHT*2014*CRC*"BRIAN*J. In this course Anthony Maritato, PT licensed physical therapist reviews some of the best post surgical rehabilitation protocols in the world. Both Bone (Radius and Ulna) Forearm Fracture ORIF. whenever you wish and gently move the elbow, wrist and fingers. 2009 Jan-Feb;18(1):138-60. doi: 10.1016/j.jse.2008.06.004 Clavicle Nonoperative. MD follow-up visits at Day 1, Day 14 with nurse for suture removal, Month 1, Month 3, and Year 1 Post-op. Department of Rehabilitation Services, Brigham and Women's Hospital. 2 Stage Tendon Grafts Lecture. Rehabilitation or specific.Patients undergoing arthroscopic rotator cuff repair still require a limited period in a sling (usually 4 to 6 weeks) with some simple range-of-motion exercises at home. Hip Arthroscopy Labral Repair Protocol PG. o Advance kinesthetic awareness exercise to multi-angle and gradually work from short to long lever arm o CKC progression: quadruped, ball compression, wall push ups, knee push ups. Isometric strengthening exercises can begin 14-18 weeks after surgery. The rotator cuff is made up of muscles and tendons that hold the shoulder in place. ROM Exercises; Maximise shoulder strength of deltoid, intact cuff muscles and scapula stabilisers. REVISED: Special Note: This protocol is only a guideline and not intended to substitute for appropriate clinical . Non-Operative Rotator Cuff Tear Protocol Acute/early phase (limited, painful AROM, painful resisted testing) Sub-acute/mid phase . DECELERATED ROTATOR CUFF REPAIR PROTOCOL Dr. David R. Guelich This rehabilitation protocol has been developed for the patient following a large to massiverotator cuff surgical procedure. Returning to work - Rotator cuff For most sedentary jobs, a week off work is recommend. SUBSCAPULARIS REPAIR REHABILITATION PROTOCOL ! Brace Abduction brace/sling, remove sling only to bathe and to complete exercises. You may have a small foam cushion between your arm and your body. 7 April . Posterior splint applied in operating room at 90 elbow flexion and neutral forearm. Weeks 10-12 The intent of this protocol is to provide guidelines for your patient's therapy progression. 7 April . rotator cuff muscles may also be recommended. Clavicle ORIF. ACTIVITIES WHEN YOU GO HOME: 1. Subpopulations protocol for an OA Trial Bank systematic review and. Boileau P, quantify the prevalence of mood disorders in patients undergoing arthroscopic rotator cuff repair using a large claims database and 2) compare opioid use and medical costs . ROTATOR CUFF REPAIR PROTOCOL ; Indiana 724.465.2676. A surgical repair is indicated when pain *COLE,*MD,*MBA RANGE OF MOTION IMMOBILIZER EXERCISES PHASE I 0-6 weeks 0-3 weeks: None 3-6 weeks: Begin PROM Limit 90 flexion, 45 ER, 20 extension 0-2 weeks: Immobilized at all times day and night Off for hygiene and gentle home exercise according to Department of Rehabilitation Services, Brigham and Women's Hospital. Background: N/A Definitions: N/A Procedure: PHASE I (surgery to 2 weeks after surgery) Rehabilitation appointments begin 3-5 days after surgery Goals: Protect the post-surgical repair 2). She serves as the Chief of Women's Sports Medicine and her clinical interests are focused on preventing and providing care for sports injuries. 1 The annual cost of treating shoulder pain was $7 billion in the year 2000 in the United States. PAGE . She performs minimally invasive arthroscopic knee and shoulder surgery including ACL reconstruction . Strengthening. ROTATOR CUFF REPAIR PHYSICAL THERAPY PROTOCOL (+/- SUBSCAPULARIS REPAIR) (+/- MINI OPEN BICEPS TENODESIS) Dr. Domb would like to personally thank you in advance for taking care of our mutual patient post-operatively. Punxsutawney 814.938.0740 . Begin gentle isotonic and rhythmic stabilization techniques for rotator cuff musculature strengthening (open and closed chain) Continue cryotherapy as necessary Phase II - Active Range of Motion Phase (starts approximately post op week 4) Goals: Minimize shoulder pain and inflammatory response Achieve gradual restoration of AROM Begin light waist level functional activities Wean out of sling by the end of the 2-3 postoperative week Return to light computer work Rotator cuff tears can occur from repeated stress or from trauma. Rehabilitation Protocol for Bankart Repair This protocol is intended to guide clinicians and patients through the post-operative course of a Bankart repair. Patte devised a classification system of rotator cuff tears during the 1980's from the findings of 256 cuff repairs. The superiorly migrated humeral head indicates rotator cuff deficiency. Distal Bicep Tendon Repair- Rehabilitation Protocol The intent of this protocol is to provide the clinician with a guideline of the post-operative rehabilitation course for a patient that has undergone a distal biceps tendon repair. Purpose of the abductor pillow is to keep tension off of the repair, avoid adduction. Elbow/wrist/hand AROM w/ no resistance. Contact Rehab Services. Only submaximal activation should be applied, maximal efforts can overload the repair. Rotator Cuff Repair Protocol . Patients with a concomitant repair of a rotator cuff tear and/or a TSA/HHR secondary to fracture or cuff arthropathy should be progressed to the next phase based on meeting the clinical criteria (not based on the postoperative time frames) as appropriate in collaboration with the referring surgeon. ROTATOR CUFF REPAIR PROTOCOL ; Indiana 724.465.2676. Begin early shoulder motion . Specific interventions should be based on the needs of the individual and should consider exam findings and clinical decision making. Begin isometrics of rotator cuff and periscapular musculature Phase III - Moderate Strengthening (weeks 6-12): Goals: Full PROM forward elevation Active flexion in the plane of the scapula to 120 degrees without shrug Gradual restoration of shoulder strength, power and endurance Gentle increase external rotation Arthroscopic Labral Repair Protocol-Type II, IV, and Complex Tears: Protect Surgical Repair 3. If you need to continue to complete range of this information about an athymic rat rotator cuff and your experiences may begin musculature, wrist and massive rotator cuff repair protocol brigham and. She performs minimally invasive arthroscopic knee and shoulder surgery including ACL reconstruction . Fig 8. The prosthesis has 5 parts: the glenoid base, the glenosphere, a polyethylene cup, humeral neck, and the humeral Figure 3. Core and lower body strengthening OKC Shoulder rhythmic stabilizations in supine at 90 elevation (stars or alphabet) Investigation performed at Brigham and some's Hospital Boston Massachusetts USA. It is not a big operation to repair a torn rotator cuff, but the rehabilitation time can be long depending on the size of the tear and the quality of the tendons/muscles. bigger than rotator tear protocol brigham and massive womens over and protocols massive rotator tear protocol brigham and. Precautions No lifting or activities that cause pain. Elizabeth Matzkin, MD, is Board Certified and fellowship trained Orthopaedic Surgeon specializing in Sports Medicine at Brigham and Women's Hospital. Brigham and Women's Faulkner Hospital Rehabilitation Services 1153 Centre Street - 2nd Floor Boston, MA 02130 617-983-7271 General Information Arthroscopic Rotator Cuff Repair is performed when there is a tear of one or more of the four muscles that comprise the Rotator Cuff. If you need to continue to complete range of this information about an athymic rat rotator cuff and your experiences may begin musculature, wrist and massive rotator cuff repair protocol brigham and. Latissimus dorsi tendon transfer protocol The intent of this protocol is to provide the physical therapist with a guideline/treatment protocol for the postoperative rehabilitation management for a patient who has undergone a latissimus dorsi tendon transfer (LDTT) for an irreparable rotator cuff tear. Isometrics . Selection and management of a postoperative rotator cuff repair rehabilitation protocol is a vital component in achieving pain control in patients, a reliable . It is not a big operation to repair a torn rotator cuff, but the rehabilitation time can be long depending on the size of the tear and the quality of the tendons/muscles. Rotator Cuff Repair. However, areas of the surface did not change as dramatically, demonstrating some degree of disorganization. May add The conservative approach may be associated with post-operative stiffness which can be managed once healing has occurred. Donohue sports physical and acl repair protocol brigham and bracing preventing a single surgery understanding surgery. This protocol uses the same components as that for small to medium tears but introduces most of them at later stages. 1 Chung SW et al. Mumford procedure rehab protocol. Total Number of Arthroscopic Rotator Cuff repair surgeries performed by Dr. Laurence D. Higgins at Brigham and WomensHospital = 200. 250 South Main St. Suite 224A Blacksburg, VA 24060 540-552-7133 All information contained in this protocol is to be used as general guidelines only. PROTOCOL . patient's readiness to return to activity. Scapular strengthening and dynamic neuromuscular control in OKC and CKC positions CKC should be cautious starting at 12 weeks with hands and knees only. It Illustration of a left shoulder with rotator cuff arthropathy. The rotator cuff is a group of four muscles: the supraspinatus, the infraspinatus, the subscapularis, and the teres minor. It may take several months to be back to normal. Rotator Cuff Repair Post-operative Rehabilitation Protocol. Reverse or inverse total shoulder arthroplasty (rTSA) is becoming a widely accepted surgical intervention. The rotator cuff is a group of four muscles: subscapularis, supraspinatus, infraspinatus and teres minor (Figure 1). ROTATOR CUFF REPAIR Most rotator cuff tears can be repaired surgically by reattaching the torn tendon(s) to the humerus. Control pain and swelling . Arthroscopic repair of massive rotator cuff tears: outcome and analysis of factors 2. If these conservative measures are insufficient, your doctor may recommend arthroscopic surgery During the surgery, your doctor will examine the labrum and the biceps tendon. Clarion 814.226.6573 . Maintain good upright shoulder girdle posture at all times and especially during sling use. MOON Shoulder Post-operative Rotator Cuff Repair Protocol - Therapist Instructions 2 Passive Motion (0-4 weeks) Passive range of motion begins within 7 days after surgery. Apply ice to the shoulder as tolerated to reduce pain and swelling. See what the surgical team from Brigham and Women's Hospital (A teaching affiliate of Harvard Medical School) recommends following a rotator cuff repair surgery. Despite a number of advances in the surgical techniques for rotator cuff repair, postoperative rehabilitation protocols, and treatment options for substantial loss of range of motion . Reverse Total Shoulder Arthroplasty Components. The deltoid muscle is separated to expose the torn . by the rotator cuff muscles, with assistance from the ligaments, glenoid labrum and capsule of the shoulder. She serves as the Chief of Women's Sports Medicine and her clinical interests are focused on preventing and providing care for sports injuries. Total Arthroscopic Rotator Cuff Repair Surgeries = 386. You can . The range of recommendations was between 3 and 6.5 months, but the highest incidence was 6 protocols (35.3%) with a recommendation for RTS at 6 months. Patient Gateway Brigham and Women's . Individually, these muscles either internally or externally rotate the humerus. 1 OF 4 . Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol. Inclusion criteria were the following: primary arthroscopic rotator cuff repair during the study period, at least 1 year from the date of surgery, and age older than 18 years. The Gundersen Health System Rehabilitation Programs are evidence-based and soft tissue healing dependent programs designed to allow patients to progress to vocational and sport-related activities as quickly and safely as possible. Monday through Friday. In the case of a delayed therapy start, the following timeframes are to be adjusted so that day 1 is the first day of therapy. 2 The rotator cuff tendons include supraspinatus, infraspinatus, teres minor, and subscapularis (Figures 1 and and2). This procedure is specifically designed for the treatment of glenohumeral (GH) joint arthritis or complex fractures, when associated with irreparable rotator cuff (RC) damage or in the presence Rotator cuff tears are increasing in frequency in the aging population and are a common issue seen by orthopaedic surgeons.1 In patients with large, multi-tendon rotator cuff tears or retears, treatment can be challenging. REVISED: Special Note: This protocol is only a guideline and not intended to substitute for appropriate clinical . Rotator cuff strengthening in at 90 abduction, and overhead. Hinged elbow braced applied at 30-100 available elbow ROM. Rotator Cuff Repair (Arthroscopic) This protocol is based on maintaining range of movement in the first phase and then gradually building strength in the middle to the last phase. Ice shoulder 3 - 5 times (15 minutes each time) per day to control swelling and inflammation. The decelerated rehabilitation avoids excessive tension on the SS & IS by avoiding excessive scaption, ER, & FF until 4 weeks. The conservative rehabilitation protocol allows Sharpey fibers to form before stressing the repair with resistive exercises. PAGE . PROM shoulder flexion/abduction/ER/IR. The rotator cuff is a group of muscles and tendons that stabilize the shoulder joint, enabling the shoulder in move in different directions. Biceps Tenodesis. Anatomy and Biomechanics . Restore muscular strength and balance. Punxsutawney 814.938.0740 . Rotator Cuff Repair Lattissimus Dorsi Tendon Transfer: Quality Measures from Dr. Warner's Experience Scapulothoracic Winging: Our Experience . Purpose: To determine whether patients who are prescribed ibuprofen after arthroscopic rotator cuff repair have significantly different patient-reported outcomes for pain, function, and overall health at baseline and 1 and 2 years after operation relative to patients only prescribed opioids. Keep the abductor pillow in for the 4 weeks as well. Clipping is a handy way to collect important slides you want to go back to later. Brigham and Women's Hospital . Rotator cuff tears are the leading cause of shoulder pain and shoulder-related disability accounting for 4.5 million physician visits in the United States annually. Rehabilitation Services at Brigham & Women's Hospital has accepted a modification of this protocol as our standard protocol for the management of patient's s/p arthroscopic repair of Type II and IV SLAP lesions. Most commonly, however, this group of muscles co-contracts and . Individual variations will occur based on patient tolerance and response to treatment. Rotator cuff surgery is performed to repair a torn tendon in the shoulder. The deltoid muscle is separated to expose the torn . The course is much slower postoperatively with more precaution to protect the repair. Arthroscopic Rotator Cuff Repair Protocol Arthroscopic Rotator Cuff Repair FAQs and Post-Operative Guidelines Biceps Tenodesis Protocol Biceps Tenotomy Protocol . Orthopaedic Surgery. Passive Range of Motion: Pendulum exercises Active Range of Motion: Cervical, elbow, fingers and hand. The majority of patients with subacromial im-pingement can be successfully managed with Time from tear to repair; Patient variables such as age, arm dominance, pre-injury level, desired level of function, work situation, patient compliance to program; Physician's philosophical approach (Wilk et al, 2000) Protocols. Indications for meniscectomy or meniscal repair are multifactorial and. It is no means intended to be a substitute for one's Protect the repair . The given time frames DEVELOPED: 4/2008 . The deltoid muscle is separated to expose the torn . Begin isotonic rotator cuff, periscapular and shoulder strengthening program. Download Contact Get Directions Request Appointment New patients please call toll-free. Arthroscopic Rotator Cuff Repair Protocol: The intent of this protocol is to provide the clinician with a guideline of the post-operative rehabilitation course of a patient that has undergone an arthroscopic assisted/mini-open rotator cuff repair. Full joint recovery typically takes several weeks. For this reason the shoulder is the most mobile joint in the body. ROTATOR CUFF REPAIR . 2. Figure 2. However, areas of the surface did not change as dramatically, demonstrating some degree of disorganization. It allows you to lift your arm and reach up. Rotator Cuff Repair Rehab Protocol-Brigham and Women's Hospital. this patient's impairments and clinical goals. It is by no means intended to be a substitute for one's clinical decision making Phone: 617-983-7271 Brigham and Women's Faulkner Hospital Rehabilitation Services 1153 Centre Street, 2nd Floor Boston, MA 02130. Rotator cuff repair protocols Small; Medium-large; Massive Pre-op. Patients who underwent rotator cuff repair and participated in the outcomes registry from July 2012 to June 2015 were screened based on inclusion and exclusion criteria. Clarion 814.226.6573 . Breakdown of Rotator Cuff Tendon Repairs: 87 = Revision Cases (23%) 102 = Massive Tears (26%) 353 involved Supraspinatus Tendon (91%) Weeks 7-9 Progress AROM/ PROM Flexion/Abduction to 180 degrees., ER to 90 degrees in 90 deg of abduction IR to 75 degrees in 90 degrees of abduction. Policy Statement: Treatment will follow the defined protocol below and be carried out by Physical Therapist, Athletic Trainer and/or Physical Therapy Assistants. The socket portion of the joint is not naturally deep. Younger individuals have shown to have done better.1 It has been reported that the older an individual is when they have a rotator cuff repair the likelihood of cuff healing diminishes.2 Increased . Specific variations may be appropriate for each patient and may be specified by the physician. Rotator Cuff Repair Post-Operative Protocol Jason Dieterle, DO Supraspinatus = small tear Supra + Infraspinatus = large tear 0-2 WEEKS POST - OP: Wear sling until 4 weeks post op unless specified. Rehabilitation protocols. Phase I: 1 through 4 to 6 weeks post-op: First 3 weeks: Patient education: movement limitations, posture, proper sling fitting, joint protection, and positioning. Figure 1. Methods: Patients who underwent a rotator cuff repair by a total of 3 surgeons and participated in the . You will be instructed by your surgeon to wear your sling from four to six weeks depending upon the size of your tear and thus the extent of the rotator cuff repair, and the sling should be worn at all times. If the injury is confined to the labrum itself, without involving the tendon, the biceps tendon attachment is still stable. Follow Dr. Gill's instructions regarding moving your shoulder after surgery. Investigation performed at Brigham and some's Hospital Boston Massachusetts USA. 4 Corner, STT, RSL Partial Wrist Fusion. Candidates for Protocol Large to massive tear Poor Click any button below to learn about our Therapy Protocols. The shoulder is a wonderfully complex joint that is made up of the ball and socket connection between the humerus (ball) and the glenoid portion of the scapula (socket). If you have questions, contact the referring physician. The classification is based on the: (1) extent of the tear, (2) topography of the PROTOCOL . Week 3: Progress above exercises. INTRODUCTION. Online physiciandirectory.brighamandwomens.org Simon Gortz, MD. 1-855-278-8010. Fix your account, acl repair center at repairing the. Rotator Cuff Repair Therapy Protocol Page 1 of 6 Bart Eastwood D.O. o Begin light isometrics with arm at the side for rotator cuff and deltoid o Advance to therabands as tolerated o Passive stretching at end range of motion to maintain shoulder flexibility Modalities per PT discretion Phase III (Weeks 8-12) Range of Motion - Progress to full AROM without discomfort Return to intense activities following shoulder surgery requires both a strenuous strengthening and range of motion program along with a period of time to allow for tissue healing. In addition, 1 protocol (5.9%) that recommended RTS at 6 months also specified no contact sports for 9 months after surgery. Rotator Cuff Repair - Small to Medium Tear Rotator Cuff Repair - Large to Massive Tear SLAP I & III Protocol SLAP Repair - Type II Subacromial Decompression Protocol Total Shoulder Arthroplasty Protocol Upper Extremity Functional Assessment Elbow Distal Biceps Tendon Repair Protocol Lateral Epicondyle Debridement Protocol No supporting of body weight by hands and arms. Passive range of motion requires the therapist or an assistant at home to put the arm through a comfortable range of motion while the patient is supine.