10.The dos and don’ts post rotator cuff repair.pptx

rotator cuff repair rehabilitation

1. The dos and don’ts post rotator cuff repair Dr. Ng Chong Sen Sports Medicine Physician HRPZ II

2. Pre-rehabilitation – What’s the aim?

3. Don’ts

4. Why? A study by de Almeida et al. titled: Pre-Operative Scapular Rehabilitation for Arthroscopic Repair of Traumatic Rotator Cuff Tear: Results of a Randomized Clinical Trial showed that pre-rehabilitation I ncreases range of motion, improves function, pain, and daily activities . – this is compared to a control group with no pre-rehabilitation therapy done. [1] Minimum of 6 weeks Cervical spine, elbow, wrist, and hand, and analgesics education. S capular and core stabilization exercises 

5. Stretching exercises

6. Stretching exercises

7. Stretching exercises

8. Stretching exercises

9. Stretching exercises

10. Strengthening exercises

11. Strengthening exercises

12. Strengthening exercises

13. Strengthening exercises

14. Strengthening exercises

15. Strengthening exercises

16. Strengthening exercises

17. Strengthening exercises

18. Strengthening exercises

19. Post rehabilitation rotator cuff repair

20. Know the type of surgery done

21. Aim

22. Which protocol to follow?

23. Immediately post op

24. Immediately post op Finger squeeze exercises Wrist range of motion exercises Elbow range of motion exercises (unless biceps tenodesis was done) Scapular control exercises – squeeze / rhomboid squeeze Cervical range of motion exercises Pain and swelling control

25. Early ROM vs late ROM

26. Early ROM vs late ROM

27. Personal recommendation Week Range of motion Strengthening Criteria to progress 0- 4 / 6 weeks None/Passive by physiotherapist 30 degrees Forward Flexion/Abduction every 2 weeks Allow periscapular strengthening exercises provided patient able to do. No shoulder strengthening Decrease pain Full PROM supine Sleeping through the night Normal posture 6-8 weeks AAROM per patient tolerance Ball on wall Isometric flexion, extension, abduction, ER, IR – 50% effort Isometric lower trap 8-10 weeks AROM per patient tolerance; avoid scapular substitution Arm ergometer Prone exercises – non weighted and below shoulder level 10-12 weeks Continue AROM per patient tolerance Add gentle IR stretching Arm ergometer- moderate resistance Ball on wall Proprioceptive exercises Supine ABC’s Full AROM with no scapular substitution No reactive inflammation with strengthening Return to full ADLs pain free

28. Personal recommendation Week Range of motion Strengthening Criteria to progress 12-16 weeks - Weighted exercises – progressive exercises Terraband exercises Prone with weight exercises Close chain upper extremity exercises Full AROM with no scapular substitution between weeks 10-12 5/5 rotator cuff strength 65-70% IR/ER isokinetic testing 4-6 months Emphasis on posterior capsule stretching General stretching/flexibility program Progressive weighted exercises Add in throwing exercises / program - gradually Completion of throwing progression No reactive effusion, pain and/or instability 65-70% IR/ER isokinetic testing Full functional mobility and strength

29. References

30. Thank you