Department of physical therapy, college of applied medical sciences, majmaah university, kingdom of saudi arabia abstract objectives. Bankart repair protocol vanderbilt university medical center. Rehabilitation guidelines after surgery, sports medicine. Partial repair of the inferior part is therefore performed, followed by teres minor tendon transfer under the coracoid figure 25, figure 26, figure 27. Rotator cuff repair protocol boston shoulder institute. Data analysis consisted of 1 assessing changes in outcomes from baseline to final followup and 2 assessing betweengroup differences with the 2tailed student.
If initial nonsurgical treatment of a rotator cuff tear fails, surgical repair is often the next line of treatment. Rehabilitation after rotator cuff repair with subscapularis repair. Literature to support the efficacy of a specific rehabilitation protocol for ssc. Physical therapy standards of care and protocol the following standards of care and protocols are the property of bwh and should not be copied or otherwise used without the permission of the director of rehabilitation services. The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone an arthroscopic assistedminiopen rotator cuff repair.
To serve as a guide to physical therapy following your surgery, this section contains rehabilitation protocols specific to your procedure. Place hand on abdomen above belly button and just below sternum. The subscapularis, located in the front of the shoulder, is one of the four muscles that make up the. New diagnostic techniques and arthroscopic repair surgeries help to treat subscapularis tears. Hand therapy massage therapy occupational therapy physical therapy subscapularis muscle k tape wrist pain trigger point therapy reflexology massage. They provide background on anatomy, etiology causes, diagnosis, and treatment of this condition.
The subscapularis release miracle shoulder pain relief. Correct postural dysfunctions with work and sport specific tasks. The intent of this protocol is to provide the clinician with a guideline of the postoperative. To this end, rehabilitation protocols have proven challenging to both the orthopaedic surgeon and the involved physical therapist. Achilles tendon repair pdf anterior cruciate ligament more about uw health sports rehabilitation acl rehabilitation. The upper subscapular nerve supplies the upper part of subscapularis, while the lower subscapular nerve branches into two, with one branch supplying the lower part of subscapularis. Nov 02, 2017 the subscapularis is the largest of the four rotator cuff muscles. Aaom for forward elevation and er with exercises demonstrated to have. Subscapularis is innervated by both the upper and lower subscapular nerves which come from the posterior cord of the brachial plexus. Purpose of the abductor pillow is to keep tension off of the repair, avoid adduction. Total shoulder replacement postoperative physical therapy. The influence of anatomic total shoulder arthroplasty. Please use this in the contributors listing for the textbook.
Both conservative nonoperative care and surgical treatment are included. In such cases, failure to repair the subscapularis tendon is associated with a poor outcome in a large percentage of individuals. Subscapularis tear recovery time, surgery, symptoms. Total shoulder replacement protocol sports and ortho. Shoulder arthroscopy rehab protocol the stone clinic. This protocol is intended to be a general outline only. It is no means intended to be a substitute for ones. Arthroscopic shoulder rehabilitation protocols shoulder surgeon. At repair sports institute, we pride ourselves on our proactive holistic 3tiered approach to functional medicine. Global rotator cuff protocol with and without subscapularis repair 201910.
Press hand into stomach while rotating elbow forward. Arthroscopic anterior stabilization protocol arthroscopic rotator cuff repair protocol arthroscopic rotator cuff repair faqs and postoperative guidelines biceps tenodesis protocol biceps tenotomy protocol. The aim of this study is to evaluate the effect of subscapularis trigger release and contract relax technique in minimizing pain, improving glenohumeral external rotation and overhead reach of patients. Immobilized at all times day and night off for hygiene and gentle home exercise according to. Physical therapy anterior stabilization of the shoulder.
Subscapularis tendon injuries the normal subscapularis. Rehabilitation minneapolis subscapularis mn sports and. Patients will then progress through a detailed physical therapy program until a full recovery is achieved. Subscapularis tear recovery time, surgery, symptoms, treatment. Achieving the criteria of each phase should be emphasized more than the approximate duration.
Department of rehabilitation services reverse total shoulder. General time frames are given for reference to the average, but individual patients will progress at different rates depending on their age, associated injuries, preinjury health status, rehab. Begin active and manual scapula strengthening exercises. Active release technique has been clinically shown to resolve the impingement pain caused by a subscapularis dysfunction in as few as 26 sessions. Subscapularis tendon injuries boston shoulder institute.
Rehabilitation guidelines for type i and type ii rotator. Rotator cuff repair rehabilitation program largemassive 5cm. If so, this should be done by direct communication with the therapist, or in writing on the therapy referral form given to the patient on the day of surgery. Postoperative rehabilitation following arthroscopic.
Subscapularis rotator cuff repair shoulder surgeon long. Subscapularis repair rehab modifications physical therapy protocol weeks 1 to 6 range of motion no external rotation beyond 0 degrees for six weeks no overhead motion exercises ultrasling for six weeks weeks 6 to 12 exercises stretching program for passive external rotation and overhead stretching flexion and scaption with. Most people do very well following arthroscopic subscapularis repair and can return to heavy work or sports at 612 months. The current biomechanical study showed that subscapularis repair through a humeral prosthesis specifically designed for subscapularis repair options allows subscapularis peel repair to achieve. The intent of this protocol is to provide the physical therapist with a guidelinetreatment protocol for the postoperative rehabilitation management for a patient who has undergone a reverse total. Postoperative rehabilitation following arthroscopic rotator cuff. Keep the abductor pillow in for the 4 weeks as well.
Rehabilitation guidelines for type i and type ii rotator cuff. One high standard, three local partners for more information go to. Allow involved arm to hang down, perpendicular to the floor. The glsm rotator cuff repair rehabilitation program is an evidencebased and soft. This protocol provides you with general guidelines for the postoperative rehabilitation of the patient following a total shoulder replacement. The patient experience at boston shoulder institute physical therapy protocols. Manual therapy during this phase should consist of softtissue techniques. Arthroscopic rotator cuff repair protocol boston shoulder institute. The clinical outcome scores were comparable in patients with an intact repair and those with failed rc healing. The following is a guideline for progression of postoperative treatment. Rotator cuff repair conservative rotator cuff repair moderate rotator cuff tear nonop runwalk program subacromial decompression with distal clavicle resection shoulder impingement shoulder home exercise program preop shoulder physical therapy visit preop slap lesion repair subacromial decompression subscapularis repair protocol. Rehabilitation guidelines for rotator cuff repair and isolated subscapularis repair. The gundersen health system rehabilitation programs are evidencebased and soft tissue healing dependent programs designed to allow patients to progress to vocational and sportrelated activities as quickly and safely as possible. Biomechanical study of a subscapularis repair technique for.
Please note these are meant to be guidelines for rehabilitation to be followed by a certified physical or occupational therapist. Subscapularis is largest muscle of the rotator cuff. The physiotherapist must exercise their best professional judgment to determine how to. At cam, we employ sound rehabilitation protocols to get you back to health and mobility. Rehabilitation after arthroscopic rotator cuff repair. Uw healths sports medicine sports rehabilitation physical therapists and athletic trainers in madison, wisconsin, help injured athletes return to health and return to sport. Sep 01, 2017 a physical therapist pt is assessing a 35yearold patient 5 weeks after large rotator cuff repair, including the subscapularis.
The supraspinatus muscle is the primary superior compressor of the humeral head and resists the superior force exerted by the deltoid muscle. Lifts and supports the plantar arch to relieve pain from plantar fasciitis, flat foot and heel spurs. Manual therapy plays a pivotal role in the effective and expeditious treatment of impingement syndrome as well as recovery from a type ii slap repair surgery. Preop exercises should be on increasing or maintaining overall rom and muscle activation.
Subscapularis exercises available at sports and orthopaedic specialists, serving minneapolis, edina, st. The main purpose of the rotator cuff is to keep the head of the humerus bone centered within the shoulder joint the subscapularis muscle functions as the internal rotator of the rotator cuff. Total shoulder replacement postop physical therapy protocol. What are my precautions regarding movements and positions after surgery. The anterosuperior subluxation of the humeral head, coming in contact with the coracoid, is often associated with fatty infiltration and tendon fragility, preventing complete subscapularis repair. Start physical therapy at 46 weeks subscapularis repair 12 weeks no er past 30 degrees no cross body adduction no active ir or ir behind back no supporting of body weight on affected side i. The subscapularis is the largest of the four rotator cuff muscles. Develop strength and control for movements required for work or sport. Uw health s sports medicine sports rehabilitation physical therapists and athletic trainers in madison, wisconsin, help injured athletes return to health and return to sport. No lifting anything heavier than a telephone or one pound for 3 months.
Restrictions or precautions may also be given to protect healing. Physical therapy services including accepted insurance list. The physician reserves the right to either advance or delay this protocol as deemed necessary. For more detail, check out our prior posts on the rotator cuff.
The following subscapularis exercises will help to build strength in the muscles of the rotator cuff, as well as provide enhanced stability and mobility of the shoulder joint. No active ir or glenohumeral extension beyond midaxillary line for 6 weeks. This is done through two small puncture holes around the shoulder. The shoulder surgeon must communicate with the physical therapist to. Ir as tolerated if no subscapularis repair wand behind back 12 finger isometrics x 6 fist in box. Rehabilitation after total shoulder arthroplasty activities and advice for in the hospital and while at home. However, anyone recovering from an injury or surgery is free to use them.
Rehabilitation protocol for reverse shoulder arthroplasty this protocol is intended to guide clinicians and patients through the postoperative course after a reverse shoulder arthroplasty. Distal rom with scapular retraction manual scapular manipulation with patient lying on nonoperative side supine passive ff in scapular plane. Interestingly enough, physical therapy started on the first postoperative day with passive flexion and abduction. Bankart repair rehabilitation protocol arthroscopicopen this protocol was developed for patients who have had a bankart repair. This is because the articular surface of the round humeral head is approximately four times greater than that of the. Apply ice, or the cooling unit, to the shoulder as it will be quite helpful. The bankart procedure is performed to increase anterior stability of the shoulder. The book is a second edition and contains 790 pages. General information there may be a loss of external rotation when compared to the other side, but the motion is. Use of a sling for 3 weeks postop unless otherwise indicated. These general rehabilitation guidelines are created by physical and occupational therapists for the rehabilitation of various pathologies of the upper and lower extremities. Our unique regenerative approach to healing joints and repairing arthritis can get you back to the activities you love, without compromise. Perform a subscapularis workout once or twice per week for the most benefit.
The subscapularis ssc tendon forms the anterior section of the rotator cuff rc and. This protocol differs from the typical rotator cuff repair protocol as the subscapularis is put under. Conservative subscapularis repair protocol weeks one to two weeks two to four initial evaluation evaluate posture, scapulothoracichumeral position passive range of motion within precautions. The links below provide general information for educational purposes only. Questions regarding the progress of a specific patient are encouraged, and should be directed to twin cities orthopedic. Subscapularis repair rehab modifications physical therapy.
Physical therapy protocol now that your subscapularis anterior rotator cuff tear has been repaired it is very important that you follow this rehabilitation protocol in order to optimize your results. The pt performed passive range of motion of the shoulder into 60 of external rotation, 90 of scaption, a passive pectoralis minor stretch, and instructed on scapular clock exercises. Begin proprioceptive and dynamic neuromuscular control retraining. The intent of posting these standards of care and protocols is to provide clinicians and patients an understanding of our current standards of care and protocols at bwh. Global rotator cuff protocol with and without subscapularis repair. Revision rotator cuff repair improves clinical outcomes and shoulder function at midterm followup.
While the purpose of the surgery is to reattach the torn tendon back to the bone, in some cases it is necessary to firstly introduce an arthroscope to assess the shoulder joint to look for other pathology which may be contributing to the shoulder problem. This article provides an overview of types of tear. In just a few short weeks of physical therapy i already have almost full range in my. A physiciansupervised physical therapy rehabilitation program is an important component of the recovery process. Diminish pain and inflammation phase il phase week goals patient guide abduction pillow brace sleep in pillow brace ice for pain and inflammatim 1520 mi. Ankle achilles tendon repair ankle arthroscopic debridement ankle lateral repairs ankle non surgical rehabilitation ankle osteochondral defect repair hip birmingham hip resurfacing hip gluteus. Some people need a lot of therapy, some hardly any. Please click on the links below to learn more about the condition and its particular best course of action.
Rehabilitation protocol for rotator cuff repair this protocol is intended to guide clinicians and patients through the postoperative course of a rotator cuff repair. Pendulum exercises bend forward at the waist, back parallel to ground is ideal. Distal rom with scapular retraction manual scapular manipulation with patient lying on nonoperative side supine passive ff in scapular plane to 90 supine passive er to 0. The subscapularis muscle is one of the four rotator cuff muscles, being the largest and strongest one of the group. Situated in front of the shoulder, the subscapularis brings 53% of the total rotator cuff strength, having several key roles in the dynamics of the arm. Slucare sports medicine and shoulder surgery specialists developed the following physical therapy protocols for slucare clinicians to use when recommending treatment and rehab for slucare patients. Youll be fitter, faster and stronger than you have been in years. Rehabilitation guidelines after surgery, sports medicine uw.
Isolated repair of the subscapularis requires a limitation of external rotation range of. Kettlebell certification, gross motor, pta, physical therapy, stretching, random stuff. Physical therapy is used when a patient has trouble regaining motion on their own. Cole,md,mba range of motion immobilizer exercises phase i 06 weeks 03 weeks. The subscapularis assists in stabilizing the humeral head during motion and works to assist with internal rotation twisting in of the arm during reaching, pulling and lifting activities. Is early physical therapy safe after a rotator cuff repair. Specific interventions should be based on the needs of the individual and should consider exam findings and clinical decision making.
Since past decade subscapularis tears are recognized as source of pain and dysfunction of shoulder joint. Physical therapy prescription rotator cuff repair 1216 weeks postop. The subscapularis assists in stabilizing the humeral head during motion and works to assist with internal rotation twisting in of the arm. The majority of patients report diminished symptoms and full joint function after undergoing this procedure. Subscapularis tendon tears repair surgery houston tx. It is evident that a successful outcome after surgical rotator cuff repair is as much dependent on surgical technique as it is on rehabilitation. It is important component of shoulder joint for necessary of unimpaired shoulder movements. The subscapularis release miracle impingement and beyond. Physical therapy arthroscopic rotator cuff repair protocol.
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