intervention considerations Flashcards
Rotator cuff phase 1
weeks 2-4
*ER will be most painful
**work on PROM: **
* flexion/abd to 90, ER to 30, IR to 30, Ext to 30
* perform ER/IR in scapular plane
* perform Flex/ext at 90 in scapular plane
gentle isometrics
scapular isometrics
gentle rhythmic stabilizations in 90 supine week 3-5
grade
gentle G1-2 mobs for pain relief
cryotherapy
rotator cuff repair phase 1
weeks 4-5
PROM goals:
*Flex: 120
* Abd: 120
* ER: 30, IR: 45
* Extension: 30
* perform ER/IR in scapular plane and at 90 abduction
ice as needed
may use heat before ROM
rhythmic stabilizations week 3-5 at 90 supine
scapular isometrics
When does the sling come off in rotator cuff repair?
phase 1: week 6, can start to do some AAROM build to AROM
When can you start rhythmic stabilization exercises for small rotator cuff repair?
week 3-5 in supine 90 for deltoid assist
week 6: can start IR/ER
rotator cuff repair phase 1:
week 5-6
PROM in all directions as tolerated
gentle joint mobs: GH and scapula
AAROM
*can start moving arm, but don’t want lifting of arm
What are the criteria to advance to rotator cuff repair phase 2?
PROM:
* flexion > 125
* ER in scapular plane > 75 (if other shoulder is > 80)
* IR in scapular plane > 75 (65 more realistic, same as above)
* abduction in scapular plane > 90
what weeks are included in RCR phase 2?
weeks 6-14
(or surgeons say strengthen week 8-12)
What is main focus of RCR phase 2?
(weeks 6-14)
dynamic stability (scapular stabilizing muscles)
What are the criteria to advance to phase 3 for rotator cuff repair?
full AROM/PROM
pain free with all strengthening exercises
dynamic stability of shoulder
Which weeks are RCR phase 3?
weeks 15-24
RCR phase 3:
what is the main focus?
15-24
main focus on strength, start to work on power
*enhance functional use of UE
*no substitution patterns with strengthening!
work FLEX, ABD, IR/ER
What criteria to advance to RCR phase 4: return to sport?
- maintenance of full, painfree ROM
- functional use of UE
- full mm strength/power
If you have a TSA + subscapularis repair, be careful of which motion?
ER ROM
(IR subscap tendon delayed strengthening to let it heal –> eventually will need to activate w/o pec and teres dominating)
T or F: you probably will not get full 180 with rTSA
true
*deltoid is doing all the work bc rotator cuff is shot, thats why humeral head is concave and glenoid is convex
how long will you wear a sling with a TSA?
3-4 weeks
longer depending on what is repaired
precautions for TSA
- no extension
- no anterior capsule stretch (sleep supine with pillow under elbow)
- no behind back (ext + IR), no excessive stretching especially into ER
criteria for progression to TSA phase 2
tolerates PROM
achieves PROM in:
90 FLEX
90 ABD
45 ER in scaption
70 IR in scaption
what can you start doing in phase 2 for TSA?
4-6 weeks post op
restore full PROM
begin AAROM –> AROM
*shoulder submax isometrics in neutral
*horizontal add AAROM
how heavy should you be lifting in TSA phase 2? 4-6 weeks post op
nothing heavier than coffee cup
What are criteria to progress to TSA phase 3
tolerates PROM/AAROM/isometrics
PROM: achieves
-140 FLEX
-120 ABD
-60 ER in scap plane
-70 IR in scap plane
-actively elevates shoulder against gravity with good mechanics to 100 degrees
when does TSA phase 3 start?
at least 6 weeks since post op
GOAL: gradual strengthening/endurance, NM control, gradual return to functional activities
light functional activities
when can you progress to AROM and initiate ASSISTED behind back motion following TSA?
phase 3: moderate strengthening
weeks 6-?
how heavy can you lift in TSA phase 3? (week 6–>)
6 lbs limit
*can start assisted behind back motion
can start resisted IR/ER in scaption
*light functional activities
*wean from sling fully
*supine elevation strengthening, progress to standing
what are criteria to progress to TSA phase 4?
tolerates AAROM/AROM
Flx to 140
ABD to 120
ER to 60
IR to 70 deg
Actively elevate shoulder against gravity with good mechanics to 120 degrees
