Lecture 10, Rotator Cuff Repair Flashcards
Rotator cuff tears
may involve individual tendons or a combination of tendons
just this word alone is an insufficient info
Types of rotator cuff tears
chronic degenerative tear
acute avulsion tear
Chronic degenrative tear
usually >40 yrs old
Typically SIT
majority of tears is this kind
history of subacromial impingement and shoulder pain
Acute avulsion tears
acute subscap tears
younger patients
fall with hyperabduction/ER or dislocation
Iatrogenic Injuries
due to failure of surgical repair
relating to illness caused by medical exam or treatment
Tears are described by their….
thickness
Determinants of success of surgery
confidence in PT
activity level
age
smoking
size of tear (3cm or less have same outcomes)
Indications for surgery (rotator cuff)
pain –> years with no other options helping
impaired function
loss of strength
How to decide on type of surgery
thickness of tear
#of tendons involved
associated lesions
acuity
surgeon
Types of rotator cuff repairs
arthroscopic
mini-open
open
What happens during the surgery?
removing scar tissue
tendon to bone fixation
capsular tightening or labral repair
General Rehab Principles
immediate or early post-op motion of GH joint
gain control of scapula for stability
gradual restoration of muscular strength and endurance
NO active motion before 6 weeks
What factors will influence the progression of a patient post-op rotator cuff repair?
Onset of injury
size and location of tear
associated pathologies
preoperative strength and ROM
General health
history of steroid injections/previous RC surgery
preinjury activity level or goals
type of repair
patient compliance
surgeon
Onset of injury and post op
chronic impingement and degeneration = slower progression vs acute injury
Size and location of tear post-op
large and more tendons = slower
Associated pathologies and post op
more structures involved in procedure = longer immobilization, slower progression of exercise, more precautions
Preoperative strength and ROM w/post-op
pre-existing weakness, atrophy of stabilizers & cuff, limited motion = slower progression
General health & post op
poor health, hx of smoking, hx inflammatory disease = slower
History of steroid injections
compromised bone and tendon tissue quality affects viability of repair = slower progression
Pre-injury activity level or post-op goals
higher level of activity creates greater risk for reinjury = more extended and advanced post-op training program
Type of repair & post op
tendon to tendon = slower vs tendon to bone
Patient Compliance and post op
doing too much or too little can affect outcome
Immobilization
Small = 1-2 weeks
Medium = 3-6 weeks
Massive = 6-8 weeks
Maximum protection phase
3-8 weeks
PROM pain free range
supine position
AAROM to AROM in late phase
good posture in spine
isometrics week 6
do NOT ____ to resistance more rapidly even if the patient has no _____
progress
pain
Moderate protection phase
8-12 weeks
arom without compensation
multiple angle isometrics
endurance over strength
focus on ADLs first
Minimum protection phase
begin at 12-16 weeks, may last up to 6 months
full function, gradual progression
task specific training
outcomes should be pain relief, ROM, strength, functional abilities
Motion post-op precautions
only PASSIVE, non-assisted ROM in supine, 6-8 weeks
Strengthening post-op precautions
no UE weight bearing activities for 6 weeks
No resistance exercises for 6-8 weeks
know which tendon was repaired, progress ER and/or IR w/caution
Stretching post-op precautions
no vigorous stretching for 6-12 weeks
know which tendon was repaired
avoid end range stretching
