Week 2: Surgical Treatment of Impingement and Rotator Cuff Tears Flashcards
Test item cluster for full thickness tear
- Drop arm sign
- Painful arc
- Infraspinatus muscle test
Drop arm sign
- Active elevation of the arm in the scapular plane, then reverse
- with pain or arm drops
Painful arc
- Elevate in the scapular plane
- + is pain or catching b/t 60-120 degrees
Infraspinatus muscle test
- Resisted contraction
- + with pain, weakness, or lag
How are RC injuries classified?
- Partial thickness
- Full thickness
How are partial thickness tears described?
- Acromial side
- Humeral side
Acromial vs Humeral side
Acromial is easier to see and fix
How are full thickness tears described?
By size:
- Small (< 1 cm)
- Medium (1-3 cm)
- Large (3-5 cm)
- Massive (> 5 cm)
How is direction of a RC tear described?
- Horizontal (grade IA)
- Longitudinal (IB): easier to fix
RC Treatment options
- Non-operative management
- Decompression w/o repair
- Repair
Decompression w/o repair
Underside of acromion is rasped
Post operative management of subacromial decompression
- Phase I (0-2 weeks)
- Phase II (3-6 weeks)
- Phase III (7-12 weeks)
Phase I (0-2 weeks) for Post operative management of subacromial decompression
- ROM: No OH lifting, but can return to AROM/PROM as symptoms allow
- Modalities: Cryo 3-5x/day; IFC is pt complains of pain
- Ex: pendulums, cans w/in painfree ROM, isometrics, rhythmic stabilizations, grade I-II MMT
- Goals: decrease pain and inflammation, return ROM, minimize strength loss
Phase II (3-6 weeks) for Post operative management of subacromial decompression
- ROM: progressing to full ROM at end of 6 weeks
- Modalities: cryo and IFC is pt complains of pain
- Ex: Unweighted GH ex, IR/ER in scaption, sidelying ER, prone ER w/ h. ABD, lower and mid traps, bi/tri, rhythmic stab
- Goals: Improve strength, normalize scapulohumeral rhythm
Phase III (7-12 weeks) for Post operative management of subacromial decompression
- ROM: Full ROM
- Modalities: cryo or hot back
- Ex: scap stabilization, OKC/CKC total arm, perturbation training, plyo
- Goals: return of static strength and endurance, normal scap motion, return to sport
How does subacromial decompression compare with conservative care?
No significant difference, but conservative care costs less
Surgical intervention for RC
- Arthroscopic
- Mini-open/deltoid splittiing
- Open w/ detachment of deltoid
Factors impacting management of surgery for RC repair
- Surgical approach
- Size/location of tear
- Quality of soft tissue and bone
- Quality of fixation
Post-operative Management of Rotator
Cuff Repair – Small / Medium Tears
- Arthroscopic or deltoid splitting approach:
- Primary goal is to protect the repair
- Sling for 4 weeks (can be d/c earlier based on MD recommendations and for PROM)
- Emphasis on PROM for 4 weeks – except ER
- No AROM or resistance
- Ice and stim for pain control
- Grade I/II Mobs for pain relief
- Active-assisted motion in supine can be added week 3
- Active-assisted motion in sitting or standing
can be added week 4 - Progress to active exercise after 6 weeks
- Light resisted exercises for RC may be initiated after 8 weeks if active motion is satisfactory
Post-operative Management of Rotator
Cuff Repair – Large / Massive Tears
- Large tears with open deltoid detachment:
- Primary early goal is to protect the repair and reduce pain
- Passive motion within limits imposed by surgeon after 1 to 2 weeks
- Sling for 6-8 weeks (can be d/c earlier based on MD recommendations and for PROM)
- Emphasis on passive motion for 4 weeks
- No elevation for 6-8 weeks because of deltoid takedown
- Continue passive motion for 3-4 weeks
- AAROM can begin 4-6 weeks. Avoid elevation, ER in scapular plane
- Active motion after 6 to 8 weeks
- Progress to active exercise after 8 weeks
- Light resisted exercises for RC may be initiated after 10 weeks if active motion is satisfactory
- Full ROM should be achieved between 12-16 weeks
Is there a possibility for accelerated rehab?
NO, if aggressive PT is applied it could cause further harm
