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Rotater Cuff Repair Protocol
Repair is weakest at 3 weeks and remains weak for 3 months Functional improvement should be expected over 12 months The repair and deltoid reattachment are stressed in active abduction Adhesions and disuse atrophy must be avoided The protocol may be modified for larger tears and for fragile repairs. Post-operative instructions must always be checked before pursuing the standard protocol.
Pre-operatively Range of movement and muscle strength are assessed Post-operative protocol explained Physiotherapy outpatient appointment arranged
Day 1-3 Polysling with body belt Removal and replacement of body sling taught Elbow, radioulnar, wrist and hand maintenance exercises Pendular exercises and passive flexion in the scapular plane Patients are usually discharged on 1 st or 2 nd day post-op.
Up to 4 weeks Continue with treatment as above Passive movements in all directions as pain allows. Do not force or stretch at this stage Shoulder girdle exercises and scapular setting Advise re. cervical range of movement exercises and posture
At 4 weeks Begin assisted range of movement exercises e.g. pulleys and stick exercises
At 6 weeks Wean off sling Commence stretching to regain full range of movement Active exercises Gentle ADL but no heavy lifting
At 8 weeks Progress to exercise with added resistance if this is appropriate for the patient's strength. Rotator cuff strengthening through range Closed chain proprioceptive work such as rhythmic stabilisations in 4 point kneeling
Return to functional activities
Return to function will differ with each individual. The following is an approximate guide but should be seen as the earliest that these activities can commence.
Patients can begin driving when they have pain free active movement and good strength and control.
Sports Swimming Breast stroke 8-10 weeks
Freestyle 12-14 weeks Heavy contact sports 6 months
Return to work Dependent on patient's job. Patients in sedentary jobs may return to work in 6-8 weeks. Manual workers should be guided by the surgeon.
Authors Clare Connor MCSP and Claire Kellaway MCSP Review date October 2003 |
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