ROTATOR CUFF REPAIR
DAVID LINTNER, MD
Tracey Baker MSPT and Kim Broderick MSPT ATC
The rotator cuff is the key to elevation of the upper extremity. It functions to center the humeral head in the glenoid by providing a compressive force with active movement.
Rotator cuff tears are most prevalent in the over 40 population. The repair progression is dependent on a number of factors including the patient’s age, tissue quality, size of the tear, acute vs chronic condition, strength and ROM status pre-op, ATS vs open repair procedure, and performance/activity demands. Video pre and post repair. If the patient is healthy and active, a more aggressive rehab approach can be taken. On the other hand, if the patient is sedentary, disuse of the RC decreases tendon fiber strength. Because of the poor tissue status, regardless of the size of the tear and subsequent repair, a more conservative approach must be taken. An open repair is more painful for the patient and has higher chance of infection and morbidity but it is also more stable; therefore, rehab can be advanced more aggressively than if the repair was done arthroscopically.
The key following RCR is communication with the physician. It is imperative that the therapist knows the size and extent of the tear, what was done in surgery, as well as any concerns or precautions the physician may voice regarding the patient.
Rehab following RC repair must focus not only on regaining N ROM but also on regaining neuromuscular control and strength of the RC. It is imperative that coordinated firing of the RC occur and this timing of recruitment must be re-trained post-operatively. Rhythmic stabilization exercises are mandatory to achieve this goal. In regards to AROM, ER/IR strength must be regained below shoulder level before one should be expected to perform OH activities without discomfort.
Early ROM is critical for patients post-operatively to increase circulation and promote healing of soft tissues. A CPM machine will sometimes be used at home for this purpose with the shoulder in a position of neutral rotation and elevation in the scapular plane.
New August 2011: We have begun using a new rehab tool called the DS2 Platform. This is a wall mounted low-friction board that is a versatile tool for closed chain rotator cuff and scapular exercises. It can be used for patient-controlled closed chain stretching as well as for strengthening of the cuff. In the early strengthening phase, active assisted exercises are initiated and progressed to high repetition exercises in various patterns. The resistance is adjusted by modifying how much pressure the patient places on the board. The board mounts on the wall, uses no floor space, and is very versatile. The DS2 Platform was invented by Roland Ramirez ATC LAT MPT SCS CSCS. Roland is the Coordinator of Rehabilitation for the Houston Texans football team and can be contacted at Roland@DS2rehabsystems.com, 713-816-0649.
Initially, the therapist must closely monitor for any signs of infection. These include significant swelling in the shoulder and surrounding areas with accompanying erythema, hypersensitivity at the joint, pain at rest, and severe limitations in ROM and/or strength.
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Revised August 2008