Debridement of an acromial bone spur and removal of the inflammed bursa arthroscopic repair of your rotator cuff mini open repair of your rotator cuff deltoid splitting large open repair of your rotator cuff took down deltoid rotator cuff debridement. However, acromioplasty without cuff repair has been reported to have both good and poor results, showing that the technique may be suspect in repair of full thickness tears alone. The physiotherapy protocol for arthroscopic rotator cuff repair consists of progression through 3 phases of exercises over 4 6 months after surgery post operative phase 1 06 wks post operative phase 2 6 wks 3 mths. The physician will make specific changes to the program as appropriate for an individual patient. Is acromioplasty of benefit for rotator cuff repair. Immobilized at all times day and night off for hygiene and. Intermittently apply grade ii mobilizations in the open packed position of the shoulder. Evidence from two or more high quality studies with consistent findings for recommending. Several randomized prospective studies have described clinical outcomes that are statistically similar when comparing patients undergoing rotator cuff repair either with or without concomitant acromioplasty. This protocol provides the rehabilitation specialist with general guidelines for the rehabilitation of the patient following decompression of the coracoacromial arch. The resulting adhesions that form in the humeroscapular interface between the acromion and the rotator cuff can limit motion and cause discomfort 5. Shoulder acromioplasty doctor philippe paillard office. Other investigators have published case series highlighting the success of rotator cuff repair without acromioplasty. The socket portion of the joint is not naturally deep.
The rotator cuff is made up of 4 muscles supraspinatus, infraspinatus, subscapularis, and teres minor that help stabilize the shoulder. The primary indication for an acromioplasty in a patient with a fullthickness or bursal rotator cuff tear is for a type 2 or 3 acromion with a frayed ca ligament attachment. This was loaded with suture and two sutures were placed in mattress fashion into the rotator cuff. The rotator cuff is formed by the tendons of four muscles. The rate limiting factor in arthroscopic rotator cuff repair is the biologic healing of the cuff tendon to the humerus, which is thought to be a minimum of 812 weeks.
The primary aims of any rehabilitation protocol for rotator cuff tendon repair are. This protocol provides you with general guidelines for the rehabilitation of patients following a standard open, mini open and or arthroscopic rotator cuff repair. Protocol s3 accelerated physical therapy protocol for. Phase i immediate postoperative phase weeks 0 6 days 014 patient is seen 2 days postoperative to remove surgical dressings and pain catheter.
This movement is usually limited and painful following rotator cuff surgery. Arthroscopic rotator cuff repair protocol medium to large. The extrinsic theory suggests detrimental acromial morphology can initiate rotator. The rotator cuff connects the humerus to the scapula. The stability and movement of the shoulder is controlled primarily by the rotator cuff muscles, with assistance from the ligaments, glenoid labrum and. This protocol provides you with general guidelines for the rehabilitation of patients following a standard open, mini open andor arthroscopic rotator cuff repair. Acromioplasty has become one of the most frequently performed. Degree of shoulder instabilitylaxity prior to surgery. Sad subacromial decompression protocol phase i postop until week 2 protective phase. This is because the articular surface of the round humeral head is approximately four times greater than that of the. Initiate and progress with scapular strengthening exercises as tolerated. For this reason the shoulder is the most mobile joint in the body.
The shoulder is one of the most complicated joints, having the ability to move in six different motions. This rehabilitation protocol has been developed for the patient following a rotator cuff surgical procedure. Rarely, an abduction pillow is needed to hold the arm up in the air away from the body. Acromioplasty, right shoulder, with rotator cuff repair. Acromioplasty surgery is performed based on the concept that the shoulder rotator cuff is being pressed upon impinged by the bones and ligaments above the rotator cuff. Acromioplasty has traditionally been an integral component of the surgical procedure of a rotator cuff repair. Progress to rotator cuff strengthening program with light free weights in all planes. Rotator cuff repair protocol rotator cuff protocol physical. Rotator cuff repair with arthroscopic acromioplasty.
Rehabilitation program following shoulder diagnostic. No abduction and rotation combined movement until 4 weeks postop. No arom exercise of the shoulder consistent use of sling unless otherwise instructed weaning starting at week 4 at earliest pendulum exercises, elbow aarom and gripping 4x per day starting pod 3. The goal of acromioplasty is to increase the size of the subacromial space. Strengthen deltoid, rotator cuff and scapular stabilizers. It is no means intended to be a substitute for ones. The conservative rehabilitation protocol allows sharpey fibers to form before stressing the repair with resistive exercises. Advance with shoulder rotator cuff, scapular stabilizers and total arm. The role of acromioplasty for management of rotator cuff. If you have any questions regarding the progress of the patient, the. Acromioplasty is a welldescribed technique used throughout the wide spectrum of treatment options for shoulder impingement and rotator cuff pathology.
Rehabilitation guidelines for type i and type ii rotator cuff repair and isolated subscapularis repair the anatomic configuration of the shoulder joint glenohumeral joint is often compared to that of a golf ball on a tee. Large open repair of your rotator cuff took down deltoid. The procedure involves stitching the torn tendon back onto its attachment to the humerus. To improve your inward rotation, you can either use a towel or your good arm to pull the operated arm upwards and across your back. Rotator cuff repair protocol boston shoulder institute. Rehabilitation after rotator cuff repair dr keith holt. The surgeon will cut these ligaments and shave down a piece of the acromion, which is a bone that sticks out of the front part of the shoulder blade. Johns hopkins shoulder surgery arthroscopic acromioplasty. It is not intended to be a substitute for clinical decision making regarding the progression of a patients postoperative course based. Keep the abductor pillow in for the 4 weeks as well. Purpose of the abductor pillow is to keep tension off of the repair, avoid adduction.
Post operative arthroscopic subacromial decompression protocol the intent of this protocol is to provide the clinician with a guideline for the post. In the impingement syndrome, the tendons of the rotator cuff muscles become irritated and inflamed as they pass through the subacromial space, the passage beneath the. Two of the most common surgical procedures for the shoulder are acromioplasty and rotator cuff repair. Johns hopkins shoulder surgery arthroscopic acromioplasty rehabilitation program johns hopkins shoulder surgeons introduction. Progression of arom against gravity and duration of sling use is predicated both on the size of tear and quality of tissue and should be guided by referring physician. Dec 19, 2012 potential benefits of acromioplasty include improving coracoacromial arch anatomy to reduce extrinsic compression on the rotator cuff, improved arthroscopic visualization during rotator cuff repair, and inducing a healing response through bleeding bone in the subacromial space 1, 9, 10. Contact dr kevin murphy at 9046340640 to know more. The protective protocol, in which muscle strengthening exercises are delayed, is applied after arthroscopic repair of rotator cuff tears greater than 5 cm or involving more than 2 tendons, poor tissue quality, or repairs with greater tension. Acromioplasty has been one of the most common techniques amongst orthopedic surgeries in the past decade. Post operative arthroscopic subacromial decompression protocol. An open surgery, which involves the deltoid, should be protected with prom for a least 3 weeks. Arthroscopy spares the anatomical structure and the joint can be accessed without damaging the muscles.
Rehabilitation guidelines for type i and type ii rotator. Rotator cuff repair protocol south shore orthopedics. Surgical repair of fullthickness tears of the rotator cuff is a controversial issue, with several procedures currently being used to treat the tear. Arthroscopic acromioplasty is used to treat severe cases of impingement syndrome, a condition resulting from an injury to the rotator cuff muscles and often seen in aging adults. The purpose of this study is to compare the effectiveness of arthroscopic cuff repair with acromioplasty to arthroscopic cuff repair without acromioplasty in repair.
It is not intended to be a substitute for clinical decision. Large rotator cuff repair protocol the intent of this protocol is to provide the clinician with instruction, direction, rehabilitative guidelines and functional goals for all rotator cuff repair procedures. The two most common treatments at this point in time are arthroscopic cuff repair with and without acromioplasty. Symptoms such as pain, swelling, or instability should be closely monitored by the patient. Rotator cuff repair with arthroscopic acromioplasty shaving. In rotator cuff repair surgery one or more of these muscles are reattached to the bone using anchorssutures. Standard open or arthroscopic rotator cuff repair protocol. Rotator cuff repair a rotator cuff repair is designed to improve pain and function in cases of rotator cuff tears. Acromioplasty is performed to modify existing acromial architecture to remove mechanical impingement.
Surgery for shoulders with torn rotator cuff tendons can lessen shoulder pain and improve function without acromioplasty download this article as a pdf repair of rotator cuff tears uw orthopaedics and sports medicine, seattle. The physiotherapy protocol for arthroscopic rotator cuff repair consists of progression through 3 phases of exercises over 4 6 months after surgery post operative phase 1. Arthroscopic acromioplasty, shoulder acromioplasty surgery in. Often times my surgeon will do an open cuff repair with a clavicle excision and an acromioplasty. The shoulder is a wonderfully complex joint that is made up of the ball and socket connection between the humerus ball and the glenoid portion of the scapula socket. An acromioplasty aims to remove the impingement by increasing the sliding space for the shoulder tendons. This protocol provides you with general guidelines for the conservative rehabilitation of the patient with a rotator cuff tear rct. Perform this exercise very gently to increase your range gradually. Care is taken to preserve as much of the ca as possible. Rotator cuff repair postoperative rehabilitation protocol. Brace abduction bracesling, remove sling only to bathe and to complete exercises. Type ii rotator cuff repair protocol arthroscopic tears for large to massive tears 5 cm joseph r. Starting the first day after surgery you should remove the sling 34 times per day to perform pendulum exercises and elbowwrist range of motion unless otherwise specified by dr.
Rehabilitation protocol for rotator cuff repair this protocol is intended to guide clinicians and patients through the postoperative course of a rotator cuff repair. Repair of rotator cuff tears uw orthopaedics and sports. Arthroscopic rotator cuff repair of full thickness tears with. Initiating rotator cuff and scapula stabilization strengthening exercises should be. Rotator cuff repair postsurgical rehabilitation protocol postop days 1 21 immobilizer with abductor pillow x 46 weeks even while sleeping place pillow under shoulder arm while sleeping for comfort hand squeezing exercises elbow and wrist active motion arom with shoulder in neutral position at side. Rotator cuff repair protocol the following procedures were performed. Open, miniopen, and allarthroscopic rotator cuff repair. Org volume 87a number 6 june 2005 open rotator cuff repair without acromioplasty the repaired tendon 12. The intent of this protocol is to provide the clinician with a. Cole,md,mba range of motion immobilizer exercises phase i 04 weeks 02 weeks. I used to code these with the appropriate open code and then 29824 and 29823 because the clavicle and acromio are done arthroscopically usually. Minimal manual resistance isometric er and ir at 4560 scapular plane.
Avoid external rotation at 45 degrees and above avoid overhead work or sports until minimal pain avoid lifting, pushing, pulling 12 weeks postop avoid leaning on elbow. This procedure is performed arthroscopically, that is, without opening the joint. Return to intense activities following a rotator cuff repair require both a strenuous strengthening and range of motion program along with a period of time to allow for tissue healing. Before undergoing subacromial decompression surgery your doctor will discuss the recovery process with you. The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone an arthroscopic assistedminiopen rotator cuff repair. The conservative approach may be associated with postoperative stiffness which can be managed once healing has occurred. Specific changes in the program will be made by the physician as appropriate for an individual patient. Arthroscopic acromioplasty protocol weeks 02 use a sling at all times, day and night. Please note on prescription if any deviation from protocol is preferred. This protocol is designed for the patient following arthroscopic rotator cuff repair. Treatment should be modified based on the condition of the rotator cuff.
Open cuff repairs with acromioplasty medical billing and. Passive, aarom, and arom exercises as symptoms allow starting with passive. Arthroscopic acromioplasty rehabilitation protocol introduction impingement syndrome is a common cause of chronic shoulder pain. Traditionally, acromioplasty have been routinely performed, as a part of the arthroscopic repair. A surgeon experienced in shoulder surgery can repair a rotator cuff tear if there is enough good quality tendon tissue. Rotator cuff repair protocol northeast orthopedics and. Protocol s3 accelerated physical therapy protocol for rotator cuff repair arthroscopic or miniopen technique recommended for mild. Those patients who have good rotator cuff tissue integrity, a one to two tendon repair, with a tear 3 centimeters or less will typically be progressed on the quicker end of these time frames.
In this condition, the rotator cuff tendon becomes pinched under the anterior aspect of the acromion during elevation of the upper. The suturesanchors hold the tendons so they can heal back to the bone. The extrinsic theory suggests detrimental acromial morphology can initiate rotator cuff dysfunction and tearing. Following a wellstructured conditioning program will also help you return to sports and other. Arthroscopic rotator cuff repair frequently asked questions. Post operative arthroscopic subacromial decompression. The role of acromioplasty for rotator cuff problems.
Showering is allowed once dressings and catheter is removed. Type three rotator cuff repair miniopen or neer approach large to massive tear greater than 5 cm i. Two studies were excluded because the size of the tears were not reported26,56. In this condition, the rotator cuff tendon becomes pinched under the anterior aspect of the acromion during elevation of the upper extremity. This is summary of the evaluation and rehabilitation of a patient following an arthroscopic acromioplasty. Post operative arthroscopic subacromial decompression protocol the intent of this protocol is to provide the clinician with a guideline for the postoperative rehabilitation course of a patient that has undergone an arthroscopic subacromial decompression. Postoperative rotator cuff repair rehabilitation protocol. It is not intended to be a substitute for ones clinical decision. Type ii rotator cuff repair protocol medical staff. The goal of rotator cuff repair is to eliminate pain and improve function with increased shoulder strength and range of motion. Rotator cuff repair protocol is a rehabilitation protocol to provide patient with the guidelines following a rotator cuff surgical procedure. This protocol will vary in length and aggressiveness depending on factors such as. Pdf is acromioplasty of benefit for rotator cuff repair. Rehabilitation guidelines for shoulder arthroscopy uw health.
Arthroscopic and open rotator cuff repair rehabilitation protocol week 1 2 shoulder sling and swathe full time day and night. Arthroscopic rotator cuff repair postoperative rehab protocol. Rotator cuff tears are one of the most common shoulder injuries and can be a source of persistent pain, disability, and decreased range of motion rom and strength. Rotator cuff tears lead to debilitating shoulder dysfunction and impairment. The shoulder is therefore susceptible to injury because of potential trauma, overuse or degeneration requiring potential surgery. Subacromial decompression protocol south shore orthopedics. After surgery you will be taken to the recovery room room, where your family can meet you.