ࡱ> HJGq` (#bjbjqPqP .6::( <02*****///////$P1h3/zzz/**/!!!z**/!z/!!V'@m(*  I@ 6' //00'xl4v!l4m(l4m(>C,!o$//v! 0zzzzDRR Small/Medium Rotator Cuff Repair Protocol Preoperative Goals Full Range of motion Normal Scapular/GH/Clavicular glides 0 to minimal edema Improve Peri-Scapular muscle strength Independent in HEP Treatment: Modalities to reduce inflammation/pain(Vasopneumatic) Grade 2, 3 mobilization GH, Scapula, Clavicle ROM exercises Passive/Active Assist/Active (pendulums, cane exercises, pulley, wall slides) Peri-Scapular muscle PREs(scapular retraction, gentle Theraband for retraction, extension, adduction, abduction) Education in HEP/edema control Post-operative Day of Surgery Goal: Control edema Initiate elbow, wrist and hand and shoulder shrug exercises for early ROM Use immobilizer all the time except for performing exercises, squeeze exercise ball as much as possible Ultrasling: will be used for approximately 4 weeks per the surgeons instruction. Okay to remove for treatment PHASE I (Week 0-2) Shoulder - Phase 1 home exercises - wrist, elbow and hand exercises - squeeze exercise ball as much as possible - Begin addressing restrictions of the upper quarter - Cervical spine stretching: Upper Trapezius, Levator Scapulae, Scalenes - Thoracic Spine and costovertebral joint mobilizations - Scapular glides - Posture training - Modalities for control of pain and inflammation - Grad I-II joint mobilizations - PROM Scapular Plane, ER and IR with shoulder abducted 45 - Codmans Pendulum exercises Maintain cardiovascular health using walking, exercise bike PHASE Ia (Week 2-4) Shoulder - Modalities for control of pain and inflammation - Grad I-II joint mobilizations - Progress ROM - Table slides in the scapular plane - Shoulder Pulleys (Normal Scapulohumeral Rhythm must exist to decrease Impingement) - Scapular mobilization - Dowel exercises - Flex: to tolerance 0 90 degrees - Abduction: 0 90 degrees - ER and IR - consider initiating pool where available - Extension and Horizontal Adduction: Avoid Scapula - AROM scapular shrugs, scapular retraction, scapular depression, PNF Diagonals Elbow/Hand - AROM Flex/ext in neutral and hand strengthening Maintain cardiovascular health using walking, exercise bike Continue work on the upper quadrant to reduce restrictions to proper physiologic movement PHASE Ib(Week 4-6) Shoulder - Modalities for control of pain and inflammation - Grad II-III joint mobilizations PA/Inferior Add in neutral, mild ER, and mild IR - PROM Continues with goal of full ROM - Continue Shoulder pulleys with focus on normal Scapulohumeral rhythm - Continue Dowel exercises - Progress table slides. Add wall slides as tolerated in the scapular plane - ER: 0 45 degrees at modified neutral. Slowly increase abduction position during ER/IR to 80 90 degrees by 4 weeks. No aggressive stretching. - Be VERY cautious with IR to avoid tension on the Infraspinatus if repaired. - Ext and Horizontal Adduction: Avoid Scapula - AROM scapular shrugs, scapular retraction, scapular depression, PNF Diagonals Elbow/hand - Sub-max isometrics elbow flex/ext in neutral shoulder position Maintain cardiovascular health using walking, exercise bike LE and trunk exercises to be initiated (no bouncing) Continue work on the upper quadrant to reduce restrictions to proper physiologic movement PHASE Ic(Week 6-8) - Modalities for control of pain and inflammation - Grad II-III joint mobilizations - PROM (supine) - Initiate AROM exs in scapular plane and IR and ER (No Resistance) Focus is on quality uncompensated movement - continue pulleys - UBE* (elbow below shoulder height with minimal reach and resistance) - Flex: to tolerance 0 180 degrees or equal to uninvolved side - Abduction: 150 180 degrees w/ deviation toward scapular plane - ER: 70 90 degrees; IR: 40 60 degrees - Ext: 30 degrees without stretching, Horizontal Adduction: Avoid - Supine stabilization exercises for the scapular muscles - initiate isometric exercises sub-maximal contraction (no pain) Scapula - AROM scapular shrugs, scapular retraction, scapular depression Elbow/Hand - Sub-maximal Isometric elbow flex/ext in neutral shoulder position progress to gentle Isotonics: 2-5 lb. BC curls and yellow Theraband Tricep pull-downs Maintain cardiovascular health using walking, exercise bike LE and trunk exercises to be progressed (no bouncing) Continue work on the upper quadrant to reduce restrictions to proper physiologic movement PHASE II(Week 8-10) - Modalities for control of pain and inflammation - Grad II-III joint mobilizations - Full ROM is allowed for PROM, AAROM, and AROM. Focus on proper technique and progress as tolerated. Initiation of isometric strengthening all planes. Contractions should not elicit symptoms No resistance UBE* (control shoulder flexion to below 75 degrees) - Progress stabilization exercises to standing for the scapular muscles Scapula - Peri-Scapular PREs(Rhomboids, Middle/Lower Trapezius, Lats, Serratus Anterior etc.) Elbow/Hand - Progress to 6 lb curls and increase resistance w/ triceps pull-downs Maintain cardiovascular health using walking, exercise bike, treadmill, Eliptical LE and trunk exercises to be progressed (no bouncing) PHASE III(Week 10 12) - Modalities for control of pain and inflammation - Grad II-III joint mobilizations - Initiate light Rotator Cuff PREs at 0 degrees abduction w/ Theraband and progress to moderate resistance - Progression of standing stabilization exercises - Progress Bicep/Tricep/Peri-Scapular strength/conditioning - Add PNF movements D1 and D2 flexion/Extension AROM and progress to light T-band resistances Maintain cardiovascular health using walking, exercise bike, consider light jogging LE and trunk exercises to be progressed PHASE IIII(Week 12-16) - Modalities for control of pain and inflammation - Grad II-III joint mobilizations - Moderate Rotator Cuff PREs at 30 degrees abduction w/ Theraband and progress to high resistance at 60 degrees abduction - Progression of standing stabilization exercises - Progress Bicep/Tricep/Peri-Scapular strength/conditioning - Begin closed chain stability exercises - Progress resistances of PNF patterned strengthening Maintain cardiovascular health using walking, exercise bike, jogging, bleachers LE and trunk exercises to be progressed PHASE V(Week 16-22) - Modalities for control of pain and inflammation - Grad II-III joint mobilizations - High resistance Rotator Cuff PREs at 90 degrees abduction w/ Theraband - Begin plyometric exercises - Progression of standing stabilization exercises - Progress Bicep/Tricep/Peri-Scapular strength/conditioning - Progress UBE/closed chain stability exercises - Add gym exercises - Initiate sport specific training/job related tasks Interval throwing program  *+ D v    ac$?Efz~8!N!!!'#(#h?h9h5 h9hhh7#h5CJaJh5CJaJ/*+8>Sx 3  > D R  u v  & Fgd & Fgd & Fgd@&gdgd $@&a$gd(# 6  ? ~ ,N^:Z ^`gd@&gdgd h^`hgdh^hgdZj!_ E %s Z(e]gd^gd ^`gd@&gdL]Lgdgd =auD@} : & Fgd & Fgd^gd@&gdgdE)s.)h_u^gd & Fgd `^``gdgd`@&^``gd @d X !6!7!8!L!!!!!"I"""" # ^`gd^gdgd #'#(#gd,1h/ =!"#$% D@D NormalCJ^J_HaJmH sH tH DAD Default Paragraph FontRiR  Table Normal4 l4a (k(No ListPoP  No Spacing CJOJQJ_HaJmH sH tH (6*+8>Sx3 >DRuv6?~,N^:Zj!_ E % s Z ( e = a u D@} :E)s.)h_u @dX 678LI '*0000 08 08 08 08 0808 08 08 08 08 0800 0> 0> 0>0>0>00v0v0v0v0v0v0v0v0v0v0v0v0v0v00000000000000000000000000000000000000 0 0 0  0 @0 @0 @0@0@0@0@0@0@0@0A 0@0@0@0@0@0@0@0@0@0A 0A 0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@00*+8>Sx3 >DRuv6?~:Zj* @0@0 @0 @0@ 0F@ 0F@ 0F@ 0F@ 0F@0F@ 0F@ 0F@ 0F@ 0F@ 0F @0 @0@ 0L@ 0L@ 0L@0L@0L @0@0,@0,@0,@0,@0,@0,@0,@0,@0,@0,@0,@0,@0,@0, @00030000@000 00(# Z #(#(#8@0(  B S  ?AA A5!A^>>C*BHH*=*urn:schemas-microsoft-com:office:smarttags PlaceName=*urn:schemas-microsoft-com:office:smarttags PlaceType9*urn:schemas-microsoft-com:office:smarttagsplace Hfp]fhoz  ? 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