Learn about physical therapy standards of care and protocols from the rehabilitation. Sling may be removed for exercises, showering and dressing. Suprascapular nerve palsy modern manual therapy blog. The subscapularis assists in stabilizing the humeral head during motion and works to assist with internal rotation twisting in of the arm during reaching, pulling and lifting activities. Restrictions or precautions may also be given to protect healing. This protocol is intended to be a general outline only. Physical therapy section pectoralis major repair revised. Begin pt 35 days postop appointments physician appointment. When conservative measures are unsuccessful in restoring. While the purpose of the surgery is to reattach the torn tendon back to the bone, in some cases it is necessary to firstly introduce an arthroscope to assess the shoulder joint to look for other pathology which may be contributing to the shoulder problem.
Arthroscopic shoulder surgery these rehabilitation protocols are based on current studies detailing healing time and the risk of stiffness after arthroscopic shoulder surgery. Seattle rotator cuff specialist premium rotator cuff surgery. Therapy services patient information subscapularis template version. The beginning of therapy focuses on reducing pain, education on protection of the surgery repair, and maintaining a certain range of motion. Evaluation of isometric strength and fatty infiltration of. Partial subscapularis tears infrequently require surgical repair. Repair of acuteonchronic subscapularis insufficiency in an. Questions regarding the progress of a specific patient are encouraged, and should be directed to twin cities orthopedic. Physical therapy standards of care and protocol the following standards of care and protocols are the property of bwh and should not be copied or otherwise used without the permission of the director of rehabilitation services. Massive rotator cuffrerepair protocol weeks 0 6 patient to wear sling or abduction pillow continuously for 46 weeks.
This protocol was adapted from the articles titled. This may include physical therapy, antiinflammatory medication, rest, and activity modification. Standard open or arthroscopic rotator cuff repair protocol. We have already covered the other three muscles in this group, the supraspinatus, infraspinatus, and the teres minor in previous posts. Johns hopkins shoulder rehabilitation protocol after. The subscapularis release miracle impingement and beyond. The subscapularis muscle scm is the main medial rotator of the humerus and contributes to the anterior dynamic stability of the glenoumeral joint. The physician reserves the right to either advance or delay this protocol as deemed necessary. The subscapularis release miracle shoulder pain relief. The intent of this protocol is to provide the clinician with a. This protocol provides the clinician with general guidelines for the rehabilitation of the patient undergoing arthroscopic, miniopen or open repair of a large or massive rotator cuff tear.
Physical therapy prescription rotator cuff repair 1216 weeks postop. Over time, as your physician protocol allows, range of motion is increased, joint mobility is restored and finally very gentle strengthening is begun. The objective is to provide surgeons and other healthcare providers the information critical for treating persons with complex peripheral nerve trauma. Pathologies subscapularis can harbor up to three trigger points, with the two most common occurring near the outside edge of the muscle.
Physical therapy standards of care brigham and womens hospital. Dec 07, 2010 the subscapularis release miracle impingement and beyond. If so, this should be done by direct communication with the therapist, or in writing on the therapy referral form given to the patient on the day of surgery. Recent literature has demonstrated successful allarthroscopic repair of isolated subscapularis tears and anterosuperior rotator cuff tears. Methods for manual and selfstretching of the posterior. Sep 10, 2015 physical therapy was started 6 weeks postoperatively. Some articles suggest that it is the cause of about 12% of conditions presenting as shoulder pain and dysfunction labetowicz, et al. Discuss glenohumeral internal rotation deficit and its association with shoulder conditions. Subscapularis tear recovery time, surgery, symptoms, treatment. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Physical therapy treatments for shoulder pain may include. You can change the dressing to a smaller one to allow the cold therapy to reach the shoulder. Rehabilitation protocol for rotator cuff repair this protocol is intended to guide clinicians and patients through the postoperative course of a rotator cuff repair. This protocol differs from the typical rotator cuff repair protocol as the subscapularis is put under.
Current evidence for stretching of the posterior shoulder. The role of soft tissue mobilization to subscapularis to improve external rotation in a type ii slap repaira case series our clinic is a smaller clinic and doesnt have the time or resources for a full research study but we did have the opportunity to perform a very small pilot studycase series. In partial tear, physical therapy might be enough in order to guarantee recovery. Conservative subscapularis repair protocol weeks one to two weeks two to four initial evaluation evaluate posture, scapulothoracichumeral position passive range of motion within precautions. You can use the lateral upper arm release on patients who are limited by pain and or postop protocol, then progress them to the functional subscapularis release once they are no longer limited. In full tears, passive and active stretching exercises combined with antiinflammatory. Specific changes in the program will be made by the physician as appropriate for an individual patient.
Tears often respond well to conservative treatments, and i personally prefer to exhaust these before even discussing surgery for the reasons listed below. This protocol provides you with general guidelines for the rehabilitation of patients following a standard open, mini open andor arthroscopic rotator cuff repair. Rotator cuff repair protocol boston shoulder institute. Total shoulder arthroplastyhemiarthroplasty protocol. Denards rehabilitation protocols arthroscopic shoulder. Nsaids like ibuprofennaproxen, physical therapy, and judicious use of cortisone injections should be considered before surgical intervention. Johns hopkins shoulder rehabilitation protocol after capsular shift with subscapularis splitting approach johns hopkins shoulder surgeons introduction. Physical therapy protocol now that your subscapularis anterior rotator cuff tear has been repaired it is very important that you follow this rehabilitation protocol in order to optimize your results. The physical therapist will give exercises that will strengthen the shoulder and also restore lost range of motion. Rehabilitation protocol for bankart repair massachusetts general. Physical therapists are challenged to return athletes to their respective sport as quickly as possible. Ok to do tabletop activities within pain tolerance eat, brush teeth, write and keyboarding.
Burke gurney1 1deparment of physical therapy, university of new mexico health sciences, albuquerque, nm, 2department of rehabilitation sciences, university of kentucky, college of health sciences, lexington, ky abstract wells sn, schilz jr, uhl tl, gurney b. Rotator cuff repair postoperative rehabilitation protocol orthoindy. The average distance from the posterior corner of the acromion to the suprascapular nerve at. If you have pain or difficulty reaching for something on a high shelf, getting dressed. Referred pain from trigger points in the subscapularis muscle concentrates in the posterior shoulder. Many of the articles i found online date back to 1976 and the amount of literature is limited. This is because the articular surface of the round humeral head is approximately four times greater than that of the. Diagram showing the surgical technique used to reattach the avulsed subscapular tendon to the lesser tuberosity of the proximal humerus. The subscapularis is the largest of the four rotator cuff muscles. Some surgeons prefer subscapularis peel because of ease of use, but some evidence suggests that. Both conservative nonoperative care and surgical treatment are included. Physical therapy arthroscopic rotator cuff repair protocol. Specific interventions should be based on the needs of the individual and should consider exam findings and clinical decision making.
Subscapularis repair rehab modifications physical therapy protocol weeks 1 to 6 range of motion no external rotation beyond 0 degrees for six weeks no overhead motion exercises ultrasling for six weeks weeks 6 to 12 exercises stretching program for passive external rotation and overhead stretching flexion and scaption with. Rehabilitation guidelines for type i and type ii rotator. Abduction bracesling, remove sling only to bathe and to complete exercises. At repair sports institute, we pride ourselves on our proactive holistic 3tiered approach to functional medicine. Postoperative physical therapy started at one week with. Arthroscopic repair of isolated pediatric subscapularis tears. Biomechanical study of a subscapularis repair technique for. Dec 17, 2014 the subscapularis is the last of the four muscles that make up the rotator cuff group and it is the most powerful of the four. Open or arthoscopic subscapularis tendon repair postoperative physical therapy protocol immediate postoperative period sling for 4 weeks modalities prn weeks 04 goals. Journal of orthopaedic and sports physical therapy. Begin early shoulder motion activities when you go home. External rotation and overhead reach were taken before and after intervention for both groups. It is no means intended to be a substitute for ones. The main purpose of the rotator cuff is to keep the head of the humerus bone centered within the shoulder joint the subscapularis muscle functions as the internal rotator of the rotator cuff.
Rehabilitation guidelines for type i and type ii rotator cuff. You may note that these protocols are more conservative than you have seen in your experience or heard from friends. We offer a team of professionals to keep you at the top of. A comprehensive shoulder rehabilitation program for the injured athlete participating in overhead activity may include the use of modalities to decrease pain, mobility exercises and manual therapy to address range of motion deficits, and strengthening exercises to address shoulder weakness. Inwardly rotate your shoulder, placing your hand on top of the book, and press downward for five to 10 seconds. Orthopedics secure subscapularis repair is an essential element of total shoulder arthroplasty. This summary of the evaluation and rehabilitation of a patient who is being treated with a shoulder stabilization procedure is designed to guide the therapist and patient. Apply ice to the shoulder as tolerated to reduce pain and swelling. This is done through two small puncture holes around the shoulder.
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. Physical therapy section pectoralis major repair revised november 2016 adapted from william beaumont army medical center postop days 1 14 shoulder immobilizer x 6 weeks even while sleeping place pillow under shoulder arm while sleeping for comfort hand squeezing exercises. Subscapularis release for loss of external rotation. Loss of subscapularis function after total shoulder. Distal rom with scapular retraction manual scapular manipulation with patient lying on nonoperative side supine passive ff in scapular plane to 90 supine passive er to 0. Johns hopkins shoulder rehabilitation protocol after capsular. Nov 02, 2017 the subscapularis is the largest of the four rotator cuff muscles. If you have any questions regarding the progress of the patient, the.
Anyone who exercises regularly is likely familiar with the dilemma. 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. They provide background on anatomy, etiology causes, diagnosis, and treatment of this condition. Isolated subscapularis tear from minimal trauma in a. The subscapularis is the last of the four muscles that make up the rotator cuff group and it is the most powerful of the four. The subscapularis is an often neglected andor undertreated cause of posterior shoulder pain with restricted range of motion rom. Repair sports institute physical therapy, chiropractic. Relax briefly, then move your elbow about 3 inches farther. Aug 09, 2010 the role of soft tissue mobilization to subscapularis to improve external rotation in a type ii slap repaira case series our clinic is a smaller clinic and doesnt have the time or resources for a full research study but we did have the opportunity to perform a very small pilot studycase series. Rotator cuff repair protocol south shore orthopedics. Physical therapy was started 6 weeks postoperatively. Methods for manual and selfstretching of the posterior shoulder region cory manton, pt, dpt, ocs, cscs sunday, october 25, 2015 11. Physical therapys role in addressing shoulder pain beaumont health. Cole,md,mba range of motion immobilizer exercises phase i 06 weeks 03 weeks.
The rehabilitation protocol for total shoulder arthroplasty tsa hemiarthroplasty hhr is based on the latest research. Try not to let the direct spray of water from the showerhead hit the incision. Start on your back with your elbow about 6 inches away from your side and flexed to 90 degrees, so your forearm points upward. Physical therapy this is recommended prior to surgery for a period of six to eight weeks but also after the surgery, after the initial critical period of four weeks. Luckily, the trigger point on the inside edge of the muscle s much less common, because it is nearly impossible to contact by palpation and release manually. Integrating shoulder and core exercises when rehabilitating. Intermediate results after unconstrained total shoulder arthroplasty tsr have been good to excellent in greater than 90% of patients. The program may be modified by the referring provider for an individual patient. Sling immobilization at all times except for showering and rehab under guidance of pt. The patient was immobilized in a sling for one week postoperatively. Successful arthroscopic treatment follows several critical steps.
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