|ROTATOR CUFF REPAIR
Assess for scapula dyskinesis and teach scapula setting.
Patient supplied with ultrasling II SAS 15 degree abduction wedge.
Wedge to be worn 24 hours/day for 4 weeks. Rolled towel or similar waterproof wedge to replace abduction wedge when showering.
The most comfortable sleeping position is supine with a pillowbehind elbow supporting arm and brace forwards.
Weeks 1 – 4
- Abduction wedge to be worn for exercises with sling. Avoid sharp, stabbing pains.
- Wrist flexion/extension
- Forearm pronation/supination.
- With arm out of sling resting on wedge, full elbow flexion/extension.
- Passive shoulder flexion to 80 degrees.
- Passive abduction to 80 degrees
- Rotation between the ranges of 30 degrees internal to 45 degrees external.
Attending physiotherapy sessions will help with pain relief. Particular attention should be paid to reducing trapezius and levator scapulae trigger points/muscle spasm. Gentle caudal traction and glenhumeral joint glides in the plane of the glenoid are especially useful.
Weeks 4 – 6
- Gradually reduce amount of abduction provided by wedge so arm is in neutral, by the side at end of week 4. Thereafter remove abduction wedge for exercise.
- Active assisted flexion to 80 degrees.
- Active assisted abduction to 80 degrees.
- Passive only rotation increasing gradually to maximum of 45 degrees internal rotation and 60 degrees external rotation.
- Begin scapulothoracic rehabilitation.
Weeks 6 +
- Remove abduction splint totally unless for sleeping comfort or unpredictable/crowded environments.
- Rhythmical stabilisation at balance point of the shoulder: with the patient supine, scapula supported, shoulder flexed to 90 degrees, allow small active movements into flexion, extension and abduction.
- Gentle isometric flexion, extension, internal rotation, external rotation and abduction with elbow on a small rolled towel, if needed for comfort, to allow slight abduction.
- Continue active assisted movements to full range – goal – Full range of movement by 10 – 12 weeks.
- Use of pulleys.
- Address core stability and kinetic chains.
- Can begin hydrotherapy.
Weeks 8 +
- Can begin work against gravity.
- Increase isometric work progressing to isokinetic as pain allows. Allow exercises that do not create impingement and minimise stress to the repair.
- Partial weight bearing proprioceptive exercises at no more than 90 degrees of abduction.