ΠΡΩΤΟΚΟΛΛΟ ΑΠΟΚΑΤΑΣΤΑΣΗΣ ΡΗΞΗΣ ΤΕΝΟΝΤΙΟΥ ΠΕΤΑΛΟΥ

Rehab Protocol for Medium (2-5) Rotator Cuff Repair
Rehab Progression Summary

  • 0-4 weeks Sling/immobilization
  • 0-6 weeks Passive gentle ROM (Phase I)
  • 4-8 weeks Active-assisted ROM (Phase II)
  • 6-12 weeks Active ROM (Phase III)
  • 12+ weeks Strengthening (Phase IV)
    Immobilization
  • Sling/abduction pillow is worn for 4 weeks during the day and night
  • Remove sling for light activity and home exercise program as indicated by therapist

Phase I – PROM: 1st post-op visit / 0-6 weeks
Goals for Treatment:
• Decrease pain and swelling
• Increase nutrition and healing response
• Infection prevention
PROM:
• Begin passive ROM exercises in clinic
• Pendulum exercise without weight: clockwise, counterclockwise, side to side, front – back
• PROM above abduction pillow: ER, IR, flexion, extension, abduction
• Table slides
• Therapist: grade I, II joint mobilizations
• Scapular retractions
• Wrist/elbow exercises; grip exercises

Patient Education:
• Wound inspection
• Begin active assisted ROM at 4 weeks
• No active motion for 6 weeks, all planes
• No weights/PRE for 12 weeks
• No active external rotation for 4 weeks
• Limit external rotation to neutral for 4 weeks
• Sling use as indicated by repair
• Icing 3x/day for 20 minutes

Other:
• Ice – PRN
• Modalities –PRN

Phase II – Assisted-AROM: 4 weeks post-op
AROM:
• Pendulum exercises with light weight
• AAROM with cane & pulleys, to patient tolerance (flexion, abduction
-ER to neutral)
• Body Blade – opposite hand, straight plane
• Shoulder shrugs – light weight/high reps
Progress with:
• Wall climbing/finger ladder
• Scar mobility
• Joint mobilizations – grade I/II
• Quadruped rhythmic stabilization
• Body Blade – opposite hand diagonals with trunk rotation
• Biceps curls
• Shoulder extension with Theraband
• Shoulder shrugs
• UBE – active assist only

Other:
• Ice – PRN
• Modalities – PRN

Phase III – AROM – 6 weeks post-op
AROM:
• Continue with Phase II A – AROM
• AAROM exercises with cane
• AROM – all planes, no resistance
• UBE – forward/reverse
• Scapular retraction
• Prone extension
• Supine “holds” at 90° flexion; progress to small circles
• Side-lying “holds” at 90° abduction; progress to small circles
• Isometrics <50% effort, no pain (flexion, extension, abduction, ER)
• Biceps curls/triceps extensions with light resistances, elbow at side

Other:
• Ice – PRN
• Modalities – PRN

Phase III – AROM continue – 8 weeks post-op
Goal:
Should have full PROM; with gentle passive stretching
AROM:
• Continue with Phase III exercises, adding weight/resistance as indicated by therapist
• Low-weight exercise (begin at 90° and increase to full ROM):
o flexion/extension
o abduction
o rows
o scaption
• Wall push-ups, wall push-ups plus
• Shoulder IR/ER with low resistance
• Scapular protraction (“serratus punch”)
• Prone fly
Other:
• Ice -PRN
•Modalities – PRN

Phase IV – Strength – 12 weeks post-op
Goal:
Should have full AROM; if not, begin aggressive stretching to achieve full ROM
Strength:
• Body Blade, involved extremity:
o one-handed grip, abduction to 90°
o two-handed grip, flexion to 90°
• Kneeling push-ups, kneeling push-ups plus
• Step-ups in kneeling push-up position
• UBE with increased resistance
• StairMaster in quadruped at level 12-15
• Treadmill in quadruped at 1.0 mph
• Plyoball:
o circles, CW & CCW, 1 minute each direction
o squares, CW & CCW, 1 minute each direction

Other:
• Ice – PRN
• Modalities – PRN

Return to Sport – Specific Training: 12-16+ weeks post-op