The Shoulder Surgeon | Specialist keyhole surgery for the treatment of shoulder and elbow problems

The Shoulder Surgeon | Specialist keyhole surgery for the treatment of shoulder and elbow problems
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Common Shoulder Injuries
 

Shoulder Problems

 

Rotator Cuff Repair Protocol
(for subscap repairs refer to italic/ bold instructions where rehab differs from routine protocol)

The protocols should be goal orientated focusing on what the patient can achieve with ease and good quality movement / technique. The times are a guideline to allow you assess the patient’s progress.

Please note that this is the protocol for the patients having different shoulder procedures.

I have to stress the fact that this protocol applies to most patients but not all. Please refer to operation notes for any special instructions. If there are no special instructions you may follow these protocols.

If for whatever reason you are concerned please do not hesitate to contact me. If you can’t contact me please contact a doctor, preferably from my team.

Thank you

 

Pre-op

  • Keep the joint supple & mobile as possible
  • Deltoid exercises to prevent pseudoparalysis
  • Scapular stabilising exercises.
Day of Op
  • Axillary hygiene
  • Finger, wrist and elbow exercises
  • DonJoy sling (+/- abduction pillow see op notes)
  • Teach how to remove sling and replace it safely before discharge

Upto 3/52

  • Postural retraining
  • Closed chain active supported flexion within pain free ROM (e.g. hands on table and walk away, duster slides on table / gym ball)
  • Active assisted ER in pain free range with good quality movement
  • Limit ER to neutral (?45°)
  • Closed chain abduction in scapula plane (i.e. bilateral dusting table in diagonal pattern)

3-6/52
  • Remove Don Joy pillow, continue with existing sling aiming to begin weaning off by 4-5/52 for complete removal @ 6/52
  • Isometric exercises through ROM
  • Avoid resisted IR until 6/52
  • Progress closed chain exercises against gravity (e.g. dusting wall)
  • Open chain bilateral active assisted elevation (e.g. short lever elevation with football in hands)
  • Continue with postural correction and movement re-education as required
  • HBB as comfortable mild stretch only
6 /52 +
  • Progress active ROM in all directions with good humeral scapula rhythm
  • Gradual introduction to resistance exercises within a pain free ROM
  • Ensure good recruitment of rotator cuff through range especially posterior cuff
  • Use manual techniques if required for  persistent tightness
  • Strengthen throughout ROM using activity / work / sport specific exercise