Rehabilitation following Arthroscopic rotator cuff repair

1. REHABILITATION FOLLOWING
ARTHROSCOPIC ROTATOR CUFF
REPAIR
DR.TARUN KUMAR BADAM
PG DNB ORTHO
INSTITUTE OF ORTHOPEDIC RESEARCH AND ACCIDENT SURGERY
(IORAS)

2. ROTATOR CUFF TEARS
Rotator cuff tear is the most common cause of shoulder disability.
Rotator cuff tears are chronic injuries caused by overuse, but can occur in
young persons as a result of trauma during sports
Rotator cuff deficiency can cause significant pain, dysfunction and disability
Majority of the patients are asymptomatic, few patients who are symptomatic
can also be treated non-operatively with analgesics and rest
Patients not relieved by conservative treatment and Sports persons who
have to return to their high intensity activities should be taken for surgery

3. In most studies, non-surgical management leads to
tear progression with fatty infiltration of muscles
and muscle atrophy
Surgical repair has shown to relieve pain and
restore function by 90%

4. PHYSICAL THERAPY
Physical therapy is an imp factor in success of
Rotator cuff Repair
Passive (PROM), Active (AROM) and
strengthening exercises lead to decreased joint
stiffness and increased strength

5. ABBREVATIONS
PROM - Passive ROM
AROM - Active ROM
HEP - Home Exercise Program
SCAPTION - Scapular elevation and abduction
UBE - Upper body exercises

6. SHOULDER MOVEMENTS

7. SCAPTION

8. TABLE SLIDES

9. THERABAND EXERCISES

10. CANE EXERCISES

11. SHOULDER PULLEYS

12. WALL WALKS

13. CAPSULAR MOBILISATION

14. PLYOMETRICS

19. REVIEW ARTICLE

20. POSTOPERATIVE OUTCOME:
EARLY VS LATE REHABILTATION

21. FUNCTIONAL OUTCOME
Functional assessment scores - ASES , UCLA , SST scores
Kim et al, Patients were randomised to receive accelerated
or slow rehab
Accelerated - active ROM 3 wks postop
Slow - active ROM 6wks postop
Significant difference ( worse in Slow group) in scores at 8 and
16 wk followup
No significant difference at 24 wks followup

22. Cuff and Pupello et al,
Early group - Pendulum Ex - 1st pod, passive ROM -
7th pod
Delayed group - Pendulum Ex - 7th pod, passive
ROM after 3 wks
Both groups - active ROM after 6 wks
Significant difference (with worse scores) in delayed
group
24 wks followup - no significant difference

23. “These studies demonstrate benefit with
early ROM protocols at early follow-up, with
equivocal results at longer follow-up”

24. RANGE OF MOTION
Several studies used CPM for early PROM
There was significant increase in ROM in CPM
group at 3 mon, but no difference at 12 months
follow up

25. PAIN
Garofo et al, reported low VAS pain score at 10 wk
follow-up , that used CPM in early Rehab

26. MUSCLE STRENGTH
Shoulder strength remained less than that of C/L
shoulder
Lee et al, No significant trend towards increased
strength in early group compared to delayed group

27. RE-TEAR RATES
Re-tear rates widely ranges from 0 - 94%
Re-tear after Arthroscopic repair is 20.4%
Deutsch et al, Cuff and Pupello et al, Lee et al, Kim et
al, Weber and Torrey et al
Re-tear rate was slightly higher in early ROM group
than delayed ROM group
BUT THIS DIFFERENCE WAS NOT STASTICALLY
SIGNIFICANT

28. SUMMARY
EARLY, AGGRESSIVE REHABILITATION
REGIMENS ARE BETTER THAN SLOW REHAB
REGIMENS

29. THANK YOU