Be sure to discuss any concerns with your provider before the procedure. 5. 4 0 obj The skin over your surgical site will be cleaned with an antiseptic solution. This protocol is time based (dependent on tissue healing) as well as criterion based. Shoulder Precautions It stabilizes the ball-and-socket joint of the shoulder and allows for normal shoulder mechanics. In some cases, a tendon graft or joint replacement may be needed. Ice shoulder 3 - 5 times (15 minutes each time) per day to control swelling and inflammation. In arthroscopic shoulder repair, the surgeon inserts a small camera called an arthroscope into the shoulder joint, which displays pictures onto a screen so that the surgeon may guide surgical instruments. collected, please refer to our Privacy Policy. Procedures may vary depending on your condition and your providers practices. You will eventually be prescribed strengthening exercises. This may include shaving off bone spurs that are pinching the shoulder, and repairing torn tendons or muscles in the shoulder. . PROM shoulder flexion/abduction/ER/IR. endobj A surgical repair is indicated when pain cannot be managed with conservative methods and is associated with weakness that causes a significant loss of function. Continue to emphasize scapular stabilizers. %gN+K(( 8VC|[WN#( Y2,,-_:,=t6h(#9 At Mass General, the brightest minds in medicine collaborate on behalf of our patients to bridge innovation science with state-of-the-art clinical medicine. 85 College Street Hamilton, NY 13346. Based on your medical condition, your provider may request other specific preparation. Arthroscopic Rotator Cuff Repair Protocol: The intent of this protocol is to provide the clinician with a guideline of the post-operative rehabilitation course of a patient that has undergone an arthroscopic assisted/mini-open rotator cuff repair. Explore fellowships, residencies, internships and other educational opportunities. 02114. The intent of posting these standards of care and protocols is to provide clinicians and patients an understanding of our current standards of care and protocols at BWH. QlR#D' augment suture repair of the rotator armband tendon in 2 stud-. You may meet with a physical therapist before your surgery to talk about rehabilitation. We have remained at the forefront of medicine by fostering a culture of collaboration, pushing the boundaries of medical research, educating the brightest medical minds and maintaining an unwavering commitment to the diverse communities we serve. We use cookies and other tools to enhance your experience on our website and <>/XObject<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 32 0 R 33 0 R 34 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Our inpatient satisfaction survey, sent to patients to assess their total care experience, helps us to monitor what we are doing well and what areas may need improvement. We use cookies and other tools to enhance your experience on our website and %PDF-1.6 % Arthroscopic Rotator Cuff Repair is performed when there is a tear of one or more of the four muscles that comprise the Rotator Cuff. Back to Rehabilitation Services Physical Therapy Protocols The following Protocols are the property of Brigham and Women's Hospital (BWH) and are linked here with permission. Search for condition information or for a specific treatment program. The incision will vary depending on the type of surgery (open surgery, arthroscopy, or a combination of both) that may be done. The intent of posting these standards of care and protocols is to provide clinicians and patients an understanding of our current standards of care and protocols at BWH and BWFH. Follow any directions you're given about not eating or drinking before your procedure. Elbow/wrist/hand AROM w/ no resistance. @O]2QCl*x[c@V(.G?L(#? Control pain and swelling Activities: 1. Pre-op. stream <> The rotator cuff consists of muscles and tendons that hold the shoulder in place and allows a person to lift his and her arm and reach up. You may not recover full range of motion in the shoulder joint. There may be other risks depending on your specific medical condition. The General Hospital Corporation. The arthroscope is often used in conjunction with other tools that are inserted through another incision. We offer diagnostic and treatment options for common and complex medical conditions. Find PDFs of our most common rehabilitation protocols. Mass General Brigham's Sports Medicine Program now offers urgent access virtual visits. If you believe you should have an evaluation and would like to schedule an appointment with one of our orthopaedic surgeons for rotator cuff surgery, knee replacement surgery or hip replacement surgery, call 1-800-294-9999 to speak to one of our knowledgeable coordinators who can help to connect you to the doctor that best meets your needs, or fill out an online appointment request form. An IV (intravenous) line may be started in your arm or hand. You may undergo blood tests or other diagnostic tests. Nonsurgical treatment may relieve pain and improve function in the shoulder; however, shoulder strength does not typically improve without surgery. In some cases, a tendon graft and joint replacement may be necessary. If your rotator cuff is injured, you may need to repair it surgically. The rotator cuff is a slow healing structure due to poor blood supply. An injury to the rotator cuff, such as a tear, may happen suddenly when falling on an outstretched hand or develop over time due to repetitive activities and eventually require rotator cuff surgery. Tell your provider if you have a history of bleeding disorders or if you're taking any anticoagulant (blood-thinning) medicines, aspirin, or other medicines that affect blood clotting. }@o~+msq8JJ|vd24a2e> For surgery at the surgery center at Brigham and Women's Hospital/MGH Foxborough Report directly to the 4th Floor SHOULDER - ROTATOR CUFF REPAIR WITH SLAP REPAIR POSTOPERATIVE INSTRUCTIONS Phase One: the first week after surgery GOALS: Control pain and swelling Protect the rotator cuff repair Protect wound healing to analyze our web traffic. The conservative rehabilitation protocol allows Sharpey fibers to form before stressing the repair with resistive exercises. Include home cuff strengthening program. Rotator Cuff Repair with Biceps Tenotomy/Tenodesis Post-Operative Protocol Phase I - Maximum Protection (Weeks 0 to 6): Goals: o Reduce inflammation o Decrease pain o Postural education o PROM as instructed Restrictions/Exercise Progression: o Sling for 6 weeks per Dr. Bjerke's instructions endobj The camera is connected to a monitoring system that allows the doctor to view a joint through a very small incision. The American Society of Shoulder and Elbow Therapists' consensus statement on rehabilitation following arthroscopic rotator cuff repair. %PDF-1.7 The rotator cuff consists of four muscles that come together as tendons to cover the head of the humerus. collected, please refer to our Privacy Policy. The shoulder is a ball-and-socket joint: the head of the humerus (upper arm bone) fits into a socket in the shoulder blade. endobj Read the form carefully and ask questions if something isn't clear. Mass General - Boston The rotator cuff keeps the shoulder in the socket. Individually, these muscles either internally or externally rotate the humerus. Rk.*Ec;g[tG$uVR/vr{O'?= 0?~zEq;*_~f~*axq{qz"ez*^L3_'0/B/''`Do5(C ORs"5>:x8= w l=q6[:!P nh;$+{/Ca p(3QOWhPj0*dpJLOq(X/_l,8Vy/_d0[ g|N!$e$=~HC=:"@("mK0e4o{p$`Y??D :]Lco139R;K)=QUvz x|r =p+43 Mastersling with body . biceps tenodesis procedure involves cutting of the long head of the biceps just prior to its insertion on the superior labrum and then anchoring the tendon along its anatomical course more distally along the humerus. %PDF-1.7 x=n8zE$ This usually involves reattaching the tendon to the head of the humerus. A Teaching Affiliate of Harvard Medical School 75 Francis St. Boston, Massachusetts 02115. . You may resume your normal diet unless your provider advises you differently. Rotator cuff surgery may be done using an arthroscope. We use cookies and other tools to enhance your experience on our website and Adobe Acrobat 8.0 Combine Files The incision will be closed with stitches or surgical staples. For more information about these cookies and the data <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> smoking, hypercholesterolemia and diabetes. This philosophy of patient- and family-focused care involves systems and services that emphasize healing in a comfortable, relaxed environment. This may include shaving off bone spurs that are pinching the shoulder or repairing torn tendons or muscles in the shoulder. It allows you to lift your arm and reach up. A surgical repair is indicated when pain Phase I: 1 through 4 to 6 weeks post-op: First 3 weeks: Patient education: movement limitations, posture, proper sling fitting, joint protection, and positioning. collected, please refer to our Privacy Policy. Boston, ROM Exercises; Maximise shoulder strength of deltoid, intact cuff muscles and scapula stabilisers. Using sutures and suture anchors, the torn muscle and tendon are sewn back to the bone where it was originally attached. Brigham and Women's Faulkner Hospital Rehabilitation Services 1153 Centre Street - 2nd Floor Boston, MA 02130 617-983-7271 General Information Arthroscopic Rotator Cuff Repair is performed when there is a tear of one or more of the four muscles that comprise the Rotator Cuff. Other incisions may be made to use other small grasping, probing, or cutting tools. The damage may be due to: Recurrent pain, limited ability to move the arm, and muscle weakness are the most common symptoms. This information is not intended as a substitute for professional medical care. Arthroscopic repair of massive rotator cuff tears: outcome and analysis of factors 2 0 obj Learn about Real Therapy Standards of Care and Protocols since that Rehabilitation Services at Brightam additionally Women's Infirmary. Your surgeon may give you other instructions after the procedure, depending on your particular situation. About Us; Meet Our Team; Our Services; collected, please refer to our Privacy Policy. This guideline is designed to mqTdYqc#\*DgVx?,a6&&tO"TP_YV{zYNm[ Dj?mk^(^N7K1_Q P ? +!B8p+*.QnMXNjtt Always follow your healthcare professional's instructions. The following Standards is Care and Protocols are the real away BWH and should not be copied or otherwise used without the get of the Director of Rehabilitation Services. Be sure to take only recommended medicines. It consists of a system of lenses, a small video camera, and a light for viewing. Take a pain reliever for soreness as recommended by your healthcare provider. Your provider will explain the procedure to you. The conservative approach may be associated with post-operative stiffness which can be managed once healing has occurred. 2023 Once your blood pressure, pulse, and breathing are stable and you're alert, you'll be taken to your hospital room or discharged to your home. Expect full recovery to take up to 4 to 6 months. The arthroscope (if used) will be put through the incision. Brigham and Women's Hospital, Division of Rheumatology, Inflammation, and Immunity, nonsteroidal anti-inflammatory medications. Rotator cuff repair may be done while you're asleep under general anesthesia or while you're awake under local or regional anesthesia. 617-732-5500, New Patients: Rehabilitation Services at Brigham & Women's Hospital has accepted a modification of this protocol as our standard protocol for the management of patient's s/p arthroscopic repair of Type II and IV SLAP lesions. An injury to the rotator cuff, such as a tear, may happen suddenly when falling on an outstretched hand or develop over time due to repetitive activities. 4. ns6K2*\2 9LSs. `6B3}"{PT(3 _x g"8. L|5C[[ZW%pGY8JMe{+u'O=1m The intent of posting these standards of care and protocols is to provide clinicians and patients an understanding of our current standards of care and protocols at BWH. ajp5 Get the latest news, explore events and connect with Mass General. MA Rotator Cuff Repair. Injuries to the shoulder are common. The circulation and sensation of your arm will be monitored. Nerves or blood vessels in the area of surgery may be injured. Medical treatments for rotator cuff injury may include, but are not limited to, the following: If medical treatments are not satisfactory, rotator cuff surgery may be an effective treatment for shoulder repair. <>/Metadata 1084 0 R/ViewerPreferences 1085 0 R>> % Arthroscopic Labral Repair Protocol-Type II, IV, and Complex Tears: Athletes and construction workers often have rotator cuff injuries due to repetitive movement and overuse of the shoulder. endobj Rotator cuff surgery may be performed using an arthroscope. Rotator cuff tears (RCT) are frequent and increase with age, yet the varying functional implications of a tear can have a unique and dramatic impact on a patient's daily life. It may be necessary for you to stop these medicines before the procedure. Turners Cuff . Your health and safety remain our top priority: Learn about our Safe Care Commitment | Use our Prescreen app before arrival for faster entry | Read the COVID-19 Vaccine FAQs. The Orthopaedic & Arthritis Center at Brigham and Womens Hospital is one of the most highly regarded orthopaedic and joint disease research and treatment programs in the world. An open repair may be done if the rotator cuff injury cant be repaired using arthroscopy. x][~G[" $`u[6=nwgz~HH[6M} ^|jg4?/>=W6ugqAxi??='O71R +gA^V%w?h0J6 }l?x)?VQ,QK-XTS1aM Connect with us. The stitches or surgical staples will be removed during a follow-up office visit. The anesthesiologist or nurse anesthetist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery. Stay Informed. Rehabilitation after Arthroscopic Labrum Repair of the Shoulder (SLAP) Phase One: 0 to 4 weeks after surgery Goals: 1. Ensure wound healing 3. General Information: Tell your provider about all prescription and over-the-counter medicines and herbal supplements that you're taking. It consists of a system of lenses, a small video camera, and a light for viewing. Physical Therapy Protocols Shoulder Elbow Hip/Knee Ankle Return to Sports Guidelines Physical Therapy Standards of Care Ankle Spine Shoulder Hip/Knee Lower Extremity Pelvic Health If regional anesthesia is used, you'll have no feeling in your shoulder. 1 The intent of this Protocol is to provide the clinician with a guideline for the post-operative rehabilitation course of a patient that has undergone a Flexor Tendon Repair.It is by no means Brigham AND women 'S HOSPITAL intended to be a substitute for one's clinical decision-making regarding the progression of a A Teaching Affiliate of Harvard Medical School patient's post-operative course . <> Tell your provider about any of the following: Redness, swelling, bleeding, or other drainage from the incision site, Numbness or tingling in the affected arm or hand. The intent of posting these criteria a care and protocols a to provide clinicians and patients an understanding of ours current standards of care and protocols at BWH. You may get a medicine (sedative) before the procedure to help you relax. The surgeon will fix or replace injured tendons and muscles with a graft tendon from another part of the body. Maintain good upright shoulder girdle posture at all times and especially during sling use. 1 Oxford Road New Hartford, NY 13413. This protocol will vary in length and aggressiveness depending on factors such as: When one or more of the tendons in the rotator cuff is torn, it no longer fully attaches to the head of the humerus. For more information about these cookies and the data The following Protocols are the property of Brigham and Women's Hospital (BWH) and are linked here with permission. Day 1 - 3 weeks. 2 0 obj We are committed to providing expert caresafely and effectively. This results in weakness or numbness. endobj We pride ourselves in the quality of patient care we provide and how we compare with other hospitals. It stabilizes the ball-and-socket joint of the shoulder and allows for normal shoulder mechanics. The Sports Physical Therapy Service is an integral part of the Sports Medicine Center and the Department of Physical and Occupational Therapy. Acrobat Distiller 8.0.0 (Windows) The information contained in these standards of care or protocols is not intended in any way to be used as primary medical advice or to replace medical advice offered by physical, occupational, speech therapists or other health care professionals. uuid:463caef0-aa5d-4b8f-bc94-142f9b3774d9 The arthroscope is often used along with other tools that are inserted through another small incision. to analyze our web traffic. Microsoft Word - Rotator cuff and SLAP patient info.doc The rotator cuff consists of four muscles that come together as tendons to cover the head of the humerus. Connect with us. The goal of rotator cuff repair surgery is to help restore the function and flexibility of the shoulder and to relieve the pain that cannot be controlled by other treatments. These muscles originate on the shoulder blade and attach to the humeral head. These treatments may include: rest, activity modification, non-steroidal anti-inflammatory medication and physical therapy. For over a century, a leader in patient care, medical education and research, with expertise in virtually every specialty of medicine and surgery. 175 Cambridge Street, 4th Floor Boston, MA 02114 Phone: 617-643-9999 Fax: 617-643-0822 Knee ACL Injuries - Non-operative Management ACL Reconstruction Autologous Chondrocyte Implantation (ACI)-Femoral Autologous Chondrocyte Implantation (ACI)-Patella High Tibial Osteotomy Protocol Iliotibial Band Syndrome Copyright 2007-2023. Equate active and passive range of motion. <>/Metadata 702 0 R/ViewerPreferences 703 0 R>> Brigham and Women's Faulkner Hospital Rehabilitation Services1153 Centre Street, 2nd FloorBoston, MA 02130. For over a century, a leader in patient care, medical education and research, with expertise in virtually every specialty of medicine and surgery. NEW HARTFORD. 3 0 obj Damage may also occur slowly over time. Rehabilitation after Rotator Cuff Repair. endstream endobj 770 0 obj<>stream Surgical techniques that may be used to repair a tear of the rotator cuff include arthroscopy, open surgery, or a combination of both. As with any surgical procedure, complications can happen. Learn about career opportunities, search for positions and apply for a job. /*jthpUxYl*ABB'.4dG^td}AU <> 3. The type of anesthesia will depend on the specific procedure being done. % Aspirin or certain other pain medicines may increase the chance of bleeding. The decelerated rehabilitation avoids excessive tension on the SS & IS by avoiding excessive scaption, ER, & FF until 4 weeks. Women's Orthopedic and Joint Disease Center, Anesthesiology, Perioperative and Pain Medicine. Bone spurs will be removed if there are any. 617-732-5500, Learn more about our sports medicine offerings, Rotator Cuff Tears: Frequently Asked Questions, Rotator Cuff Tears: Surgical Treatment Options, Rotator Cuff and Shoulder Conditioning Program, Anesthesiology, Perioperative and Pain Medicine. Arthroscopic Anterior Shoulder Stabilization Protocol, Latissimus Dorsi Tendon Transfer Protocol, Open Anterior Shoulder Stabilization Protocol, Posterior and Posterior Inferior Capsular Shift of the Shoulder Protocol, Proximal Humeral Fracture Open Reduction Internal Fixation (ORIF), Reverse (Inverse) Total Shoulder Arthroplasty Protocol, Rotator Cuff Repair Small to Medium Tear, Rotator Cuff Repair Large to Massive Tear, Ulnar Collatoral Ligament of the Elbow Reconstruction Protocol, Autologous Chondrocyte Implantation Protocol, Medial Patellofemoral Ligament (MPFL) Reconstruction, Post-operative Rehabilitation Protocol following Arthroscopic Hip Surgery for Femoroacetabular Impingement, Ankle Fracture with Open Reduction and Internal Fixation (ORIF), Brostrom Gould Repair for Ankle Instability, Functional Activity Progression Protocol following Lower Extremity Stress Injury, Return to Sport Following Knee Injury/Surgery, Running Injury Prevention Tips & Return to Running Program, Running Injury Prevention Tips & Strength Training Program, 2023Brigham and Women's Faulkner Hospital. Stay Informed. Call 617-643-3333 if youre experiencing a sports injury. They should not be copied or otherwise used without the permission of the Director of Rehabilitation Services. Frequency of treatment will be determined by your specific needs together with the physician and physical therapist recommendations. Start progressive rotator cuff and shoulder strengthening at 3 months - isometrics initially Initiate isotonic strengthening at 4 months (Theraband, dumbbells, Hughston's exercises, etc). Connect with us. Journal of Shoulder and Elbow Surgery, 4:521-535. This procedure is specifically designed for the treatment of glenohumeral (GH) joint arthritis or complex fractures, when associated with irreparable rotator cuff (RC) damage or in the presence of RC arthropathy. For very large tears, physical therapy may be delayed to promote rotator cuff healing up to 6 weeks postoperatively. Rehab Plans and Exercises Minor Rotator Cuff Repair Protocol for Physiotherapy Following Surgery. Let us help you navigate your in-person or virtual visit to Mass General. Rotator cuff strengthening with light Theraband - ER and IR with arm at side and pillow or towel roll under arm - Flexion to 60 degrees - Abduction to 60 degrees - Scaption to 60 degrees - Extension to 30 degrees Standing rows with Theraband Prone scapular retraction exercises (with light weight) Ball on wall (arcs, alphabet) There may be other reasons for your healthcare provider to recommend rotator cuff repair. Stay Informed. We use a comprehensive approach to caring for the whole athlete, treating your sports injury and helping you return to the activities you love. We provide our patients with comprehensive, coordinated care from experts who understand the unique needs of women in sports. Brigham and Womens Hospital is committed to providing all of our patients with the safest, highest-quality, most-satisfying care possible and following established protocols that have been shown to improve patient outcomes. Nikolaidou O, M. S. (2017). The damage may be due to: Inflammation of the bursa (bursitis) in the shoulder, Inflammation of the tendons (tendinitis) in the shoulder. Reverse or inverse total shoulder arthroplasty (rTSA) is becoming a widely accepted surgical intervention. You should keep the sling or immobilizer on as directed by your provider. Arthroscopic Rotator Cuff Repair Frequently Asked Questions: The rotator cuff is a group of four muscles: the supraspinatus, the infraspinatus, the subscapularis, and the teres minor. 800-294-9999. Van der Meijden OA, W. P . LL`}*Tg/#VA|5RQSVt*#bH|5 [oB]bPY) 1ULXv$6*jthb Ylv Your recovery process will vary depending on the type of anesthesia that is given and the type of surgery thats done. Stay Informed. Before you agree to the test or the procedure make sure you know: The reason you're having the test or procedure, What results to expect and what they mean, The risks and benefits of the test or procedure, What the possible side effects or complications are, When and where you're to have the test or procedure, Who will do the test or procedure and what that persons qualifications are, What would happen if you didn't have the test or procedure, Any alternative tests or procedures to think about, Who to call after the test or procedure if you have questions or problems, How much you'll have to pay for the test or procedure. General Information: Quick Links. Its one of the most important parts of the shoulder. Tech How Assam. Brigham and Womens Hospital has long been committed to not only the care of our patients but also the many other needs that they and their families have. In the case of a delayed therapy start, the following timeframes are to be adjusted so that day 1 is the first day of therapy. It's one of the most important parts of the shoulder. uuid:5fa44141-9c8c-4c9c-b6ca-f862302a5ebb to analyze our web traffic. Your surgeon will give you specific bathing instructions. 175 Cambridge Street, 4th Floor The rotator cuff is made up of muscles and tendons that hold the shoulder in place. All rights reserved. An injury to the rotator cuff, such as a tear, may happen suddenly when falling on an outstretched hand or develop over time due to repetitive activities. 1 0 obj BRIGHAM AND WOMEN'S HOSPITAL. You'll be positioned on the operating table. Operative report should be read to determine the extent of rotator cuff involvement, integrity of the articular surface, involvement of the biceps tendon and glenoid labrum. The tendons attach the humerus to the shoulder blade and aids in lifting and rotating the arm. Women's Sports Medicine Rotator Cuff Repair The shoulder is a ball-and-socket joint: the head of the humerus (upper arm bone) fits into a socket in the shoulder blade. Numerous rehabilitation protocols for the management of rotator cuff disease are based primarily on . Protect the surgical repair 2. Small/Medium Rotator Cuff Repair Protocol; Subscapularis Repair Protocol; Superior Capsule Repair Protocol; Triceps Tendon Repair Protocol; Locations: HAMILTON. Your provider will discuss this with you in advance. Your provider will arrange for an exercise rehabilitation program to help you regain muscle strength, flexibility, and function of your shoulder. Recurrent pain, limited ability to move the arm, and muscle weakness are the most common symptoms. COPYRIGHT*2014*CRC*"BRIAN*J. SUBSCAPULARIS REPAIR REHABILITATION PROTOCOL ! Connect with us. There are a number of different anchoring techniques that surgeons are currently using. An arm sling is used for 4 weeks post-op. You can ask questions. For more information, please visit the following webpages on orthoinfo.org: Please visit orthoinfo.org if your condition is not listed above. Connect with us. Most commonly, however, this group of muscles co-contracts and . The presence of a RCT can cause a vast array of impairments and associated dysfunctions. To help reduce swelling, you may be asked to apply an ice bag to the shoulder several times per day for the first few days. skip to Cookie . vywh0*-)Ha[ %2+$t^> K5$*{c Z Q.@B[,4nr^{.zlqE@`Cu.> 833 0 obj <>/OCGs[835 0 R 836 0 R]>>/StructTreeRoot 164 0 R/Type/Catalog>> endobj 98 0 obj <> endobj 2783 0 obj <>stream Mass General Brigham's network of Harvard Medical School-affiliated experts leads the nation in sports medicine research, technology, and innovations. *COLE,*MD,*MBA RANGE OF MOTION IMMOBILIZER EXERCISES PHASE I 0-6 weeks 0-3 weeks: None 3-6 weeks: Begin PROM Limit 90 flexion, 45 ER, 20 extension 0-2 weeks: Immobilized at all times day and night Off for hygiene and gentle home exercise according to
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