Subscapularis tendon injuries the normal subscapularis. Press hand into stomach while rotating elbow forward. Rehabilitation minneapolis subscapularis mn sports and. They provide background on anatomy, etiology causes, diagnosis, and treatment of this condition. Keep the abductor pillow in for the 4 weeks as well. The following subscapularis exercises will help to build strength in the muscles of the rotator cuff, as well as provide enhanced stability and mobility of the shoulder joint. It is no means intended to be a substitute for ones. Pendulum exercises bend forward at the waist, back parallel to ground is ideal. The following is a guideline for progression of postoperative treatment. Questions regarding the progress of a specific patient are encouraged, and should be directed to twin cities orthopedic. Achilles tendon repair pdf anterior cruciate ligament more about uw health sports rehabilitation acl rehabilitation. Please use this in the contributors listing for the textbook. Our unique regenerative approach to healing joints and repairing arthritis can get you back to the activities you love, without compromise. Conservative subscapularis repair protocol weeks one to two weeks two to four initial evaluation evaluate posture, scapulothoracichumeral position passive range of motion within precautions.
The subscapularis muscle is one of the four rotator cuff muscles, being the largest and strongest one of the group. The subscapularis assists in stabilizing the humeral head during motion and works to assist with internal rotation twisting in of the arm. Subscapularis tendon injuries boston shoulder institute. The intent of this protocol is to provide the physical therapist with a guidelinetreatment protocol for the postoperative rehabilitation management for a patient who has undergone a reverse total. General information there may be a loss of external rotation when compared to the other side, but the motion is. The subscapularis ssc tendon forms the anterior section of the rotator cuff rc and. Interestingly enough, physical therapy started on the first postoperative day with passive flexion and abduction. Revision rotator cuff repair improves clinical outcomes and shoulder function at midterm followup. Physical therapy arthroscopic rotator cuff repair protocol. Rehabilitation after arthroscopic rotator cuff repair. Hand therapy massage therapy occupational therapy physical therapy subscapularis muscle k tape wrist pain trigger point therapy reflexology massage. The gundersen health system rehabilitation programs are evidencebased and soft tissue healing dependent programs designed to allow patients to progress to vocational and sportrelated activities as quickly and safely as possible. The book is a second edition and contains 790 pages.
A physiciansupervised physical therapy rehabilitation program is an important component of the recovery process. Specific interventions should be based on the needs of the individual and should consider exam findings and clinical decision making. The upper subscapular nerve supplies the upper part of subscapularis, while the lower subscapular nerve branches into two, with one branch supplying the lower part of subscapularis. This protocol provides you with general guidelines for the postoperative rehabilitation of the patient following a total shoulder replacement. Most people do very well following arthroscopic subscapularis repair and can return to heavy work or sports at 612 months. Restrictions or precautions may also be given to protect healing.
In such cases, failure to repair the subscapularis tendon is associated with a poor outcome in a large percentage of individuals. Correct postural dysfunctions with work and sport specific tasks. Data analysis consisted of 1 assessing changes in outcomes from baseline to final followup and 2 assessing betweengroup differences with the 2tailed student. One high standard, three local partners for more information go to. Physical therapy prescription rotator cuff repair 1216 weeks postop. Rehabilitation protocol for reverse shoulder arthroplasty this protocol is intended to guide clinicians and patients through the postoperative course after a reverse shoulder arthroplasty. Nov 02, 2017 the subscapularis is the largest of the four rotator cuff muscles. Situated in front of the shoulder, the subscapularis brings 53% of the total rotator cuff strength, having several key roles in the dynamics of the arm. No lifting anything heavier than a telephone or one pound for 3 months. Physical therapy anterior stabilization of the shoulder. Arthroscopic shoulder rehabilitation protocols shoulder surgeon.
Department of rehabilitation services reverse total shoulder. Rehabilitation after rotator cuff repair with subscapularis repair. This protocol is intended to be a general outline only. If initial nonsurgical treatment of a rotator cuff tear fails, surgical repair is often the next line of treatment. Patients will then progress through a detailed physical therapy program until a full recovery is achieved. Rotator cuff repair conservative rotator cuff repair moderate rotator cuff tear nonop runwalk program subacromial decompression with distal clavicle resection shoulder impingement shoulder home exercise program preop shoulder physical therapy visit preop slap lesion repair subacromial decompression subscapularis repair protocol. It is evident that a successful outcome after surgical rotator cuff repair is as much dependent on surgical technique as it is on rehabilitation. Develop strength and control for movements required for work or sport. While the purpose of the surgery is to reattach the torn tendon back to the bone, in some cases it is necessary to firstly introduce an arthroscope to assess the shoulder joint to look for other pathology which may be contributing to the shoulder problem. Arthroscopic anterior stabilization protocol arthroscopic rotator cuff repair protocol arthroscopic rotator cuff repair faqs and postoperative guidelines biceps tenodesis protocol biceps tenotomy protocol. Aaom for forward elevation and er with exercises demonstrated to have. Perform a subscapularis workout once or twice per week for the most benefit. The subscapularis assists in stabilizing the humeral head during motion and works to assist with internal rotation twisting in of the arm during reaching, pulling and lifting activities. Total shoulder replacement postoperative physical therapy.
Bankart repair protocol vanderbilt university medical center. Place hand on abdomen above belly button and just below sternum. Subscapularis repair rehab modifications physical therapy protocol weeks 1 to 6 range of motion no external rotation beyond 0 degrees for six weeks no overhead motion exercises ultrasling for six weeks weeks 6 to 12 exercises stretching program for passive external rotation and overhead stretching flexion and scaption with. The subscapularis release miracle shoulder pain relief. If so, this should be done by direct communication with the therapist, or in writing on the therapy referral form given to the patient on the day of surgery. Subscapularis exercises available at sports and orthopaedic specialists, serving minneapolis, edina, st. Some people need a lot of therapy, some hardly any. Ankle achilles tendon repair ankle arthroscopic debridement ankle lateral repairs ankle non surgical rehabilitation ankle osteochondral defect repair hip birmingham hip resurfacing hip gluteus. The majority of patients report diminished symptoms and full joint function after undergoing this procedure. Achieving the criteria of each phase should be emphasized more than the approximate duration. Rehabilitation guidelines for rotator cuff repair and isolated subscapularis repair. Total shoulder replacement protocol sports and ortho.
Global rotator cuff protocol with and without subscapularis repair 201910. Purpose of the abductor pillow is to keep tension off of the repair, avoid adduction. Department of physical therapy, college of applied medical sciences, majmaah university, kingdom of saudi arabia abstract objectives. The anterosuperior subluxation of the humeral head, coming in contact with the coracoid, is often associated with fatty infiltration and tendon fragility, preventing complete subscapularis repair. Sep 01, 2017 a physical therapist pt is assessing a 35yearold patient 5 weeks after large rotator cuff repair, including the subscapularis.
Rehabilitation guidelines for type i and type ii rotator. 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. Subscapularis is largest muscle of the rotator cuff. The main purpose of the rotator cuff is to keep the head of the humerus bone centered within the shoulder joint the subscapularis muscle functions as the internal rotator of the rotator cuff. Is early physical therapy safe after a rotator cuff repair. Physical therapy protocol now that your subscapularis anterior rotator cuff tear has been repaired it is very important that you follow this rehabilitation protocol in order to optimize your results. Begin proprioceptive and dynamic neuromuscular control retraining.
The influence of anatomic total shoulder arthroplasty. Physical therapy is used when a patient has trouble regaining motion on their own. To serve as a guide to physical therapy following your surgery, this section contains rehabilitation protocols specific to your procedure. Ir as tolerated if no subscapularis repair wand behind back 12 finger isometrics x 6 fist in box. Allow involved arm to hang down, perpendicular to the floor. These general rehabilitation guidelines are created by physical and occupational therapists for the rehabilitation of various pathologies of the upper and lower extremities. In just a few short weeks of physical therapy i already have almost full range in my. The clinical outcome scores were comparable in patients with an intact repair and those with failed rc healing. Rehabilitation protocol for rotator cuff repair this protocol is intended to guide clinicians and patients through the postoperative course of a rotator cuff repair. General time frames are given for reference to the average, but individual patients will progress at different rates depending on their age, associated injuries, preinjury health status, rehab.
To this end, rehabilitation protocols have proven challenging to both the orthopaedic surgeon and the involved physical therapist. Begin active and manual scapula strengthening exercises. Rehabilitation guidelines after surgery, sports medicine. Use of a sling for 3 weeks postop unless otherwise indicated. Postoperative rehabilitation following arthroscopic. For more detail, check out our prior posts on the rotator cuff. Subscapularis rotator cuff repair shoulder surgeon long. The links below provide general information for educational purposes only. Rotator cuff repair rehabilitation program largemassive 5cm.
New diagnostic techniques and arthroscopic repair surgeries help to treat subscapularis tears. Manual therapy during this phase should consist of softtissue techniques. Subscapularis tear recovery time, surgery, symptoms. The supraspinatus muscle is the primary superior compressor of the humeral head and resists the superior force exerted by the deltoid muscle. Immobilized at all times day and night off for hygiene and gentle home exercise according to. What are my precautions regarding movements and positions after surgery. The subscapularis release miracle impingement and beyond. Bankart repair rehabilitation protocol arthroscopicopen this protocol was developed for patients who have had a bankart repair. Both conservative nonoperative care and surgical treatment are included. However, anyone recovering from an injury or surgery is free to use them.
Rehabilitation guidelines for type i and type ii rotator cuff repair and isolated subscapularis repair the anatomic configuration of the shoulder joint glenohumeral joint is often compared to that of a golf ball on a tee. Kettlebell certification, gross motor, pta, physical therapy, stretching, random stuff. The physician reserves the right to either advance or delay this protocol as deemed necessary. Cole,md,mba range of motion immobilizer exercises phase i 06 weeks 03 weeks. Literature to support the efficacy of a specific rehabilitation protocol for ssc. At cam, we employ sound rehabilitation protocols to get you back to health and mobility. The shoulder surgeon must communicate with the physical therapist to. Youll be fitter, faster and stronger than you have been in years. Lifts and supports the plantar arch to relieve pain from plantar fasciitis, flat foot and heel spurs. The subscapularis is the largest of the four rotator cuff muscles. Global rotator cuff protocol with and without subscapularis repair. Apply ice, or the cooling unit, to the shoulder as it will be quite helpful. The patient experience at boston shoulder institute physical therapy protocols. The authors protocol of choice, used within a large sports medicine rehabilitation center, is presented and the rationale behind its implementation is discussed.
Physical therapy standards of care and protocol the following standards of care and protocols are the property of bwh and should not be copied or otherwise used without the permission of the director of rehabilitation services. This article provides an overview of types of tear. This is done through two small puncture holes around the shoulder. Rehabilitation protocol for reverse shoulder arthroplasty. The subscapularis, located in the front of the shoulder, is one of the four muscles that make up the. The glsm rotator cuff repair rehabilitation program is an evidencebased and soft. It is important component of shoulder joint for necessary of unimpaired shoulder movements. Preop exercises should be on increasing or maintaining overall rom and muscle activation.
Partial repair of the inferior part is therefore performed, followed by teres minor tendon transfer under the coracoid figure 25, figure 26, figure 27. At repair sports institute, we pride ourselves on our proactive holistic 3tiered approach to functional medicine. The physiotherapist must exercise their best professional judgment to determine how to. Isolated repair of the subscapularis requires a limitation of external rotation range of. The bankart procedure is performed to increase anterior stability of the shoulder. Active release technique has been clinically shown to resolve the impingement pain caused by a subscapularis dysfunction in as few as 26 sessions. Repair sports institute physical therapy, chiropractic. Distal rom with scapular retraction manual scapular manipulation with patient lying on nonoperative side supine passive ff in scapular plane to 90 supine passive er to 0. Postoperative rehabilitation following arthroscopic rotator cuff. Arthroscopic rotator cuff repair protocol boston shoulder institute. This protocol differs from the typical rotator cuff repair protocol as the subscapularis is put under.
Patients with additional surgery will progress at different rates. Rotator cuff repair protocol boston shoulder institute. The aim of this study is to evaluate the effect of subscapularis trigger release and contract relax technique in minimizing pain, improving glenohumeral external rotation and overhead reach of patients. Please note these are meant to be guidelines for rehabilitation to be followed by a certified physical or occupational therapist. Manual therapy plays a pivotal role in the effective and expeditious treatment of impingement syndrome as well as recovery from a type ii slap repair surgery. The intent of this protocol is to provide the clinician with a guideline of the postoperative. The current biomechanical study showed that subscapularis repair through a humeral prosthesis specifically designed for subscapularis repair options allows subscapularis peel repair to achieve. Subscapularis tear recovery time, surgery, symptoms, treatment. Physical therapy services including accepted insurance list. Subscapularis is innervated by both the upper and lower subscapular nerves which come from the posterior cord of the brachial plexus.
Apr 10, 20 this is an instructional video demonstrated correct palpation, manual therapy, and stretching of the subscapularis. Diminish pain and inflammation phase il phase week goals patient guide abduction pillow brace sleep in pillow brace ice for pain and inflammatim 1520 mi. Uw health s sports medicine sports rehabilitation physical therapists and athletic trainers in madison, wisconsin, help injured athletes return to health and return to sport. This protocol provides the clinician with general guidelines for the rehabilitation of the patient undergoing arthroscopic, miniopen or open repair of a large or massive rotator cuff tear. Slucare sports medicine and shoulder surgery specialists developed the following physical therapy protocols for slucare clinicians to use when recommending treatment and rehab for slucare patients. Subscapularis tendon tears repair surgery houston tx.
Since past decade subscapularis tears are recognized as source of pain and dysfunction of shoulder joint. Start physical therapy at 46 weeks subscapularis repair 12 weeks no er past 30 degrees no cross body adduction no active ir or ir behind back no supporting of body weight on affected side i. The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone an arthroscopic assistedminiopen rotator cuff repair. Rehabilitation guidelines after surgery, sports medicine uw. Shoulder arthroscopy rehab protocol the stone clinic. Please click on the links below to learn more about the condition and its particular best course of action. Total shoulder replacement postop physical therapy protocol.
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