rehabilitation following arthroscopic rotator cuff repair
TRANSCRIPT
REHABILITATION FOLLOWING ARTHROSCOPIC ROTATOR CUFF
REPAIR
DR.TARUN KUMAR BADAMPG DNB ORTHO
INSTITUTE OF ORTHOPEDIC RESEARCH AND ACCIDENT SURGERY (IORAS)
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
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%
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
ABBREVATIONS
PROM - Passive ROM
AROM - Active ROM
HEP - Home Exercise Program
SCAPTION - Scapular elevation and abduction
UBE - Upper body exercises
SHOULDER MOVEMENTS
SCAPTION
TABLE SLIDES
THERABAND EXERCISES
CANE EXERCISES
SHOULDER PULLEYS
WALL WALKS
CAPSULAR MOBILISATION
PLYOMETRICS
REVIEW ARTICLE
POSTOPERATIVE OUTCOME:
EARLY VS LATE REHABILTATION
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
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
“These studies demonstrate benefit with early ROM protocols at early
follow-up, with equivocal results at longer follow-up”
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
PAIN
Garofo et al, reported low VAS pain score at 10 wk follow-up , that used CPM in early Rehab
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
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
SUMMARY
EARLY, AGGRESSIVE REHABILITATION REGIMENS ARE BETTER THAN SLOW REHAB REGIMENS
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