rehabilitation following arthroscopic rotator cuff repair

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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