By 8 weeks, initiation of collagen alignment and organization was noticed. One primate study showed an almost mature tendon-to-bone healing by 15 weeks after surgery. The healing process is divided into three stages: inflammation (0–7 days), repair (5–14 days), and remodeling (> 14 days). Throughout this process, healing of the rotator cuff repair should be respected. As range of motion is achieved, proper exercise progression should be followed in order to limit stress on the healing repair. Appropriate range of motion after surgery is important in order to minimize chances of developing post-operative stiffness. Pain and inflammation have been reported to inhibit shoulder musculature which is why the post-surgical team should make every effort to use cryotherapy and other modalities as necessary. Immediately after surgery, patients are placed in an immobilizer, typically between 4 and 6 weeks. Initial phases of rehabilitation emphasize tissue healing, reduction of inflammation and pain, and protection of the repair. When functioning properly, the rotator cuff complex allows for GH movement with stability however, if the rotator cuff becomes damaged or torn through injury or disease, dysfunction may occur. The subscapularis works to internally rotate the shoulder and provide compression as well as anterior stability. The infraspinatus and teres minor make up the posterior rotator cuff and are largely responsible for external rotation of the shoulder as well as providing an inferior compression force of the humeral head in the glenoid, which helps minimize subacromial impingement. The supraspinatus plays an important role in GH joint stability and is responsible for initiating abduction and rotation of the joint as well as compression at lower elevation angles. When working together, this group of muscles creates force vectors which provide dynamic stability to the GH joint by maintaining centralization of the humeral head within the glenoid fossa. These include the supraspinatus, infraspinatus, subscapularis, and teres minor which function to assist in glenohumeral (GH) elevation and rotation. The rotator cuff is composed of a group of four muscles and tendons that surround the shoulder. In order to properly treat this group of patients, a sound understanding of anatomy, biomechanics, and evidence-based exercise progression are essential. The ultimate goal of post-operative rehabilitation after rotator cuff repair is to relieve pain and restore range of motion as well as prior levels of function. Successful treatment of rotator cuff repair relies on constant communication between the surgical and rehabilitation staff. It is imperative that patients not only have extremely skilled surgical care but a knowledgeable and experienced physical therapist to help guide their post-operative progression. Even with advances in surgical management of rotator cuff injuries, recurrent tears of large or massive repairs remain a problem, in some cases ranging from 13 to 94%. showed 20.7% of 1366 shoulders had full-thickness rotator cuff tears in the general population with the biggest risk factors being age, dominant arm, and history of trauma. Of these visits, rotator cuff disease is the most common cause. Shoulder pain results in over three million visits to physicians each year. It is important that patients are educated early in the rehabilitation process so that they can manage their expectations to realistic time frames. Advanced strengthening is initiated when all preceding criteria have been met. When treating overhead athletes, advanced strengthening in the overhead position is performed, followed by plyometric training. As exercises are progressed, scapular muscle activation is initiated, followed by isometric and lastly isotonic rotator cuff exercises. Even though time frames are not used for progression, it is important not to place excessive stress on the shoulder for up to 12 weeks to allow for proper tendon-to-bone healing. When advancing range of motion, progression from passive, active assisted, and active movements allow for gradual introduction of stress to the healing construct. During the early stages, reducing pain and inflammation should be prioritized followed by progressive restoration of range of motion. Awareness of complication management, healing potential of the repaired tendon, and anatomy of the shoulder complex are critical. During rehabilitation after rotator cuff repair, there should be constant communication with the surgical team.
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |