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, 7 (2), 197-218

Rehabilitation After Arthroscopic Rotator Cuff Repair: Current Concepts Review and Evidence-Based Guidelines

Rehabilitation After Arthroscopic Rotator Cuff Repair: Current Concepts Review and Evidence-Based Guidelines

Olivier A van der Meijden et al. Int J Sports Phys Ther.

Abstract

Purpose: To provide an overview of the characteristics and timing of rotator cuff healing and provide an update on treatments used in rehabilitation of rotator cuff repairs. The authors' protocol of choice, used within a large sports medicine rehabilitation center, is presented and the rationale behind its implementation is discussed.

Background: If initial nonsurgical treatment of a rotator cuff tear fails, surgical repair is often the next line of treatment. It is evident that a successful outcome after surgical rotator cuff repair is as much dependent on surgical technique as it is on rehabilitation. To this end, rehabilitation protocols have proven challenging to both the orthopaedic surgeon and the involved physical therapist. Instead of being based on scientific rationale, traditionally most rehabilitation protocols are solely based on clinical experience and expert opinion.

Methods: A review of currently available literature on rehabilitation after arthroscopic rotator cuff tear repair on PUBMED / MEDLINE and EMBASE databases was performed to illustrate the available evidence behind various postoperative treatment modalities.

Results: There is little high-level scientific evidence available to support or contest current postoperative rotator cuff rehabilitation protocols. Most existing protocols are based on clinical experience with modest incorporation of scientific data.

Conclusion: Little scientific evidence is available to guide the timing of postsurgical rotator cuff rehabilitation. To this end, expert opinion and clinical experience remains a large facet of rehabilitation protocols. This review describes a rotator cuff rehabilitation protocol that incorporates currently available scientific literature guiding rehabilitation.

Keywords: Arthroscopic rotator cuff repair; rehabilitation; scientific rationale.

Figures

Figure 1 A–D.
Figure 1 A–D.
Gentle joint oscillations in short-arm traction and various degrees of rotation with the arm in slight abduction.
Figure 2.
Figure 2.
Therapist-assisted passive range of motion exercise of forward flexion.
Figure 3 A–B.
Figure 3 A–B.
Isolated scapular depression and protraction.
Figure 4 A–B.
Figure 4 A–B.
Active-assisted range of motion exercises of internal rotation with the aid of a cane (A) and forward flexion with the help of the uninvolved limb (B).
Figure 5.
Figure 5.
Stimulation of scapulothoracic musculature in the prone position.
Figure 6 A–B.
Figure 6 A–B.
The ‘salute’ exercise. Beginning (A) and ending (B) positions.
Figure 7.
Figure 7.
Open chain proprioceptive exercise with the patient in supine position and the involved upper extremity held in 90° of forward elevation.
Figure 8 A–B.
Figure 8 A–B.
‘Bear hug test’; horizontal adduction of both upper extremities in an axial plane, following an imaginary arc at approximately 60 degrees of elevation until maximum scapular protraction is obtained by touching fists together (B).
Figure 9.
Figure 9.
The standing sport cord row exercise in order to strengthen the trapezius and rhomboid musculature.
Figure 10 A–B.
Figure 10 A–B.
Conventional biceps curl exercises with free weight resistance.
Figure 11 A–B.
Figure 11 A–B.
Triceps extension exercises with free weight resistance.
Figure 12 A–B.
Figure 12 A–B.
Strengthening of the posterior rotator cuff by performing external rotation against elastic resistance with the arm in 45° of abduction.
Figure 13.
Figure 13.
The push-up plus progression exercise.
Figure 14.
Figure 14.
The ‘Statue of Liberty’ exercise.
Figure 15 A–B.
Figure 15 A–B.
Throwing exercises against a rebounder starting at or near shoulder height (A) progressing to the overhead position (B).

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