Rehabilitation following reverse total shoulder arthroplasty. Neer developed a humeral prosthesis for the treatment of fourpart fractures in 1955. The current neer protocol for postoperative tsa rehabilitation. Arthroscopic acromioplasty rehabilitation protocol introduction impingement syndrome is a common cause of chronic shoulder pain. Pdf rehabilitation following total shoulder arthroplasty. Rehabilitation protocol for rotator cuff repair this protocol is intended to guide clinicians and patients through the postoperative course of a rotator cuff repair. The postoperative rehabilitation following arthroscopic rotator cuff repair begins preoperatively when the shoulder surgeon explains to the patient the planned operative procedure, the perioperative course and the demands of the postoperative rehabilitation. Control pain and edema normal rom, proprioception, strength. Exercise protocol for the treatment of rotator cuff. Rehabilitation following total shoulder arthroplasty. They range from doing nothing to use of a formal physical therapy protocol. Dr jonathan herald au, explaining and demonstrating the neer shoulder rehab protocol with nsw waratah and australian wallaby adam ashley. The first reported total shoulder arthroplasty was reported by a french. Keeping these muscles strong can relieve shoulder pain and prevent further injury.
The physician will make specific changes to the program as appropriate for an individual patient. Postoperative rehabilitation following arthroscopic. Subacromial decompression neer acromioplasty and distal clavicle resection mumford postsurgical rehabilitation protocol postop days 1 7 sling for comfort dc within a few days hand squeezing exercises elbow and wrist active motion arom. Optimal management of shoulder impingement syndrome.
When performing the stretch as described in the protocol, the individual is instructed to place his or her hands at shoulder level on either side of a door or corner and to lean forward. Strengthening the muscles that support your shoulder will help keep your shoulder joint stable. Bending over at the waist and balancing with the good arm let the stiff side relax and swing with gravity. Subacromial decompression neer acromioplasty and distal clavicle resection mumford postsurgical rehabilitation protocol postop days 1 7 sling for comfort dc within a few days hand squeezing exercises elbow and wrist active motion arom pendulum exercises. Articles were excluded if they addressed other shoulder conditions eg. Specific interventions should be based on the needs of the individual and should consider exam findings and clinical decision making. Department of rehabilitation services physical therapy arthroscopic rotator cuff repair protocol. A total of 14 patients with shoulder pain were randomized to perform a structured wii protocol n 8 or conventional therapy n 6. Pdf total shoulder arthroplasty tsa is a standard operative treatment for a variety of disorders of the glenohumeral joint.
Rehabilitation protocol for total shoulder arthroplasty and. Abduction bracesling, remove sling only to bathe and to complete exercises. Nonsurgical shoulder impingement rehabilitation protocol ramin r. The current neer protocol for postoperative tsa rehabilitation is widely used and based on tradition and the basic science of soft tissue and bone healing.
The socket portion of the joint is not naturally deep. Subacromial impingement with rotator cuff tendinopathy is a very common condition seen by both orthopedic surgeons and physical therapists. The shoulder is a wonderfully complex joint that is made up of the ball and socket connection between the humerus ball and the glenoid portion of the scapula socket. Pdf reverse or inverse total shoulder arthroplasty rtsa is becoming. Structured wii protocol for rehabilitation of shoulder. Pull down with good arm to raise the injured shoulder. Once able to perform 3 sets of 10 repetitions without pain or fatigue, progress to the red band, and then to the green band. It is clear that postoperative rehabilitation is pivotal in determining successful outcome following tsa. Shoulder impingement often starts after a repetitive shoulder activity especially if it involves overhead motions. This physical therapy protocol is based on the best evidence demonstrating a beneficial effect for exercise in the treatment of rotator cuff tendonitis. Rotator cuff repair postoperative rehabilitation protocol orthoindy. The overall outcomes that are reported after surgical intervention are quite good and appear to be primarily determined by the underlying pathology and the tissue quality of the rotator cuff. Rehabilitation after proximal humeral fractures erin singleton, dpt, robert turner, pt, ocs, and lawrence gulotta, md abstract. Rehabilitation protocol for total shoulder arthroplasty.
Neer 1955 developed a humeral head prosthesis to treat a 4part fx in the mid1970s he refined his prosthesis for degenerative humeral head. Rehabilitation following total shoulder arthroplasty neer. Rehabilitation of both neer group 1 phfs and complex phfs was investigated as the former is most common and the latter is most dificult to treat whether acute management involves surgery or not 12. This is because the articular surface of the round humeral head is approximately four times greater than that of the relatively flat shoulder blade face glenoid fossa1 figure 1. Rehabilitation protocol for total shoulder arthroplasty and hemiarthroplasty this protocol is intended to guide clinicians and patients through the postoperative course after a total shoulder. Phase i immediate post surgical phase meets criteria for progression to phase ii. Treatment algorithm for progressing the rehabilitation program for a patient that has had a total shoulder arthroplasty. Based on current evidence, the anterior shoulder stretch in the proposed protocol might not be the most effective way to stretch the pectoral muscles. Ethics the study protocol and study tool received ethics approval from the hamilton. Shoulder rehabilitation western orthopaedic clinic. Shoulder impingement syndrome can be defined as the encroachment of the acromion, coracoacromial ligament, coracoid process, andor acromioclavicular joint on the structures.
For this reason the shoulder is the most mobile joint in the body. What is the role of exercise in the treatment of rotator cuff impingement syndrome rcis, and what evidencebased exercises can be synthesized into a criterionstandard exercise rehabilitation protocol. Charles neer ii is quoted as saying shoulder replacement will fail without adequate rehabilitation. Theraband exercises internal rotation, external rotation, extension, beginning with yellow bands 3foot length. Impingement syndrome was determined by a positive impingement sign per neer or hawkins criteria, or both. In this condition, the rotator cuff tendon becomes pinched under the anterior aspect of the acromion during elevation of the upper extremity. Rehabilitation of shoulder impingement syndrome and rotator. Johns hopkins shoulder surgery arthroscopic acromioplasty rehabilitation program johns hopkins shoulder surgeons introduction. Hughes and neer hughes and neer, 1975, who were among the first. Phase i immediate postoperative phase weeks 0 6 days 014 patient is seen 2 days postoperative to remove surgical dressings and pain catheter. Showering is allowed once dressings and catheter is removed. Nonsurgical shoulder impingement rehabilitation protocol.
No excessive shoulder external rotation or abduction. Rotator cuff repair protocol boston shoulder institute. Neer protocol the neer protocol for postoperative total shoulder arthroplasty rehabilitation is widely used and based on tradition and the basic science of soft tissue and bone healing. Rehabilitation protocol for total shoulder arthroplasty and hemiarthroplasty this protocol is intended to guide clinicians and patients through the postoperative course after a total shoulder arthroplasty tsa and hemiarthroplasty. Rotator cuff repair protocol shoulder arthroscopic capsular release shoulder arthroscopy rehabilitation no repair shoulder exercise descriptions comprehensive list shoulder exercise descriptions for bankart shoulder exercise descriptions for combined labrum repair shoulder exercise descriptions for posterior bankart. Rehabilitation recommendations following reverse shoulder arthroplasty vary and are not well substantiated in the literature. This protocol provides you with general guidelines for the conservative rehabilitation of the patient with impingement syndrome is. In this condition, the rotator cuff tendon becomes pinched under the anterior aspect of the acromion during elevation of the upper. Debridement, subacromial decompression, andor distal. This is summary of the evaluation and rehabilitation of a patient following an arthroscopic acromioplasty. Total shoulder replacement protocol sports and ortho.
Rotator cuff repair protocol south shore orthopedics. Protocols can vary as drastically as beginning gentle passive range of motion and isometric exercises postoperative week 1 to delaying 12 weeks for the initiation of similar exercises. Exercise in the treatment of rotator cuff impingement. Sling for 3 weeks athletes can wean off sooner under guidance of club therapist teach axillary hygiene. Mar 15, 2015 dr jonathan herald au, explaining and demonstrating the neer shoulder rehab protocol with nsw waratah and australian wallaby adam ashley. Treatment should be modified based on the condition of the rotator cuff. Rehabilitation guidelines for slap lesion repair the anatomic configuration of the shoulder joint glenohumeral joint is often compared to a golf ball on a tee. Nonoperative treatment of subacromial impingement rehabilitation protocol. The first reported total shoulder arthroplasty was reported by a french surgeon named jules emile pean in 1893 for the purpose of treating tuberculous arthritis of the shoulder. Specific interventions should be based on the needs of the individual and. If initial nonsurgical treatment of a rotator cuff tear fails, surgical repair is often the next line of treatment. Rehabilitation following total shoulder arthroplasty talal hariri, pt, dpt, scs talal. Placement of the shoulder in a position of 90 of abduction and 90 of external rotation causes the supraspinatus and.
Postoperative rehabilitation of patients with shoulder. The intent of this protocol is to provide the clinician with a. Same exercise but rotate the arm outwards and inwards. Total shoulder arthroplasty brigham and womens hospital. Department of rehabilitation services standard of care. Initiate daily stretches for the shoulder and postural exercises. Kavanagh, pac this protocol provides general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. Physical therapy rehabilitation following total shoulder. Rehabilitation of the athlete with shoulder impingement is a complex process that requires a comprehensive evaluation and multifactorial treatment programme. Neers impingement sign, hawkinskennedy maneuver, compression of. Proximal humeral fractures are the third most common type of fractures in those over 65 years of age. Pdf rehabilitation following reverse total shoulder arthroplasty. General shoulder arthroscopy debridement, subacromial decompression, andor distal clavicle resection postoperative rehabilitation protocol 02 weeks post op modalities as needed sling until comfortable, or until follow up with doctor. Rehabilitation protocol following arthroscopic rotator.
Total shoulder arthroplasty tsa is a standard operative treatment for a variety of disorders of the glenohumeral joint. 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. Painfree shoulder range of motion, strength, shoulder pain and disability, and quality of life were assessed pre and posttreatment. Conservative treatment for patients with subacromial. Neer1 2 has outlined three stages of primary impingement as it relates to rotator cuff pathology. The authors protocol of choice, used within a large sports medicine rehabilitation center, is presented and the rationale behind its implementation is discussed. Shoulder impingement rehabilitation protocol exercise. David ebaugh 2010 exercise protocol for the treatment of rotator cuff impingement syndrome. Glenohumeral joint replacement and postoperative rehabilitation. Pdf optimal management of shoulder impingement syndrome. Rehabilitation of shoulder impingement syndrome and. J shoulder elbow surg 2009, janfeb general instructions. Neutral position of the back, shoulders, and spine should be maintained during standing, sitting, and lifting activities.
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