Shoulder Lecture
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| Post-Op Rehab Emphasis | Immediate Motion
Muscle Activation
Restricted fxnal activities
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| Primary Goals of Surgery | Restore fxnal abilities
Maintain integrity of repair
Reduce pain/muscle inhibition
Re-establish PROM
Re-establish muscular balance/motor control
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| What are 2 major factors in the ability of tendons to heal? | Patient's age
Tear size
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| What increases risk of poor tendon healing without associated injury? | Biceps & AC joint pathology
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| 4 Types of RTC Tears | Bursal side partial-thickness
Mid-substance
Articular side- vascularty/ssn may be less than that of bursal side tears
Full-thickness
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| Tear Sizes | Small- <1 cm
Medium- 1-3 cm
Large- 3-5 cm
Massive- >5 cm
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| When can someone with a medium tear lift arm against gravity? Massive tear? | 6 weeks
12 weeks
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| What factors determine tears? | Age >60
Weak shoulder abduction
(+) impingement (Neer's/H-K)
98% chance of full-thickness tear
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| Dx of RTC Tears | (+) painful arc sign
Drop arm sign
Weak ER
>90% chance having full-thickness tear
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| When is stiffness significant? | Full-thickness tears
Posterior superior tears
Patients with trauma
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| Obligate GH Translation | Abnormal arthrokinematics
Result when capsule asymmetrically tight
May be selective posterior or inferior
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| RROM Guidelines | Protect surgical repair
Shortened musculo-tendon unit length-tension
Neuromotor control
Sub-max
Pain-free
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| AROM Based on Tear Size | Small- 4 wks
Medium- 6 wks
Large- 8 wks
Massive- 10-12 wks
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| Criteria to progress from phase 1 to 2 | Passive fwd elevation 125
Passive ER/IR in scapular plane 75
Passive abd in scapular plane 90
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| Can strengthening be performed in phase 1? | Gentle GH submax isometrics in balance position
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| Goals of Phase 2 | Allow soft tissue healing
Don't overstress healing tissue
Normalize arthrokinematics
Gradually restore full PROM ~wk 5-6
Improve neuromm control of shoulder complex
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| Phase 2 Precautions | NO:
Lifting, support of full body wt on hands, sudden jerking motion, excessive behind back motions, bike/ergometer till wk 6
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| Criteria to progress from phase 2 to 3 | Full ROM
Minimal pn/tenderness
Good MMT of IR, ER, flexion
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| Keys to Phase 2 | Don't initiate scapula/shoulder mm activation ex's till overall shoulder pain is low
Ex's can't create pain or increase s/sx
DON'T allow shrug sign; if it occurs, work on ex's below 90 degrees with no AROM >90
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| ROM in Phase 2 | Begin more aggressive IR stretching
Mobilization of post capsule/cuff critical
Begin shoulder ext, cross body, sleeper stretches
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| Phase 2 Strengthening | Gentle RTC sub-max isometrics
AROM in other planes
Low load, high rep
Light side-lying isotonics
NM control, trunk ex's, UE endurance ex's
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| Goals of Phase 3 | Gradual restoration of GH/ST strength, power, endurance
Gradual return to fxnal activities
Optimize NM control
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| Criteria to progress phase 3 to phase 4 | Able to tolerate progression to low-level fxnal activities
Demo return of strength/dynamic shoulder stability
Re-establish dynamic shoulder stability
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| Phase 4 goals | Maintain full non-painful AROM
Advanced conditioning ex's for enhanced fxnal & sport-specific use
Improve mm endurance, power, strength
Gradual return to all fxnal activities
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