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Reference
Lädermann, Alexandre, Patrick J. Denard, and Philippe Collin. "Massive rotator cuff tears: definition and treatment." International orthopaedics (2015): 1-12. (2C)
Phase
Phase
: 18 to 26 weeks after surgery
:12-18 weeks after surgery
Activities:
Goal
Ski 6 months
Golf 6 months
Weight Training 6 months
Tennis 6 -8 months
Swimming 6 -8 months
Throwing 6 months
Goal
Exercise Program
Before returning safely to your activity, you must have full range of motion, full strength and no swelling or pain.
Exercise Program
Your doctor and sports physical therapist will provide you with specific instruction
Days per week: 3 Times per day: 1
Protect the rotator cuff repair
Jain, Nitin B., et al. "Clinical examination of the rotator cuff." PM&R 5.1 (2013): 45-56. (2A)
STRETCHING / ACTIVE MOTION / STRENGTHENING
Continue to protect the repair
(avoid lifting excessively heavy weights)
Days per week: 3 Times per day: 1
Theraband Strengthening
Stretching
Restore full shoulder motion
Dynamic Strengthening
Stretching ,Theraband Strengthening Dynamic Strengthening 은 이전 단계와 같은 운동들을 시행한다.
Regain full range of motion
External Rotation Internal Rotation Standing Forward Punch Shoulder Shrug Dynamic hug
“W”’s
Seated Row
Biceps curl
Restore full shoulder strength
이전 단계와 같은 운동들을 시행한다.
Plyometric Exercises
Continue gentle strengthening
Gradually begin to return to normal
activity
Your doctor or physical therapist will provide you with a specific plyometric-training program to follow when appropriate.
Dynamic Strengthening exercise can gradually be added!
Weight Training
See weight training precautions
starting with 1 Ib~ not exceed 3 Ib
감사합니다
Rehabilitation
Rotator cuff injury protocol
Phase
: 6 to 12 weeks after surgery
: 0 to 6 weeks after surgery
Activities:
Activities:
1. Sling:
Your sling is no longer necessary unless your doctor instructs you to continue using it
1.Sling :
Use your sling most of the time. Remove the sling 4 or 5 times a day to do pendulum exercises.
Exercise Program
Goal
2. Use of the operated arm :
Exercise Program
2. Use of the affected arm :
You can lift your arm forward in front of your body but not to the side
Goal
*No Lifting of Objects
*No Excessive Shoulder Extension
*No Excessive Stretching or Sudden Movements
*No Supporting of Body Weight by Hands
Stretching
/ Active Motion
STRETCHING / PASSIVE MOTION
Days per week: 5-7 Times per day: 1-3
Days per Week: 7 Times per day: 4-5
Protect the rotator cuff repair
Protect the rotator cuff repair
Active Motion
stretching
Prone scaption “Y”
Supine Cross-Chest Stretch
Pendulum exercises
Ensure wound healing
Improve range of motion of the shoulder
Side-lying External Rotation
Wall slide Stretch
Active-Assisted Arm Elevation
Supine external Rotation with Abduction
Resisted forearm supination-pronation
Resisted wrist flexion-extension
Standing,supine external rotation
Prevent shoulder stiffness
Behind the back internal rotation
isometric exercises :
internal and external rotation at neutral with physical therapist
Supine passive arm elevation
Begin gentle strengthening
Regain range of motion
Shoulder shrug
X- rays
MRI
Clinical examination
•avoiding certain activities because they cause pain
•difficulty achieving full range of shoulder motion
•difficulty sleeping on the affected shoulder
•pain or tenderness when reaching overhead
•pain in the shoulder, especially at night
•progressive weakness of the shoulder
•trouble reaching behind the back
Rotator cuff test
Tests for subscapularis
Tests for Supraspinatus and Infraspinatus
Jobe’s test
Belly Press test
90 abduction
standing position
30 forward flexion
puts on hand stomach and push
Thumbs pointing downward
isometric contraction
Patient attempt elevation
shoulder position: Internal rotation
moves the elbow forward
- active and passive range of motion
- strength tests
- rotator cuff tests
Test for Teres minor
Tests for Supraspinatus and Infraspinatus
Hornblower’s Sign
external rotation lag test
shoulder and elbow 90 flexion
maintain maximal external rotation
hand comes to the mouth
+ : angular drop
+ : pain and inability maintain UE external rotation
Rotator cuff injury
The most common injuries are strains, tendinitis, and bursitis.
the number of tendons which are torn
the size of the tear
Strain
Tendinitis
Bursitis
overuse
inflammation of the bursa
overuse
acute injury
muscles to bones can overstretch
Tennis players, who use an overhead serve
1. Small tear: less than 1 cm
2. Medium tear: 1–3 cm
3. Large tear: 3–5 cm
4. Massive tear: greater than 5 cm.
painters who have to reach upward to do their jobs
fall
car accident
another sudden injury
The rotator cuff exists of four muscles:
M. Subscapulairs
Internal rotation
M. Supraspinatus
GH Joint abduction
GH Joint stability
시
제공
M. Infraspiantus
External rotation
M. Teres Minor
CONTENTS
1. Anatomy
2. Definition&Description
4. Symptoms
5. Diagnosis
6. Rehabilitation
7. Reference
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호남대학교 문선애