Delayed passive range of motion in post op physical therapy

X-ray of total knee replacement, anterior-posterior front to back view. X-ray of total knee replacement, lateral side view.

Delayed passive range of motion in post op physical therapy

Although our surgical techniques have gradually progressed from full open repairs, to smaller mini-open repairs, to the current standard all-arthroscopic repairs, many clinicians continue to utilize the same rehabilitation guidelines from past invasive procedures. And more confusing is the lack of consensus among surgeons regarding the optimal postoperative rehabilitation protocol following arthroscopic rotator cuff repair.

Protocols can vary as drastically as beginning gentle passive range of motion and isometric exercises post-operative week 1 to delaying 12 weeks for the initiation of similar exercises.

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Before downloading the protocol, I want to explain the goals of rehabilitation and what I believe are the 3 keys to rehabilitation. These principles are the cornerstone behind the protocol you are about to download. Goals of Rehabilitation Following Rotator Cuff Repair When rehabilitating after an arthroscopic rotator cuff repair surgery, the main goals of the rehabilitation protocol should be: Protect the integrity of the rotator cuff repair Minimize postoperative pain and inflammation Restore passive range of motion Restore strength and dynamic stability of the shoulder Restore active range of motion Return to functional activities Pretty simple, right?

When you lay it out like that, we simply combine those goals with what we know about the basic science of healing tissue and you can fill in the gaps and individualize a program based on the patient and your treatment preferences.

The 3 Most Important Keys to Rotator Cuff Repair Rehabilitation Now that you understand the goals, I want to share what I consider the 3 most important keys to rotator cuff repair rehabilitation.

Restore full passive ROM quickly. It is extremely easy to lose motion following surgery.

Delayed passive range of motion in post op physical therapy

Passive range of motion should be initiated immediately following surgery in a gradual and cautious fashion. Studies have shown that passive range of motion into flexion and external rotation actually decreases strain in the rotator cuff repair still need to be cautious with adduction, extension, and internal rotation.

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Restore dynamic humeral head control. This is likely the most important goal of postoperative rehabilitation, other than maintaining the integrity of the repair. That is caused by the inability of the cuff to compress the humeral head and the resultant superior humeral head migration.

This is why it is imperative to begin gentle isometrics, rhythmic stabilization drills, and other drills to re-educate the rotator cuff. Maximize external rotation strength. I often refer to external rotation as the key to the shoulder.

Weakness of ER is common in almost every pathology and strengthening of the area is extremely important to balance the anterior and posterior balance of cuff. Several studies have shown that ER strength takes the longest amount of time to restore after rotator cuff repair.

The longer this area is weak, the more difficult it will be to stabilize the joint. James Andrews, we have recently revised and expanded all of our protocols and made them completely online and downloadable.

Our physical therapy rehabilitation protocols have been published in several journals over the years and based on our decades of research, scientific evidence, and experience.

Want to see what our protocols include? You can download our 3 most popular protocols for FREE: If you work in an outpatient orthopedic or sports medicine clinic, these protocols are an invaluable resource to help guide your treatment approach.Response data showing initial referral to physical therapy (PT) and passive range of motion (PROM) within the first 2 weeks after arthroscopic rotator cuff repair.

Unrestricted PROM trended toward later time points, with the majority of surgeons waiting between 4 and 7 weeks postoperatively.

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disuse can result in delayed recovery (Millis, a) (Figure 1). Early post-operative physiotherapy is now the use of cold therapy in the immediate post-operative period can result in re- Passive range of motion (PROM) exercises PROM exercises involve the physiotherapist moving.

Stiffness after a rotator cuff tear is common. So is stiffness after an arthroscopic rotator cuff repair.

In the literature, however, postoperative restriction of passive range of motion after open rotator cuff repair in shoulders with free passive range of motion at surgery has seldom been recognized. Number: Policy. Aetna considers continuous passive motion (CPM) machines medically necessary durable medical equipment (DME) to improve range of motion in any of the following circumstances.

Inclusion Criteria

During the post-operative rehabilitation period for members who have received a total knee arthroplasty (TKA) or revision TKA as an adjunct to ongoing physical therapy (PT); or. Our departments consist of the Departments of Physical Therapy, Occupational Therapy and Communication Sciences & Disorders.

timeline for progressing between phases as well as progressing key interventions such as passive range of motion (PROM) to active-assisted range of motion (AAROM) to active range of motion (AROM) and resisted. Rotator Cuff Repair and Isolated Subscapularis Repair The anatomic configuration of the shoulder joint (glenohumeral joint) • Passive range of motion (PROM) for forward elevation in the plane of the scapula with delayed 9 weeks post-op.

• Initiate light muscle performance activities.

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