43 male Post R Rot cuff repair (Person (Professional socialisation…
43 male Post R Rot cuff repair
middle aged aussie man, loves cricket. drinking beer
Surgeon (post op orders)
Friend of Aaron's from cricket
Work > return to work. This first one was not caused at work but the workplace will be very tentative to make sure this does not turn into a work cover situation
Narrative Based reasoning
Goals: resume driving to get back to work, works for hilti tools (has to be able to show customers how to use products i.e hardware) Keen to get back to cricket next season spoke with him about indoor as an option would prefer outdoor doesn't like the pace of indoor
getting very bored after spending such a long time off work (8 wks) and not being able to do anything plus relying on family to drive him round.
Pt agreeable to not return to work until he is ready
Got sore after last exercise session, had difficulty sleeping, educated for position of comfort
looking to go back to work next monday 24/9 got clearance from surgeon
AROM Abd 60, flex 60 Passive flex 110 abd 90. Rx wall walks to 100 deg flex // AROM flex 80 abd 60. scap clock, pendulum // arom flex 80 abd 60. wand ex flex and ER // little sore after wand reduced AROM flex 70. Iso's // same as after wand.
Consider pool session to do longer duration of pain free exercises
AROM Abd 20, flex 30 Passive flex 100 abd 90 ER 20. Rx Shoulder Mobs AP and inferior // flex 130 abd 90. flex + ext iso 40 x 4. bicep curls 4 kg, standing row, cable ext // AROM abd 50 flex 60
Passive AA. Wand exercises + pendulum 20s x 5, Iso and grip with straight arm (progress to ecc ER)
Passive ROM Flex 95 abd 90 ER 20. Pulley flexion 10 x 3, wand ex's flex and ER in supine 10 x 3, 20s Iso ER red TB x 5, grip 1 min x 3
Passive Rom: flex 95, abd 90, ER 20. Pulley, wand exercises, 20s iso red TB x 5, grip
Seen rot cuff repairs previously mobilisations have typically not worked as what pulley, wand exercise, pendulum and RC strengthening exercises have. Patients are very variable in how they respond, important to push the shoulder as much as possible to prevent Frozen shoulder developing.
Use of pain free isometrics, wand exercises, standing rows, supine punch, PNF diagonals post 12+weeks surgery
Supporting the use of hydrotherapy as it "may improve soft tissue extensibility" "By utilizing a pool for rehabilitation, the patient’s goal of improving range of motion can be achieved easier and much earlier than land-based exercises without compromising the repair integrity "
Consideration for rehab is that as an overhead athlete (cricket) comprising OH positions. As exercises are progressed, scapular muscle activation is initiated, followed by isometric and lastly isotonic rotator cuff exercises. When treating overhead athletes, advanced strengthening in the overhead position is performed, followed by plyometric training