Il trattamento riabilitativo post-operatorio dopo riparazione della cuffia dei rotatori

Abstract

Progress in techniques and materials for rotator cuff repair allows today the repair of a large variety of type and extension of cuff lesions in patients with a wide range of ages and practicing different kinds of jobs and sports, with a wide range of expectations in terms of recovery of function and pain relief. A large amount of co-factors must be taken in account before implementing a rehabilitation protocol after rotator cuff surgery. First among these is the technique (materials and procedure) used by the surgeon; tissue quality, retraction, fatty infiltration, time after rupture are important biological factors; the patient’s job or sport or daily activities after surgery and expectations of recovery must be evaluated. The rehab protocol must also take in account the timing of the biological healing of the bone-to-tendon or tendon-to-tendon interface, depending on the type of rupture and repair. This timing must drive the action of the therapist for choosing the correct passive or assisted exercise and mobilisation manoeuvre and teaching the patient correct active mobilisation movements. Based on accepted knowledge of the timing of biological tissues healing, surgery technique and focused rehab exercise, a conceptual rehab protocol in four phases can be applied, tailoring the protocol to each patient, starting from sling rest with passive self-assisted little arm motion in phase one, to prevent post-op stiffness. In phase two passive mobilisation by the PT in or out of the water, integrated by scapular mobilisation and stabilizer reinforcing. In phase three progressive active arm mobilisation in or out of the water complemented by proprioceptive exercise and “core” stabilisation. In phase four full strength recovery integrated by recovery of the movements used for work or sport will complete the protocol. Because of the multi-factorial aspects of the problem, the best results could be obtained through a full transfer of info from the surgeon to the therapist to optimize the timing and sizing of each rehab protocol for each patient.