Shoulder arthroscopic labral debridement rehabilitation. Because the head of the humerus much larger than the. Bankart repair protocol vanderbilt university medical center. No active forceful bending of elbow or turning palm up please refer to physician and prescription as additional procedures may have been performed including anterior or posterior stabilization depending on size of tear. Arthroscopic labral repair protocoltype ii, iv, and complex tears. Slap superior labral anterior to posterior tears can begin as a result of a traumatic injury such as a foosh or an atraumatic, degenerative injury as a result of repeated activity. Although advancement in arthroscopic techniques has enhanced arthroscopic repair of slap lesions, the clinical diagnosis of slap lesions can still be difficult. No active forceful bending of elbow or turning palm up please refer to physician and prescription as additional procedures may have been performed including anterior. Arthroscopic labral repair protocol type ii, iv, and complex tears. Find pdfs of our most common rehabilitation protocols. Slap type ii biceps tenotomytenodesis repair protocol p.
The path to regaining range of motion, strength and function can require a sustained and coordinated effort from the patient, his or her family, the ohio state sports medicine physical therapy team and sometimes, other healthcare providers. In repair of a slap lesion, the labralbiceps complex is reattached. Conservative treatment of a rock climber with a slap. Figure 2d a type iv slap lesion is a superior labral buckethandle tear that extends into the biceps tendon. We provide our patients with comprehensive, coordinated care from experts who understand the unique needs of women in sports. It is no means intended to be a substitute for ones clinical decision making. Arthroscopic slapbankart repair protocol andrea saterbak. Usually most comfortable in a seated position instruct patient in various alternative sleeping positions for early, painful stages i. Bankart repair rehabilitation protocol arthroscopicopen. The glsm slap type ii repair rehabilitation program is an evidencebased and soft. Arthroscopic slap lesion repair rehabilitation guideline.
The overall goals of the surgical procedure and rehabilitation are to. The therapist may modify the program appropriately depending on the individuals goals for activity following arthroscopic slap lesion repair. Physical therapy protocol shoulder anteriorposterior labral. Posterior labral repair protocol weeks 12 objective is to protect healing capsule, allow early, graded, protected motion, prevent stiffness, minimize atrophy, and control pain and inflammation wear sling during the day for 34 weeks sleep in your sling for 34 weeks monitor neurovascular status. Arthroscopic type ii slap repair rehabilitation protocol.
This protocol was designed to provide the rehabilitation professional with a guideline of postoperative care. The sports physical therapy service is an integral part of the sports medicine center and the department of. The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone an arthroscopic labral repair. Slap lesion superior labral anterior to posterior tear. Slap type ii repairbiceps tenodesistenotomy protocol. Sling immobilization at all times except for showering and rehab under guidance of pt range of motion aarom arom as tolerated o restrict motion to 140 of forward flexion, 40 of external rotation and internal rotation to stomach o no internal rotation up the backno external rotation behind the head therapeutic exercise. Phase i immediate post surgical phase protected motion days 1 to week 6 04 weeks pain control. Outcome following nonoperative management of superior labral anterior to posterior slap lesions has been under reported with little empirical data demonstrating the ef fectiveness of conservative treatment. It is extremely important to protect the bicepslabral complex for 6 weeks postoperatively to allow appropriate healing. Rehabilitation appointments begin within 7 days of surgery, continue 12. Slap repair biceps tenodesis obtain pain free passive and active rom with appropriate mechanics diminish early pain and inflammation less assertive therapy produces improved motion, strength, patient satisfaction, and functional outcomes if in doubt, less is more when doing shoulder rehabilitation. Slap tears are classified based on the type of tear as well as the portion of the labrum that is affected.
Slap lesion repair protocol slap lesion repair protocol this rehabilitation protocol has been developed for the patient following a slap superior labrum anterior posterior repair. Conservative treatment for patients with suspected slap. Slap lesion type ii repair rehabilitation program gundersen. Slap lesion is a superior labral buckethandle tear that extends into the biceps. The socket portion of the joint is not naturally deep. Tears can be located either above superior or below inferior the middle of the glenoid.
Department of rehabilitation services physical therapy arthroscopic rotator cuff repair protocol. Advance as tolerated to aggressive rotator cuff and periscapular strengthening. The bankart procedure is performed to increase anterior stability of the shoulder. Achieving the criteria of each phase should be emphasized more than the approximate duration. Protection weeks 0 to 6 goals allow healing of sutured capsule initiate early protection range of motion retard muscular atrophy decrease pain and inflammation brace discontinue use after four weeks unless otherwise advised by dr.
Rotator cuff repair protocol boston shoulder institute. Slap tears are common in overhead athletes and overhead workers. Click here to download pdf arthroscopic labrum repair of the shoulder slap. It is designed for rehabilitation following shoulder arthroscopic labral debridement. Rehabilitation guidelines after surgery, sports medicine. All exercises and activities to remain nonprovocative and low to medium velocity. Patients with additional surgery will progress at different rates. Posterior labral repair physical therapy protocol phase i. Arthroscopic debridement of type i and iii slap lesions. For this reason the shoulder is the most mobile joint in the body. To repair the damaged origin of the long head of biceps tendon slap tear to repair the damaged origin of the long head of biceps tendon slap tear protocol. Outcome following nonoperative management of superior labral anterior to posterior slap lesions has been under reported with little empirical data demonstrating the ef. Protective phase day 1 to week 6 weeks 02 shoulder sling x 6 weeks sleep in sling x 3 weeks shoulder, elbow, and hand rom o no resisted active isolated biceps activity elbow flexion or forearm supination x 6 weeks. Rehabilitation protocols ohio state sports medicine.
Maintain integrity of repair gradual return of promaarom increase shoulder strength while respecting repair. Rehabilitation guidelines for open latarjet anterior shoulder. Ohio state physicians and physical therapists work collaboratively to develop best clinical practices for postsurgical rehabilitation. The following is a guideline for progression of postoperative treatment.
The patient will followup monthly or as needed between 4 and 6 months postop the patient will return at 6 months postop for the final time to see the physician and the therapist. This protocol provides you with general guidelines for the postoperative rehabilitation of the patient following arthroscopic slap repair. Rehabilitation following slap repair surgery kevin e. It is no means intended to be a substitute for ones. The shoulder is a wonderfully complex joint that is made up of the ball and socket connection between the humerus ball and the glenoid portion of the scapula socket. Achilles tendon repair and rehab pdf anterior cruciate ligament more about uw health sports rehabilitation acl rehabilitation. Shoulder arthroscopic labral debridement rehabilitation guideline this rehabilitation program is designed to return the individual to their activities as quickly and safely as possible.
The rehabilitation of your shoulder after surgery is essential for the success of your treatment. Specific changes in the program will be made by the physician as appropriate for individual patients. Clinic appointments at 8 to 11 days, then at 6 weeks, 12 weeks, 18 weeks and possibly 24 weeks physical therapy appointment starting at 2 weeks acute phase. The intent of posting these standards of care and protocols is to provide clinicians and patients an understanding of our current standards of care and protocols at bwh. This handout describes details of the postoperative care of your shoulder. The size and location of the labral tear along with amount of bony injury may also affect the rate. Arthroscopic labral repair protocoltype ii, iv, and complex. Rehab protocols list of protocols click here to download pdf. Physical therapy can help to increase the strength and mobility in your shoulder to help you return to normal activity quickly and safely. Clinic appointments at 8 to 12 days, then at 6 weeks, 12 weeks, 18 weeks and possibly 24 weeks physical therapy appointment starting at 2 weeks. Arthroscopic slapbankart repair protocol andrea saterbak, md.
The purpose of a slap repair operation is to reattach the. Figure 2c a typeiii slap lesion is a superior labral buckethandle tear. Conservative treatment for patients with suspected slap tears. Rehab must match the surgery nonoperative rx can often be attempted first and with success team approach to rx is key slap pain generator. Anterior labral repair adopted 509 1 general principles. Jennifer hart, pac, michelle post, pac postoperative rehabilitation protocol slap repair, bankart repair, or biceps tenodesis phase i. Shoulder labral repair rehabilitation protocol labral repairs are limited by the inherent limitation of softtissue healing to bone.
A slap lesion superior labrum, anterior front to posterior back is a tear of the labrum above the middle of the glenoid that may also involve the biceps tendon. Surgical intervention may include reattachment of the labrum, debridement, or a combination. Arthroscopic type ii slap repair rehabilitation protocol orthoindy. Sports medicine physical therapy rehabilitation protocols. Sling immobilization at all times except for showering and rehab under guidance of pt. Postoperative rehab protocol bankart repair, slap repair or biceps tenodesis phase i. Rehabilitation protocols by wilk, reinold, and andrews. Slap lesion repair protocol northeast orthopedics and. Physical therapy standards of care brigham and womens. It should be stressed that this is only a protocol and should not be a substitute for clinical decision making regarding a patients progression.
Bankart and slap repair post operative pt protocol revised. Arthroscopic labral repair protocol, ii, iv, and complex tears. By design and necessity, it is incomplete, to allow for individualization of the. These injuries can also occur from trauma, such as falling on your arm, bracing your arm in an accident,armtacklinginfootballorany large sudden force applied to the arm. This evidencebased arthroscopic slap lesion repair rehabilitation guideline is criterionbased. Arthroscopic anterior labral repaircapsulorraphy rehabilitation protocol general sling for four weeks avoid the throwing position for three months cooling device or ice used on shoulder every two to three hours for 20 minutes for first seven days then as needed and after physical therapy sessions. Avoid ckc exercises for 8 wks to minimize compressionshear forces. Figure 2b with a typeii slap lesion, the biceps attachment and the adjacent superior aspect of the labrum have pulled off the superior glenoid tubercle. The gundersen health system rehabilitation programs are evidencebased and soft tissue healing dependent programs designed to allow patients to progress to vocational and sportrelated activities as quickly and safely as possible. Arthroscopic labral repair protocoltype ii, iv, and. Arthroscopic labral, slap, or bankhart shoulder repair rehab protocol craig l. Bankart and slap repair post operative pt protocol please contact the uwmc shoulder and elbow team with any questions.
A tear of the labrum below the middle of the glenoid socket that also involves the. The tendon of the biceps muscle also attaches to the labrum in this area and may also be affected by the injury. Postoperative protocols in this procedure, the superior labrum and biceps anchor is reattached to the superior glenoid or upper humerus. Slap superior labrum, anterior and posterior is a lesion that begins posterior in the labrum and extends anteriorly, involving the anchor of the long head of the biceps brachii to the labrum. Based on the diagnosis of your slap tear, your doctor will most likely refer you to physical therapy. Aug 08, 2016 a slap tear superior labrum anterior and posterior is an injury to the labrum of the shoulder and is usually caused by acute trauma to the shoulder or repetitive motion. Superior labral tears slap lesions can pose a significant challenge to orthopaedic surgeons and rehabilitation specialists alike. Bankart repair rehabilitation protocol arthroscopicopen this protocol was developed for patients who have had a bankart repair. Bankart slap and biceps tenodesis rehabilitation protocol.
The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone an arthroscopic assistedminiopen rotator cuff repair. Protection phaseimmediate motion 0 6 weeks postop goals. Physical therapists specialize in human movement and are the best healthcare professionals to treat labral tears via conservative methods. The following are guidelines only and physical therapists should contact us if they have any questions they may have. Th e full recovery from these procedures occurs after 69 months. The 26 year old man had injured his right shoulder while trying to reach a distant socket with. Sling and abduction pillow for four weeks may remove for bathing and exercises. Nonoperative shoulder rehabilitation protocol ben rubin, m. For 4 weeks, worn at all times unless performing hep bicep. Arthroscopic labrum repair of the shoulder slap anatomy. Bankart and slap repair post operative pt protocol revised january 2009. This case report describes the clinical presentation and conservative treatment of a patient who suffered from a superior labrum anteroposterior slap tear of the shoulder after a rock climbing session. Arthroscopic debridement of type i and iii slap lesions protocol the intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone an arthroscopic debridement of a type i or iii slap lesion.
Rehabilitation after arthroscopic labrum repair of the shoulder slap phase 0. Slap tears are classified based on the type of tear as well as the portion of the labrum. The following list of exercises and treatment options is an approximate order of progression. Kevin wilk, dpt, mike reinold dpt, scs, cscs, and james andrews, md have created some of the most widely used, published, cited, and respected rehabilitation protocols based on exactly how they progress their patients. Early passive range of motion is highly beneficial to enhance circulation within the joint to promote healing. Rehabilitation guidelines for slap lesion repair uw health. Bankart and slap repair post operative pt protocol revised january 2009 please note that the surgical team may adjust any of these protocols as necessary for each individual patient. A shoulder labrum tear can be a painful injury that limits your ability to use your arm normally.
The intent of this protocol is to provide the clinician with a guideline of the postoperative. Physical therapy is the best nonoperative treatment. Uw health s sports medicine sports rehabilitation physical therapists and athletic trainers in madison, wisconsin, help injured athletes return to health and return to sport. Slap repair therapy protocol 5 of 4 clinical followup. This guideline is intended to provide the treating clinician a frame of reference for rehabilitation. You will go to the recovery room and generally will be discharged after 12 hours. Uva sports medicine university of virginia school of. General information there may be a loss of external rotation when compared to the other side, but the motion is. Slap lesions, or tears of the labrum superior labrum, anterior. Modifications to this guideline may be necessary dependent on physician specific instruction, location of repair, concomitant injuries or procedures performed.
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