Our radiologists work closely with ohsu mri technologists in the art of creating. Clinical guidelines for cpm following rotator cuff repair. Imaging algorithms for evaluating suspected rotator cuff disease. Large rotator cuff repair protocol the intent of this protocol is to provide the clinician with instruction, direction, rehabilitative guidelines and functional goals for all rotator cuff repair procedures. The rotator cuff is comprised of the supraspinatus, infraspinatus, subscapularis, and teres minor muscles and tendons. It outlines all sequences and protocols currently applied in our mri section. Diagnosis of torn rotator cuff symptoms of shoulder pain that awaken you at night, and weakness raising the arm are suggestive of a torn rotator cuff. What to order when the radiologists at radia have developed the following scanning guidelines for our referring providers to assist you in selecting the most effective imaging modality for your patients clinical presentation. The diagnosis can be confirmed by magnetic resonance imaging mri or an xray taken after dye has been. Degree of shoulder instabilitylaxity prior to surgery. Protocol s5 conservative physical therapy protocol for rotator cuff repair arthroscopic or miniopen technique recommended for a large to massive. Magnetic resonance imaging of rotator cuff tears in shoulder. Rotator cuff and slap patient info boston sports medicine. Mri protocols for essr european society of musculoskeletal.
Rotator cuff repair protocol is a rehabilitation protocol to provide patient with the guidelines following a rotator cuff surgical procedure. Magnetic resonance imaging mri is an accurate imaging modality f or ev aluating the rotator cuff and biceps tendon, allowing visualisation of the soft tissues and the adjacent bony structur es. Brent carlson arthroscopic rotator cuff massive repair. The protocol is both chronologically and criterion based for advancement through four postoperative phases. Shiley flexible tracheostomy tube with taperguard cuff provides a flexible design with the sealing benefits associated with the taperguard cuff. Mr imaging revealed a high percentage and degree of severity of rotator cuff tears in individuals with paraplegia and thus proved useful in evaluating shoulders in these patients. The blood pressure cuff should be used with care taken not to. Examination of the shoulder usually reveals weakness. Boyle cryotherapy as needed for pain relief cryocuff or ice pack no pendulum.
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. Please apply by visiting the unit and sending your cv to jan barker visits to the reading shoulder unit are welcome please liaise with prof. Contact dr kevin murphy at 9046340640 to know more. Rotator cuff repair protocol rotator cuff protocol physical.
Critical zone in rotator cuff tendons radiology reference. This protocol will vary in length and aggressiveness depending on factors such as. Tears that involved the posterior portion of the rotator cuff were revealed on mr images in 74% of the paraplegic subjects compared with 50% of the ablebodied subjects. Magnetic resonance imaging protocol and interpretation mri was performed with 1. Evaluation of rotator cuff is a common indication for magnetic resonance imaging mri scanning of the shoulder. Protocol s5 conservative physical therapy protocol for. Discuss the implications of the morphologic features and extent of rotator cuff tears for glenohumeral joint mechanics, treatment, and prognosis. Mri handbook mr physics, patient positioning, and protocols. Standardized cardiovascular magnetic resonance imaging cmr protocols.
Rotator cuff repair protocol medium to large day 1 postop to 2 weeks change dressings day 1 postop. Shiley tracheostomy products quick reference guide. Applications for the reading shoulder fellowship starting in late 2019 and for 2020 is now open. Shawn hennigan, md rotator cuff repair rehabilitation protocol.
A more sensitive test such as arthrogram mri or arthroscopy may be needed to diagnose a small tear or a partial tear of the rotator cuff. The procedure involves stitching the torn tendon back onto its attachment to the humerus. Cmr protocols journal of cardiovascular magnetic resonance. Conservative treatment in most cases, initial treatment for a rotator cuff tear is nonsurgical. Synchronized or isolated protocol the primary goal of postsurgical rehabilitation following rotator cuff repair is to control pain, protect repaired tissue during the healing process, restore function, improve rangeofmotion, restore strength and prevent a. The socket portion of the joint is not naturally deep. Rotator cuff repair rehabilitation protocol protocol for subscapularis repair rehabilitation prepared by dr boyle. The repaired rotator cuff frequently appears abnormal on magnetic resonance imaging mri and ultrasound us.
Rotator cuff repair protocol boston shoulder institute. Figure 1 is a front view of the shoulder that shows a normal rotator cuff. The importance of impingement in the pathogenesis of rotator cuff rupture is supported by various. This rehabilitation protocol has been developed for the patient following a rotator cuff surgical procedure. Rehabilitation guidelines for type i and type ii rotator cuff. Strengthening of rotator cuff at week 12 if full painfree arom this protocol provides the clinician with general guidelines for the rehabilitation of the patient undergoing arthroscopic, miniopen or open repair of a large or massive rotator cuff tear. Shoulder magnetic resonance imaging mri improves the. Phase i immediate postoperative phase weeks 0 6 days 014 patient is seen 2 days postoperative to remove surgical dressings and pain catheter.
Type three rotator cuff repair miniopen or neer approach large to massive tear greater than 5 cm i. Sling for everyone with or without abduction pillow as directed by dr. Rotator cuff repair rehab protocol the stone clinic. The case demonstrates clearly the effect of subacromial and subcoracoid impingement syndromes with associated subscapularis and supraspinatus tendon complete tear. Rotator cuff repair rehab protocol in the early 1990s, dr.
Arthroscopic view from the posterolateral portal onto the four anchor knotless interconnected doublerow rotator cuff repair of the crescent shaped tear in a right shoulder is shown. The study protocol was approved by our institutional ethics committee amg. Mr imaging of rotator cuff tears in individuals with. The purpose of this study was to compare the diagnostic performance of a 5minute shoulder mri protocol consisting of multiplanar 2d fast spinecho fse sequences with parallel imaging to that of a standard shoulder mri protocol. Showering is allowed once dressings and catheter is removed. Magnetic resonance imaging can demonstrate the extent and configuration of rotator cuff abnormalities, suggest mechanical imbalance within the cuff, and document abnormalities of. Comparison of a fast 5minute shoulder mri protocol with a. Shawn hennigan, md rotator cuff repair rehabilitation protocol the following document is an evidencebased protocol for arthroscopic rotator cuff repair rehabilitation.
Conventional mri is the most commonly used technique, while magnetic resonance mr arthrography is reserved for certain cases. Change dressing to light gauze daily for first 4 days, then leave open to air. Mri of the shoulder 2nd edition pdf download medical books. Nov 03, 2014 shoulder joint is a common site of musculoskeletal pain caused, among other things, by rotator cuff tears due to narrowing of subacromial space, acute trauma or chronic shoulder overload.
The most common causes of shoulder pain include rotator cuff disease. Intermediate phase 16 weeks postop at this point you should begin your formal physical therapy, the instructions that follow are to aid your therapist in maximizing the results of your surgery while still protecting the repair. Rehabilitation guidelines for type i and type ii rotator cuff repair and isolated subscapularis repair the anatomic configuration of the shoulder joint glenohumeral joint is often compared to that of a golf ball on a tee. Rotator cuff repair a rotator cuff repair is designed to improve pain and function in cases of rotator cuff tears. In 2000, an assessment of the prevalence and incidence of consultations for shoulder problems in uk primary care estimated the annual prevalence to be 2. Mr imaging of the rotator cuff and rotator interval. Stay in sling except for exercises therapeutic exercise. Pendulums table slides into flexion, external rotation, and abduction in scapular p. For this reason the shoulder is the most mobile joint in the body. Our literary philosophy is that mri books for clinicians should be written by clinicians. Rotator cuff repair protocol northeast orthopedics and.
Rotator cuff repair protocol small day 1 postop change dressings. This may be performed arthroscopically or through open surgery, using sutures and bone anchors. Rotator cuff repair protocol south shore orthopedics. Rotator cuff disorders are thought to be caused by a combination of internal and external mechanisms. The first five chapters of the book introduce the reader to the basics of mr. Rotator cuff repair protocol small orthopaedicsone. Hip pelvis thigh knee lower extremityshin ankle foot special cases soft tissue mass metal protocol.
It is no means intended to be a substitute for ones. The critical zone of the rotator cuff is an area approximately 815 mm from the insertion of the rotator cuff tendons onto the greater tubercle of the humeral head, mainly within the supraspinatus tendon. Begins immediately after surgery to approximately 4 weeks postop. 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.
Type one rotator cuff repair arthroscopic or miniopen small tear less than 1 cm i. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Protocol for the united kingdom rotator cuff study ukuff. Stone invented one of the first suture anchors designed for rotator cuff repair, the questis suture anchor, and has been involved in technique design, modifications, and improvements ever since. Aug, 2018 ultrasound scan us is proven to be as reliable as mri for rotator cuff diagnosis and can be static or dynamic. Dr jonathan herald au, explaining how to read an mri relative to shoulder rotator cuff tears. Rotator cuff tear patterns dictate repair technique. Mri of the shoulder 2nd edition pdf mri of the shoulder 2nd edition pdf free download, mri of the shoulder 2nd edition pdf, mri of the shoulder 2nd edition ebook content now in its second edition, this residentfriendly reference explains the basics of mri then walks readers easily through the radiologic evaluation of shoulder disorders. Ue cryocuff or ice as much as possible for first 2 days, then as needed for pain. It is not intended to be a substitute for clinical decision. Critical zone in rotator cuff tendons dr daniel j bell and dr amir rezaee et al. Figure 2 is a similar view that shows a torn rotator cuff.
Reliability of magnetic resonance imaging in s e rotator cuff. Treatment involves a combination of modalities including. Magnetic resonance imaging mri is an excellent modality for imaging. Another imaging test, mri magnetic resonance imaging, may be required to confirm a rotator cuff tear. Rehabilitation guidelines for type i and type ii rotator. This is because the articular surface of the round humeral head is approximately four times greater than that of the. What the clinician needs to know1 learning objectives for test 4 after reading this article and taking the test, the reader will be able to. Routine mri protocols ucsf department of radiology.
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