July 27, 2024
Rotator cuff repair with biceps tenodesis is a surgical procedure often performed to address significant shoulder pain and dysfunction resulting from injuries to the rotator cuff and the biceps tendon. This combined surgery aims to restore shoulder function, alleviate pain, and improve the overall quality of life for patients. Here’s a detailed look at the Rotator Cuff Repair with Biceps Tenodesis Protocol.
Understanding the Rotator Cuff Repair with Biceps Tenodesis Protocol
Rotator Cuff Repair
The rotator cuff consists of a group of four muscles and their tendons that provide stability and facilitate movement of the shoulder joint. Injuries to the rotator cuff, such as tears, can result in pain, weakness, and limited range of motion. Rotator cuff repair involves reattaching the torn tendons to the head of the humerus (upper arm bone).
Biceps Tenodesis
The biceps tendon can often be implicated in shoulder injuries, contributing to pain and dysfunction. Biceps tenodesis involves the surgical detachment of the long head of the biceps tendon from its attachment in the shoulder joint and reattachment to the humerus. This procedure is often performed alongside rotator cuff repair to alleviate pain and improve shoulder function.
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Post-Surgery Rehabilitation Protocol
Rehabilitation following rotator cuff repair with biceps tenodesis is critical for achieving optimal outcomes. The protocol is typically divided into several phases, each with specific goals and exercises. It’s important to follow the protocol closely and work with a physical therapist to ensure proper healing and recovery.
Phase 1: Immediate Post-Operative (Weeks 0-6)
Goals:
- Protect the surgical repair
- Minimize pain and inflammation
- Begin gentle passive range of motion (PROM)
Guidelines:
- Wear a shoulder sling or immobilizer at all times, except during prescribed exercises.
- Ice the shoulder regularly to reduce swelling and pain.
- Avoid active shoulder movements and lifting objects.
Exercises:
- Pendulum Exercises: Gently swing the arm in small circles to promote circulation.
- Passive Range of Motion (PROM): Assisted movements for shoulder flexion, abduction, and external rotation within pain-free range.
| Exercise | Frequency | Notes |
|---|---|---|
| Pendulum Exercises | 3-4 times/day | Small circles, both directions |
| PROM Exercises | 3 times/day | Use the non-operated arm or a therapist’s assistance |
Phase 2: Early Motion (Weeks 6-12)
Goals:
- Gradually restore passive and active-assisted range of motion (AAROM)
- Maintain integrity of the surgical repair
- Begin gentle strengthening exercises
Guidelines:
- Gradually discontinue the use of the sling as directed by the surgeon.
- Continue to avoid heavy lifting and overhead activities.
Exercises:
- Active-Assisted Range of Motion (AAROM): Use a cane or pulley system for shoulder flexion, abduction, and external rotation.
- Scapular Stabilization Exercises: Focus on strengthening the muscles around the shoulder blade to support shoulder movements.
| Exercise | Frequency | Notes |
|---|---|---|
| AAROM Exercises | 3 times/day | Use cane or pulley for assistance |
| Scapular Stabilization | 3 times/week | Include exercises like scapular retraction and protraction |
Phase 3: Intermediate Strengthening (Weeks 12-18)
Goals:
- Achieve full range of motion
- Begin progressive strengthening exercises
- Improve shoulder stability and function
Guidelines:
- Gradually increase the intensity of exercises.
- Avoid activities that cause pain or discomfort.
Exercises:
- Resistive Band Exercises: Use resistance bands for internal and external rotation, rows, and shoulder flexion.
- Isometric Exercises: Perform isometric holds for shoulder muscles without moving the joint.
| Exercise | Frequency | Notes |
|---|---|---|
| Resistive Band Exercises | 3-4 times/week | Start with light resistance and progress |
| Isometric Exercises | 3-4 times/week | Hold for 5-10 seconds each repetition |
Phase 4: Advanced Strengthening and Return to Activity (Weeks 18+)
Goals:
- Restore full strength and function
- Gradually return to regular activities and sports
- Ensure stability and prevent re-injury
Guidelines:
- Engage in sport-specific and functional training.
- Continue to progress the intensity and duration of exercises.
Exercises:
- Plyometric Exercises: Incorporate plyometric movements for dynamic strength and power.
- Sport-Specific Drills: Engage in drills that mimic the movements of your specific sport or activity.
| Exercise | Frequency | Notes |
|---|---|---|
| Plyometric Exercises | 3 times/week | Include exercises like medicine ball throws and rebound catches |
| Sport-Specific Drills | 2-3 times/week | Tailor exercises to the demands of your sport |
Important Considerations
- Follow-Up Appointments: Regular follow-up with your surgeon and physical therapist is crucial to monitor progress and make necessary adjustments to the rehabilitation plan.
- Listen to Your Body: Pay attention to any signs of pain or discomfort and report them to your healthcare provider. Overexertion can jeopardize the surgical repair.
- Consistency: Consistency in performing rehabilitation exercises is key to a successful recovery.
Conclusion
Rotator cuff repair with biceps tenodesis is a complex procedure requiring a well-structured rehabilitation protocol to ensure optimal recovery. By following each phase diligently and working closely with healthcare professionals, patients can expect to regain shoulder function, alleviate pain, and return to their normal activities.
Frequently Asked Questions about Rotator Cuff Repair with Biceps Tenodesis Protocol
What is the recovery time for biceps tenodesis surgery?
The recovery time for biceps tenodesis surgery typically ranges from 3 to 6 months. Initial healing and rehabilitation focus on protecting the surgical site and gradually increasing shoulder mobility and strength. Full recovery, including the return to sports or strenuous activities, can take up to 6 months or longer, depending on the individual and adherence to the rehabilitation protocol.
What can you not do after biceps tenodesis?
After biceps tenodesis surgery, patients should avoid:
- Lifting heavy objects, especially overhead, for at least 6 weeks
- Repetitive overhead activities or motions that stress the biceps tendon
- Forceful pushing or pulling movements
- Activities that involve sudden or jerky shoulder movements
- Engaging in sports or strenuous activities until cleared by the surgeon
Is biceps tenodesis included in rotator cuff repair?
Biceps tenodesis can be included in rotator cuff repair if there is concurrent pathology of the biceps tendon. It involves reattaching the biceps tendon to the humerus to relieve pain and improve shoulder function. Surgeons may perform this procedure alongside rotator cuff repair to address both issues simultaneously.
What are the side effects of biceps tenodesis?
Potential side effects of biceps tenodesis include:
- Pain and discomfort at the surgical site
- Swelling and bruising around the shoulder
- Stiffness and limited range of motion initially
- Risk of infection
- Nerve injury, which can cause numbness or weakness
- Failure of the tendon to heal properly or re-rupture
- Muscle cramping or spasms in the biceps
- Possible cosmetic deformity due to the altered position of the biceps muscle
It’s important for patients to follow post-operative care instructions and attend physical therapy to minimize these risks and promote successful recovery.
