rehabilitation

Epidemiology

Usually young patients

- 15 - 40

15% compound

Aetiology

High velocity injury

- MBA

- MVA

- pedestrian v car

- fall from height

Emergency Managment

EMST principles

- need for transfusion not uncommon

Surgical Options

1.  Open antero-lateral approach 

Large / Massive Cuff Tear

2.  Deltopectoral approach

Large Subscapularis tear

3.  Arthroscopic Assisted Mini-open

Indication

- Small / Moderate Cuff Tear < 3cm

- no retraction

Technique

- arthroscopic SAD

Concept Accelerated Rehabilitation

Shelbourne 1995

- noticed patients noncompliant with their rehab protocol were doing much better

- looked at what noncompliant patients were doing

- what they were doing was advancing activities as tolerated

Reviewed results of accelerated rehabilitation

- fewer ruptures with better ROM

Major recommendations