肩部肌腱修复康复
19周中级康复训练，每周2次，逐步恢复肩部活动度、力量与功能。
专业康复方案，旨在帮助有效恢复和疼痛管理。
关键信息一览
- 检查部位
- 上肢 · 肩关节
- 损伤类型
- 肌腱修复后
- 级别
- 中级
- 疗程
- 19
- 每周次数
- 2
- 每次时长（分钟）
- 30
- 证据等级
- 中度
- ICD-10
- S42
- 费用档位
- 中度
肩部肌腱修复——中期康复计划（19周）
本计划适用于肩部肌腱修复手术后处于恢复中期、已准备好接受监督下中期康复方案的人群。它面向已获得外科医生许可、可以超越早期保护阶段的患者。目标是在19周内，通过指导性锻炼、手法治疗以及划船机和治疗用橡皮泥等器材，逐步恢复肩部活动度、力量和日常功能。进度根据您自身的反应来安排，临床医生会随着您的改善调整计划。
开始之前
只有在获得外科医生和物理治疗师批准后，才能开始本计划。如果您存在修复部位不稳定、严重骨质疏松或任何活动性感染，请告知您的医疗团队——这些情况可能使本计划对您不安全。运动前务必热身，避免肩部过度负荷。如果出现突发剧烈疼痛、新出现的无力、肿胀、发热或肩部周围发红，或疼痛持续加重而非缓解，请停止并联系您的临床医生。
每周安排
本计划为期19周，每周两次，每次约30分钟，使用划船机和治疗用橡皮泥。计划按清晰的步骤分阶段推进：首先在治疗师帮助下活动手臂的同时保护修复部位，然后进行轻柔的主动活动，再逐步增强力量和控力。请勿自行提前进阶——治疗师会根据您肩部的反应、疼痛情况和活动情况，决定您何时准备好进入下一阶段。
一次典型训练的内容
每次训练都以热身开始，让肩部和身体做好准备，通常是低强度的轻松划船和轻柔的手臂活动。主要训练包括渐进抗阻练习、肩胛骨（肩胛）控制训练、由治疗师指导的动作模式以及必要的手法技术；橡皮泥可用于轻度握力和肩袖训练，电刺激可能有助于肌肉激活。训练以轻柔拉伸和轻松活动的放松环节结束，让肩部平静下来。
跟踪进展
治疗师会使用具体的检查节点——例如疼痛程度、肩部活动范围以及您对训练的耐受情况——来决定何时进入下一阶段。这些是参考指南，而不是您必须独自达到的目标。标准结局指标（包括肩部功能评分、疼痛评分、活动度和力量测试）会随时间记录，以显示您的进展并指导计划调整。如实反馈疼痛和功能情况，有助于临床医生精细调整每一步。
恢复与自我照护
遵循医疗团队关于活动和休息的指导，避免忍痛强行活动或任由疼痛加剧。严格按照处方继续使用吊带或支具。请勿自行增加新练习或加大强度——过度负荷可能使恢复倒退。如出现发热、红肿扩散、突然失去活动能力或力量、胸痛或气短等警示信号，请及时就医。
康复阶段
Pain at rest ≤2/10 on visual analog scale,Passive glenohumeral flexion to 90° achieved without pain,Passive external rotation at 0° abduction to 20° achieved,No active shoulder motion permitted,Sling immobilization maintained as prescribed,Scapular stabilization exercises initiated in neutral
进入下一阶段： Phase 2
Pain at rest ≤2/10 maintained,Passive glenohumeral flexion to 110° achieved,Passive external rotation at 0° abduction to 30° achieved,Passive internal rotation at 90° abduction to 50° achieved,No compensatory scapular hiking during passive motion,Tolerance to 30-minute session without increased symptoms
进入下一阶段： Phase 2
Passive flexion to 140° achieved,Passive external rotation at 0° abduction to 40° achieved,Active-assisted shoulder flexion to 90° pain-free,Active-assisted external rotation at 0° abduction to 20° achieved,Scapular retraction during supine arm elevation confirmed,No increase in morning stiffness >30 minutes
进入下一阶段： Phase 3
Active-assisted flexion to 120° achieved,Active-assisted external rotation at 0° abduction to 30° achieved,Active elbow flexion and extension with shoulder stabilized,Scapular protraction/retraction control in prone demonstrated,Gravity-eliminated abduction to 60° achieved,Subjective improvement in functional baseline
进入下一阶段： Phase 3
Active-assisted flexion to 140° achieved,Active-assisted external rotation at 90° abduction to 30° achieved,Full passive glenohumeral ROM maintained,Active shoulder abduction to 60° in scapular plane achieved,No lag during scapular stabilization tests,Tolerance of isometric rotator cuff contractions at low resistance
进入下一阶段： Phase 3
Active shoulder flexion to 150° achieved,Active shoulder abduction to 90° in scapular plane achieved,External rotation at 90° abduction to 45° achieved,Internal rotation at 90° abduction to 70° achieved,Grade 4/5 manual muscle testing for infraspinatus and supraspinatus,Scapular control during active arm elevation without winging
进入下一阶段： Phase 4
Full active shoulder flexion achieved,Full active shoulder abduction in scapular plane achieved,External rotation at 90° abduction to 60° achieved,Internal rotation at 90° abduction to 80° achieved,Rotator cuff isometric exercises at 50% effort pain-free,Prone scapular stabilization exercises initiated
进入下一阶段： Phase 4
Full active ROM in all planes maintained,Grade 4/5 supraspinatus manual muscle testing,Grade 4/5 infraspinatus and teres minor manual muscle testing,Grade 3/5 subscapularis manual muscle testing,Scapular upward rotation during arm elevation demonstrated,Patient report of decreased catching with overhead activities
进入下一阶段： Phase 4
External rotation at side against resistance 3/5 grade,Internal rotation at side against resistance 3/5 grade,Shoulder flexion against gravity to 160° no lag,Scapular stabilization endurance >20 seconds in modified push-up position,Biceps tendon resistance exercises initiated at minimal load,No reproduction of acromioclavicular joint pain during ADL
进入下一阶段： Phase 5
External rotation at 90° abduction 3/5 grade achieved,Internal rotation at 90° abduction 3/5 grade achieved,Supraspinatus resistance in empty can position 3/5 grade,Scapular retraction against resistance 4/5 grade,Progressive biceps curl resistance to 3kg tolerated,Shoulder flexion endurance >10 repetitions at moderate resistance
进入下一阶段： Phase 5
Full rotator cuff strength 4/5 in all planes,Scapular stabilization 4/5 on manual muscle testing,Biceps strength 4/5 on manual muscle testing,Closed-chain scapular exercises tolerated,Proprioceptive exercises in quadruped position initiated,AC joint stability confirmed without pain on cross-body adduction
进入下一阶段： Phase 5
Rotator cuff strength 4-5/5 in all planes,Scapular stabilization endurance >30 seconds,Biceps strength 4-5/5 with functional resistance,PNF diagonal patterns initiated with resistance,Shoulder proprioception at 90° flexion achieved,Patient able to perform light ADL without compensation
进入下一阶段： Phase 6
External rotation at 90° abduction against resistance 4/5 grade,Internal rotation at 90° abduction against resistance 4/5 grade,Push-up plus exercises initiated,Wall dribbles for internal rotation mobility achieved,Rhythmic stabilization in quadruped position tolerated,Labral repair stability confirmed on compression test
进入下一阶段： Phase 6
Full shoulder strength compared to contralateral side,Functional reach without pain or instability,Shoulder endurance 80% of contralateral side,Sport-specific or occupation-specific movements initiated at low intensity,Proprioceptive exercises at 135° abduction achieved,No pain with resisted biceps activities
进入下一阶段： Phase 6
Shoulder flexion endurance 90% of contralateral side,External rotation strength 90% of contralateral side,Internal rotation strength 90% of contralateral side,Timed functional tests within 10% of baseline,Patient confidence 8/10 on shoulder specific questionnaire,No pain with functional progression
进入下一阶段： Phase 7
Isokinetic shoulder evaluation within 85% bilateral ratio,Push-up test >20 repetitions without fatigue,Scapular control during loaded overhead activities,Return to light manual work activities tolerated,AC joint loading without symptoms,Biceps tendon load tolerance without anterior pain
进入下一阶段： Phase 7
Full return to work activities without restrictions,Sport-specific drills at 75% intensity tolerated,Shoulder endurance tests within 5% of pre-injury baseline,Patient satisfaction >8/10 on global rating of change,No recurrence of symptoms with increased activity,Cleared for full sport or occupational participation
进入下一阶段： Phase 8
Sport-specific or job-specific training at 90% intensity,Shoulder biomechanics normalized during complex movements,Proprioceptive retraining at high-speed activities completed,Maintenance program independently performed,No fear of movement or re-injury anxiety,Strength ratios within normal limits for population
进入下一阶段： Phase 8
Full return to pre-injury activity level,Shoulder outcome measures meet success criteria,Maintenance exercise program independently understood,Patient educated on warning signs requiring follow-up,No limitations in activities of daily living,Discharge criteria met for therapeutic conclusion
进入下一阶段： Discharge
活动恢复里程碑
Pain-free basic activities of daily living
Week 5No sign of shoulder impingement with resisted empty can test
Light functional activities and conditioning
Week 8Able to tolerate light resisted flexion and extension without flare
Moderate activity and sport-specific conditioning
Week 11Pain ≤ 3/10 during functional reaching and lifting activities
Full return to sport, occupation, and recreation
Week 19Patient adherence to home exercise programme ≥ 5 days per week
注意事项
- 训练前充分热身
- 避免过度负荷
禁忌症
- 内固定不稳定
- 重度骨质疏松
- 活动性感染
疼痛管理
- Cryotherapy (ice pack application 15-20 minutes post-exercise)
- Non-steroidal anti-inflammatory medication as prescribed
- Gentle soft tissue mobilization to posterior capsule
- Subcutaneous needling or dry cupping for myofascial trigger points
- Activity modification and ergonomic education
设备与检查方式
常见问题
训练后我会酸痛吗？
我可以在家多做训练或练习吗？
我如何知道可以进入下一阶段？
本信息仅供教育用途，不能替代专业医疗建议、诊断或治疗。
本内容仅供一般信息和教育用途，不能替代专业医疗建议、诊断或治疗。对于任何医疗问题，请务必咨询合格的医疗服务提供者；切勿因阅读本站内容而忽视专业医疗建议或推迟就医。
如果您认为自己可能出现医疗紧急情况，请立即拨打当地急救电话或前往最近的急诊科。
医学审核:WellAlly 编辑团队 最后审核 2026年10月6日. · 阅读我们的编辑政策