Obtain range of motion (ROM) first then proceed to strengthening. The rotator cuff tendons are repaired to the bone and to themselves. The quality of the repair is determined by the quality of the bone and tendon tissue and dictates how and when therapy is performed. Most of the time the patient will have arthroscopic pictures of their own surgery which can be reviewed with them if desired.Īt the time of the rotator cuff repair other procedures might need to be performed. These can include a subacromial decompression which typically involves removing any bone spurring and making ample space for the rotator cuff. It can also include repairing the biceps tendon and cleaning up any other damaged tissue. There are several repair techniques, but we usually repair these tears arthroscopically with a two row technique which has been shown to have improved biomechanical strength and surface area for healing. It is cliché to say that every tear is a little different, but in many respects this is true. The tendons can be torn from the bone (most common) and within its substance. The tears can also have different shapes and tissue quality. Operative intervention is typically indicated in acute rotator cuff tears especially in younger and more active patients and in chronic tears that have failed nonoperative treatment. Start 4 way shoulder resistive band strengthening and periscapular strengthening exercises working on proper joint kinematics.ĭownload Printable Version Pathology and Treatment:.Begin Alternate Internal Rotation Stretch, Overhead Pulley, Sleeper stretch, Wall slide into Scaption, ER at the doorway, Hand across chest.Begin passive supine FE-ER to full, AROM in all planes, ER with stick, IR behind the back and Cross body adduction.
If the patient does not get FROM in the first 6 weeks, then it will be very difficult to obtain it thereafter. Periscapular and postural strengthening exercises may be initiated once FROM is attained. Make sure to pay close attention to diabetic patients, as they will tend to have higher recurrence rates and thus need to be especially diligent with the stretching.
It should be emphasized to the patient that these stretches should be performed 2-3 times daily at home. Each session should last 20 minutes. Instruct the patient on the use of heat and analgesics 30 minutes prior to stretching. Emphasize holding each stretch for at least 10 seconds. The most important time is the first 6 weeks. The goal of the postop rehabilitation is to maintain this ROM gained in the operating room with long slow stretches in all planes to prevent recurrence. Remove sling after the first postoperative day. Patients may use arm for all ADL’s.
Download Printable Version Goals & Guidelines: