Rotator Cuff Repair
Mini-open / Arthroscopic + arthroscopic sub-acromial decompression
Sling for 4-6/52.
Day 1 on the ward. Physiotherapist to start passive and gentle active-assisted (dependant on post-op instructions) ) external rotation to neutral, elevation in neutral with weight of arm supported avoiding pain. Hand squeeze can reduce pain, use of ball to slide along lap or table surface to support weight of arm. Ensure good posture and scapula set before each movement.Patient will only be able to achieve up to 40 degrees in first few weeks.
Maintenance elbow, wrist, hand and neck exercises (this may be taught to relative as appropriate).
Posture and scapula setting.
Washing techniques and sling advice/management. Patient may need a donjoy ER brace with extra instruction to take on and off.
Gradual increase in assisted ROM in scaption and flexion with weight of arm assisted. Usually aim to achieve 60 degrees actively by week 4 with humeral head centred. If humeral head upwardly or anteriorly migrating – exercises level is too difficult. Continue with ball rolling on table – can progress to ball up wall in flexion/scaption if pain and control allows.
Early neutral isometric cuff work can be activated in pain free effort levels. Start with post/ant deltoid with elbow flexed at 90 degrees – progress to med rotation then lat rotation. Progress isometric to 30 and 60 elevation – keeping humeral head centred.
Short lever AROM scaption, flexion and lat rotation to pain free range.
Outpatient physiotherapy may increase joint range with gentle passive and active-assisted techniques after 4/52. If the joint is becoming tight, accessory mobilisations and soft tissue techniques can be applied to post joint capsule.
Milestone at 6 weeks: Active assisted ROM to 90 degrees pain free.
6 weeks +
> 6/52 progress to full AROM actively if pain allows – don’t underestimate the weight of the arm. Start and finish with short lever.
6-12/52. Active/light activation cuff retraining through range, start with light Thera band in neutral and progress as pain allows. Do not use theraband if still has night pain. Avoid movement into pain.
>12/52. Full activation of cuff through range and functional rehabilitation to include proprioceptive training. Ensure good quality scapulo: humeral movement patterns through range.
Patient has follow-up appointments in shoulder clinic at 6/52, 3/12 and 9/12.
NB ½-1 kilo weight usually sufficient for cuff activation with weight of arm against gravity. If patient has a large degenerative RC repair or margin convergence – NO resistance for 12 weeks.
Return to work: Sedentary 3-6 weeks (as pain allows). Physical 3-6 months (as pain allows).
Driving: 6 weeks (as pain and range allows) patient confirms they are able to drive safely.
Sport: Non contact 6 months. Contact: 9 months to 1 year
Swimming: Gentle with modified stroke 8-10 weeks. Freestyle 16 weeks plus