Recovery: Rotator cuff repair

The operation

Your rotator cuff repair can be done arthroscopically (key hole) or as a mini-open approach where a small portion of deltoid from the acromion and then splitting the muscle vertically. This operation normally involves the supraspinatus tendon and will be repaired if it is a full thickness tear. If the tear is medium to large it may involve infraspinatus and teres minor. A massive tear may also involve subscapularis. A subacromial decompression (SAD) is normally done as part of the procedure, to give the repaired tendon more room in which to move. If a tear is irreparable, a SAD will be carried out for pain relief. If the tear has been repaired and is secure, it will be immobilised in a sling for 3 weeks, unless Mr. Cole advises otherwise. Outpatient physiotherapy is normally started from 3 weeks post-operation.

0–three weeks post-operation

The main emphasis is on regaining passive range of movement with minimal muscle activity.

i. Keep immobilised in sling, take out for exercises and axilla hygiene
ii. Elbow, wrist, neck and scapula movements
iii. Scapula setting
iv. Pendular exercise – ‘passive’ flexion (neutral rotation)
v. ‘Passive’ flexion – supine (assisted with other side)
vi. ‘Passive’ external rotation – supine – to 0º. Use stick between hands and towel under humerus for support. Can take beyond 0º, if range before tension on repair is greater than 0 and recorded in operation notes. However DO NOT DO THIS if subscapularis has been repaired. This is relatively rare and should be recorded in op notes. Check with Mr. Cole for confirmation.

Throughout this period, emphasize the ‘passive’ nature of the movement and reinforce this with patient education. Teach carers if your patient is not able to do this alone, or is tending to do active movement.

Do once a day if good mobility, twice a day otherwise, three times a day if tendency to be stiff.

Three weeks post-operation

The main emphasis is on regaining active movement, with maximal passive movement available. Facilitate movement do not resist.

i. Wean off sling gradually as control increases
ii. Continue with ‘passive’ range of movement – gh joint – end of range ‘tight’ but no forcing or sudden stretching
iii. Start active assisted elevation, in scaption – progressive programme with short lever arm (elbow flexed). Start supine, pulleys, auto-assisted, up wall
iv. Correct movement pattern
v. Progress scapula muscle programme
vi. Start isometrics for internal and external rotation in neutral if pain free – do not target supraspinatus i.e. abduction
vii. Hydro – exercises in water (not swimming)
viii. Functional tasks (not lifting) at waist height

Six weeks post-operation

The main emphasis is on improving endurance and quality of movement with reference to functional activities.

i. Progress active assisted movements – extension, hand behind back, abduction
ii. Progress cuff rehabilitation – through range – progressive loading – do not target supraspinatus with abduction +/- resistance exercises
iii. Progress scapular activity
iv. Integrate scapula/cuff with dynamic control and endurance through range
v. Build endurance
vi. Increase functional tasks into elevation
vii. Can stretch if required
viii. No lifting

Twelve weeks post-operation

The main emphasis is on muscular endurance and strength in relation to functional demands.
i. Increase endurance for arm elevation activities
ii. Progress resistance to cuff and scapula as indicated
iii. Start general strengthening activities
iv. No contraindications
v. Functional demands will direct rehabilitation

With thanks to the Oxford Shoulder & Elbow Clinic, and in particular Jane Moser at the Nuffield Orthopaedic Centre for sharing their written physiotherapy guidance with us.