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  • Dr. Mackenzie Trevellyan, PT, DPT

Physical Therapy after Rotator Cuff Surgery

Shoulder pain is extremely common and can be very frustrating to deal with, simply because of how much it affects our daily function. This pain can be caused by a number of different factors, and frequently, the muscles of the rotator cuff are involved in some way. Most people are familiar with the rotator cuff in the shoulder, a group of 4 muscles that provide support to the shoulder joint, allowing the arm to move freely in all directions. These muscles are vital in holding the upper arm bone (humerus) in the proper position in the shoulder socket. Injury to these muscles may make typical activities that involve using your arm more difficult to complete either due to pain or limited mobility. Injury may be caused by a traumatic event or merely the repetitive rubbing of the muscles against the surrounding structures of the shoulder through habitual motions.




Anatomy of the Shoulder

The shoulder is a ball and socket joint, hence the ability to move your arm in all different directions. The 4 muscles of the rotator cuff sit on the shoulder blade and attach via tendons to the top of the humerus (upper arm bone), and they include the supraspinatus, infraspinatus, teres minor, and subscapularis. The tendons attach the muscles to the humerus, and in turn the muscles move the bones by pulling on the tendons. The 4 muscles come together as a tendon group at the top of the shoulder and depending on where they each specifically attach, they can create a variety of shoulder movements.


Tear of the Rotator Cuff

A partial thickness tear may include injury of any one of the four muscles, and may include injury to all 4 muscles without complete separation of the tissues. Repetitive strain on these muscles causes small tears to form within the muscle and tendon, thus increasing the pain and irritation within the shoulder as these already injured tissues are continuously used. A partial tear may lead to a full thickness tear if these tissues are not properly rehabilitated.

A full thickness RC tear involves a complete rupture of the tendons, due either to overuse or a traumatic event where all 4 tendons are affected and are no longer forming a connection between the shoulder blade and the humerus. With a full thickness tear, the muscles cannot provide the pull required to perform shoulder movement and mobility is significantly limited.

Generally speaking, the larger the tear, the more shoulder weakness you will experience.


Symptoms of Rotator Cuff Tear

People experience rotator cuff tear symptoms differently. Some symptoms you may experience include:

  • Vague pain in shoulder and upper arm

  • Weakness or Inability to move arm away from body (may have pain with this movement)

  • Weakness or Inability to reach up and out (may have pain with this movement)

  • Pain with compound movements, such as the twisting and lifting required to comb your hair or put on a jacket.

  • Difficulty sleeping on affected side due to pain

Depending on the severity of the injury, you may be able to rehab the shoulder with proper strengthening and mobility training, or you may require a surgical repair.


Surgery for Rotator Cuff Repair

If you have shoulder pain that does not respond favorably to physical therapy and conservative management, you may have to check in with your physician. He or she may order diagnostic tests, like an MRI, to assess for rotator cuff tear. If you do have a tear, you may benefit from surgery. (Careful here; many people have rotator cuff tears on MRI with no pain and no loss of motion. The presence of a tear does not necessarily mean you need surgery.)


The surgery for rotator cuff repair occurs on an outpatient basis. Your surgeon will make 3 or 4 small holes in your shoulder. The holes are used to introduce specialized tools and cameras into your shoulder area. The surgeon will then be able to visualize your rotator cuff, and sutures can be applied to the injured tissue to hold it together.


After surgery, you will likely go home with a sling on your shoulder. This is to protect the surgical site as it heals. Your physician may refer you to PT in the first few days after surgery, or you may need to wait a few weeks before starting outpatient rehab for your rotator cuff repair.


Physical Therapy Eval after Rotator Cuff Surgery

Physical Therapy is instrumental in the recovery following a rotator cuff surgery. Following surgery, there will be a specific protocol for recovery that will guide your treatment plan. You will likely be required to wear a sling for a number of weeks to fully

immobilize the shoulder while it begins to heal. Following this period of immobilization, you will begin a specialized treatment program based on the nature of your particular surgery and your goals for rehabilitation.



Treatment

The first step with any protocol following surgery is to keep pain under control and to begin regaining mobility. Rotator cuff rehabilitation plans usually take a phased approach, progressing through each level based on reaching the specific goals set for each phase.


After being immobilized for a number of weeks, your shoulder will likely feel extremely stiff and difficult to move without pain. Working with your therapist, you will establish a gentle range of motion program to allow your shoulder to start moving and to encourage the muscles to stretch. As motion begins to return in your shoulder, light strengthening will be gradually introduced to the treatment plan. It is exceedingly important to follow your protocol in these first few weeks of healing as this is when the shoulder is the most vulnerable to re-injury.


Following the reintroduction of basic shoulder strengthening, you will progress through functional strengthening and then on to unrestricted return to function (or sport, depending on your rehab goals).


Prognosis

Within the first few weeks following surgery you will be able to return to light activities, likely avoiding overhead motions until your shoulder strength and stability are improved. At about the 2 month mark you should have recovered most of your shoulder range of motion. Within about 3 months it is expected that you will have full range of motion and your functional strength should be progressing steadily. At this point you will likely have returned to your normal daily activities with very few modifications, and if you are returning to sport, you will continue from here with a return to sport program.


Recovery of full function is possible!


Having an issue with your rotator cuff can be a scary prospect, especially if you need surgery to repair it. While the process may be longer than some recoveries, you can expect a return to normal within about 3-6 months following surgery. Working alongside your physical therapist, you can and will establish a plan for recovery and return to your life as it was prior to this injury. If this sounds like you, please give our office a call at (518)439-5006 and we will be happy to work with you on your road to recovery!



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