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Post Surgical Rotator Cuff Rehab

Physio Penrith Recommended Rehabilitation

Post Surgical Rotator Cuff Rehab at Sydney Muscle & Joint Physio Penrith

Why have I had rotator cuff surgery?

Rotator cuff tears can occur from repeated stress or from trauma and will generaly present as shoulder pain and weakness, aggravated with overhead movements and carrying or lifting heavy things. Most rotator cuff tears involve the supraspinatus and/or the infraspinatus muscles and will often also have an irritated bursa (subacromial and/or subdeltoid bursitis). Occasionally isolated tears of the subscapularis can also occur. The majority of rotator cuff tendons can undergo degeneration with age and this process alone can lead to rotator cuff tears in older patients. 

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Rotator cuff tears can be classified in various ways. A partial thickness tear or type 1 tear starts on one surface of the tendon, but does not progress through the depth of the tendon - these can be bursal surface tears or articular sided tears. Bursal surface tears occur on the outer surface of the tendon and may be caused by repetitive impingement. Articular sided tears occur on the inner surface of the tendon, and are most often caused by internal impingement or tensile stresses related to overhead sports.

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A full thickness or complete tear or type 2 tear extends from one surface of the tendon all the way through to the other surface of the tendon. Full thickness tears are often caused by trauma, such as falling on the arm. Since a portion of the tendon is completely disrupted, there also will be some tendon retraction. Retraction is movement of the tendon away from its insertion point back toward the muscle.

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Why is post-surgical rotator cuff rehab important?

Rehabilitation after surgical intervention is vital to reducing pain, regaining motion, minimising loss of muscle mass and strength and ensuring function of the shoulder after surgery. Initially, patients will need to protect the surgical repair site by using a sling and allow healing of the tendon back to the bone.

 

During this time, passive motion exercises are started to prevent the shoulder from getting stiff and losing mobility. The rehabilitation program will gradually progress to more strengthening and control type exercises. The rehabilitation guidelines will vary depending on the size of the tear, quality of the tissue, healing potential and surgical technique, as well as other patient factors including age, activity level and pre-and post-operative stiffness. Most often your surgeon will have clear guidelines that they like patients to follow and these are certainly respected and followed by our Penrith physiotherapists.

Post-surgical rotator cuff rehab - what does it look like?

At Sydney Muscle & Joint Physio Penrith our physiotherapists pride ourselves on a high quality, consistent approach and this is very important when you participate in a post-surgical rehab program. High quality physiotherapy at Sydney Muscle & Joint Clinic means:

  • we correspond with your surgeon to ensure we follow the protocols specific to you and the surgical technique

  • we use useful measurements to ensure consistent progress - these include range of motion, muscle strength measurements and grip strength

  • we use research supported outcome measures - SPADI, quickDASH, UEFI and PSEQ questionnaires

  • we follow specific phases of rehabilitation that are in line with phases of healing

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Phases of soft tissue healing:

  • Acute (2-4 days) – Protection Phase: a soft tissue injury is termed as acute from the initial time of injury and while the pain, bleeding and swelling is at its worst. Your body’s aim at this point is to protect your injury from further damage.

  • Sub-Acute (up to 6 weeks) – Repair Phase: a soft tissue injury is termed as sub-acute when the initial acute phase makes a transition to repairing the injured tissues. This phase commonly lasts up to six weeks post-injury when your body is bust laying down new soft tissue and reducing the need to protect your injury as the new scar tissue etc begins to mature and strengthen.

  • Late Stage (6 weeks to 3 months)– Remodelling Phase: your body does not magically just stop tissue healing at six week post-injury. Healing is a continuum. At six weeks post-soft tissue injury your healing tissue is reasonably mature but as you stretch, strength and stress your new scar tissue it often finds that it is not strong enough to cope with your increasing physical demand. When your body detects that a repaired structure is still weaker that necessary, it will automatically stimulate additional new tissue to help strengthen and support the healing tissue until it meets the demands of your normal exercise or physical function.

Phases of post-surgical rotator cuff rehab

Phase 1 (surgery to 2 weeks) - rehabilitation appointments begin 5-8 days after surgery

  • Rehabilitation goals: education on rehabilitation expectations and expected time frame for return to function, precautions; normalise scapular positioning and mobility; reduce pain and swelling in the post-surgical shoulder; maintain active range of motion (AROM) of the elbow, wrist and neck; minimise loads placed over healing repair.

  • Precautions: standard sling utilisation is 6 weeks continuously or at the surgeons request, then weane from use.; no active range of motion (AROM); no lifting or supporting body weight with hands; relative rest to reduce inflammation.

  • Progression criteria: at least 14 days post-operative; passive forward elevation 60-90°; passive external rotation to 20° at 20° of abduction.

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Phase 2 (usually 2-4 weeks post-op) - begin after meeting Phase I progression criteria

  • Rehabilitation goals: progression of elevation in scapular plane and external rotation in 20-30° of abduction; correct postural dysfunctions.

  • Precautions: sling utilisation will be determined by communication between surgeon and our physiotherapist; no active abduction range of motion for 8 weeks to protect repair and no external resistance to abduction and supraspinatus for 12 weeks.

  • Progression criteria: at least 8 weeks post-operative; passive forward elevation 90-120°; passive external rotation to 20-30° at 20° of abduction.

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Phase 3 (usually 8-12 weeks post-op) - begin after meeting Phase 2 progression criteria

  • Rehabilitation goals: passive forward elevation to 130-155°; passive external rotation at 20° of abduction to at 30-45° and passive external rotation at 90° of abduction to at 45-60° to full; controlled progression of active assistive range of motion (AAROM) and AROM; initiate light muscle performance activities; correct postural dysfunctions; active elevation 80-120° without compensation.

  • Precautions: wean out of the sling slowly starting post-op weeks 6-8 based on surgeons preference; no active abduction range of motion for 8 weeks to protect repair and no external resistance to abduction and supraspinatus for 12 weeks.

  • Progression criteria: passive forward elevation to at least 140° to full; passive external rotation at 20° of abduction to at least 30° to full and assistive external rotation at 90° of abduction to at least 75° to full; active elevation to at least 120° without compensation; appropriate static and dynamic scapular positioning.

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Phase 4 (usually 3-5 months post-op) - begin after meeting Phase 3 progression criteria

  • Rehabilitation goals: full passive and active range of motion (PROM & AROM); gradually restore shoulder strength, power, and endurance; return to ADLs, work, and recreational activities that do not require heavy lifting, powerful movements, or repetitive overhead activities; advance proprioceptive and dynamic neuromuscular control retraining.

  • Precautions: post-rehabilitation soreness should alleviate within 12 hours of the activities; no lifting of objects more than 8-12kg with short lever arm; lifting only light resistance with long lever arm; no sudden lifting, jerking, or pushing movements.

  • Progression criteria: not all patients will progress to Phase V. Individuals that are involved in sports and physical labor will be progressed, those that are not should continue with progressive, low velocity loading; full shoulder AROM in all planes and multi-plane movements; manual muscle testing (MMT) of 5/5 in neutral' pain free during strengthening exercises; negative impingement signs.

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Phase 5 (usually 18-22 weeks post-op) - begin after meeting Phase 4 progression criteria

  • Rehabilitation goals: normalise muscular strength, power and endurance; return to high demand activities; complete return to sport training; develop strength and control for movements required for sport/work; develop work capacity cardiovascular endurance for sport/work.

  • Precautions: post-rehabilitation soreness should alleviate within 12 hours of the activity; avoid activities that result in substitution patterns; avoid exercises that generate a large increase in load compared to previous exercises

  • Progression criteria: the patient may return to sport after receiving clearance from the orthopaedic surgeon and the sports rehabilitation provider.

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