Rotator cuff rupture postop rehabilitation

Following rotator cuff repair, recovery depends on the quality of rehabilitation.

GENERAL PRINCIPLES
You must understand and manage your rehabilitation as well as your physical therapist. As I often tell my patients: YOU are in charge of your rehabilitation. Your physical therapist is your teacher and he checks that what you are doing is correct.
To understand the rehabilitation, it is necessary to understand what was done during surgery: rotator cuff tendons were reattached using anchors and sutures. This reattachment maintains the tendons in good position until they are replaced by tendon-bone healing.
Healing takes six weeks. After six weeks, progressive strengthening occurs according to the use of the tendons.

This rehabilitation is:
MANDATORY :
Begun in the early days after surgery, it should be continued until complete recovery.
One session per day is useful in the beginning. After the second month, sessions are progressively spaced out (3 times / week).

SIMPLE BUT SPECIFIC:
The goals of rehabilitation are simple, but you must take time to understand them.
Your physiotherapist and your surgeon can help you. Improper rehabilitation may compromise the outcome of the surgery.

LONG:
Complete recovery of the shoulder usually needs three to six months of rehabilitation. Some patience is necessary; premature recovery of certain movements is a temptation that must be resisted.

REHABILITATION HAS TWO GOALS:
To protect the repair:
Tendon repair must be protected during the healing process. The duration of protection depends on the quality of the tendons, the traction applied on the tendons, the quality of the repair, and the healing capacity of the patient. Smoking has a very strong negative effect on tendon healing.
To save the joint flexibility
The shoulder should not remain immobile because of the risk of stiffness. To prevent stiffness, joint mobility must be preserved immediately after surgery and continued until the end of rehabilitation. The physiotherapist will show you the movements allowed in each period.

TWO DEFINITIONS
PASSIVE MOBILITY : it is a movement where you are not the actor; the muscles are completely relaxed. Your arm is lifted by an external force (the physiotherapist).

ACTIVE MOBILITY : it is a voluntary movement you make by contraction of your shoulder muscles without any external help .

THE FIRST THREE WEEKS
Attention should focus on tendon healing. Purely passive mobilization of the shoulder must be limited[Prescribed or controlled ?] by the surgeon, based on the quality of the repair.

BETWEEN THREE AND SIX WEEKS:
Passive mobilization.
The physiotherapist will raise your arm without any help from you. You must leave your muscles totally relaxed. It takes time to recover elevation without too much pain. Complete passive arm elevation should be restored at the end of 6 weeks.
It is important to note that the arm should be raised slightly on the operated side, in the so-called “scapula plane” to facilitate muscle relaxation.
Passive motion is often easier when you are lying on your back.
Other passive exercises help to preserve the rotation of the shoulder.
When full passive elevation and a good control of muscle relaxation is obtained, your therapist will show you exercises you can do at home.

For yourself :
Pendulous mobilisation is very important .
Fig 1
In a standing position, the hand of the unaffected side must be placed on a table to protect your back while bending slightly forward. The affected arm is relaxed, hanging loosely from the shoulder and small circular and front to back movements are performed. This exercise should be done several times a day.

AFTER THE SIXTH WEEK
Active mobility
With your physiotherapist, recovery of active mobility is progressive.
The first step is to stabilise the arm vertically and then gradually bring it down. If you feel pain, do not go lower.
When the arm is horizontal the stress on the repaired tendon is maximal.
Weight lifting or active mobilisation against resistance are forbidden before the 3rd month after surgery.

Do this Yourself :
At this point you can use your unaffected arm to mobilise your operated shoulder.
Elevation
Fig 2
In a supine position:
The wrist of the operated side is grasped by the non affected hand
A – to the ceiling *
B – above the head
External rotation
In a supine position:
The operated elbow is slightly raised by a towel.
Elbows are flexed at 90 °, keeping the arms close to body.
A stick held by the healthy side is used to push the hand of the operated side outwards.
Internal rotation :
Fig 3
In a standing position:
The hand of the healthy side grasps the wrist of the operated side.
Then flex your elbows between the shoulder blades.

CONCLUSION
After surgery your shoulder rehabilitation is based on close collaboration between the surgeon, physiotherapist and yourself. It is simple but precise. Patience is essential because it needs a total of three to six months for complete recovery.