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Rotator cuff repair

The muscles around the shoulder girdle can be broadly split into 2 groups:

The movers


These are all the big strong muscles around the shoulder that produce powerful movements such as lifting, i.e.; The Pectorals, Latisimus Dorsi, Trapezius, Deltoid, Biceps and Triceps.

The stabilisers

These are needed to control the head of the Humerus (the ball) in the Glenoid (the socket) while the arm is moving, This allows the powerful movers to work efficiently and to minimalise shoulder dysfuctions which can result in pain. The Rotator Cuff is a collective term given to the following muscles: Supraspinatus, Infraspinatus, Subscapularis and Teres Minor that form a strong cuff around the shoulder joint. A muscle becomes a tendon when it inserts into a bone, thus the term muscle and tendon are often synonymous.

The Supraspinatus muscle is the most commonly injured muscle. Its tendon runs under the bone on top of the shoulder and can get squashed between the underside of the shoulder blade and the head of the Humerus (the ball).

Commonly patients notice a loss of power in the arm, changed patterns of movement and often pain, especially at night. The aims of surgery are to try to address these problems, however a full range of movement and normal power is not always achievable. Not all tears are painful and to some extent may be a consequence of ageing; not all tears need surgery either.

The early goals of rehabilitation:

1) Prevent shoulder stiffness
2) Allow the tendon repair to heal
3) Keep pain controlled 
4) Keep expectations realistic 
5) Maintain unaffected muscle groups 

Post operative information

The aim of the repair is to reunite the torn ends of the muscle or reattach it to the bone.

Due to its anatomical position a sling will need to be worn after the operation, this helps to take the weight of the arm off the tendon whilst it is healing. The bigger the tear the longer the sling will be needed. Commonly this is usually the first 4-6 weeks following surgery. The sling must be worn all night; however it can be removed for washing and dressing. If you feel comfortable, you are able to rest out of the sling at intervals during the day, as long as the arm is supported by a cushion or pillow.

Sometimes other procedures such as decompression are done alongside a repair and may alter the levels of pain expected. The cuff repairs can be done arthroscopically which means that 4 small holes are made, however it is sometimes necessary to open the shoulder up with a larger incision. The rehab for both procedures post op are however the same.

The sling is essential to allow healing to take place, but is not without its complications. Preventing stiffness is one of the main aims of physiotherapy in the early stages. This can be achieved with your physiotherapist in outpatients but also through various home exercises.

Pain control

Pain should be controlled with prescription drugs. On leaving the ward you will have a 5 day prescription, after this time you may be able to downgrade to over the counter analgesics which can be discussed with the pharmacist or you may need to visit your GP to continue with the prescription drugs. Ice can be used at home as a useful adjunct or alternative.

A rotator cuff repair is a big undertaking with regards to the rehabilitation. The first stages of repair have been covered in this information sheet and during the first 4-6 weeks this will form the mainstay of your physiotherapy programme. You will need to see your physiotherapist once / twice or three times a week during this initial stage (depending on how well your shoulder moves) to prevent stiffness. Following this, physiotherapy becomes less frequent as you continue your exercises independently and move through the subsequent stages of rehabilitation, namely the return to functional activities and work and finally to sports and hobbies. This can often take 9 - 12 months.

Milestones

Sling 4 - 6 Weeks
Full Passive range of movement 3 - 5 Weeks
Full Active range of movement 6 - 12 Weeks
Driving short distances 7 - 9 Weeks
Typing for half an hour 8 - 12 Weeks
Return to Manual Jobs 12 Weeks or more

Total recovery period could be up to 9 months

Early Phase Rotator Cuff Exercises

These exercises are designed to complement your Rotator Cuff Repair Information Sheet.

Shoulder pendular exercises
Position: Step standing. With arm out of sling lean your body forward. Support your body weight resting the un-operated arm on a table.
Action: Gently rock your weight from your front foot to your back foot, enabling the arm to move back and forth using your body weight.
Reps:  Repeat x6-10 x 3 per day

Progress to taking the arm out of the sling, as you feel comfortable.

Fist squeeze
Position: Arm in sling.
Action: Make a fist clenching tightly to perform a static contraction of your shoulder muscles.
Reps:  Repeat x6-10 x 3 per day.

Belly Press
Position: Arm in sling.
Action: Firmly press your hand into your stomach allowing the fingers to extend. This will produce a static contraction of the unaffected shoulder muscles.
Reps:  Repeat x6-10 x3 per day.

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Assisted flexion
Position: Lying on your back.
Action: Hold your operated arm around the wrist using your unoperated arm. Raise both arms up towards your head using your unoperated arm to assist the exercise.
Reps:  Repeat x6-10 reps x3 per day.

Assisted External rotation to neutral
Position: Lying on your back, hold a stick or similar.
Action: Start with your elbows tucked in at sides of body. Use un-operated arm to help move the operated arm, by pushing the stick rotating the arm away from body. Keep elbows tucked in. Move the arm to midline as shown by your Physiotherapist, this will protect the repair (Weeks 1-4)
Reps:  Repeat x6-10 x 3 per day.

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info@shoulder-and-bone.co.uk
 

Alternatively, please call Michele Murphy:
T: 02392 352 206

 
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