As I sat in the waiting room with a family member about to have Shoulder surgery, I decided it would be a good time to write a post on rotator cuff surgery.  Rotator cuff surgery is a common surgery with approximately 250,000 performed per year in the US.1, 2

The Injury

The rotator cuff is actually made up of four muscles that stabilize the ball in the socket (glenohumeral joint) with the most commonly torn muscle being the supraspinatus muscle.  When this muscle is fully torn, patients are unable to raise the arm overhead, will often need to shrug the shoulder to raise the arm up, and/or will be unable to hold the arm in the air when a physician raises it (a.k.a the Drop Test).

Treatment

If your physician detects a rotator cuff tear, he/she will likely order an MRI for confirmation and to detect if any other damage has occurred.  For a full rotator cuff tear, surgery is likely the only option to return your shoulder to normal function.  An orthopedic surgeon will essentially re-attach your rotator cuff to the bone (humeral head) using an arthroscopic procedure that places three small holes in your arm.  Following surgery, you will be placed in a sling and return home the same day. If you have a nerve block with surgery, initially you should not have pain; but about eight to 12 hours following surgery, the nerve block will wear off and the pain will greatly increase.  It is essential to take pain medication as recommended by your physician.

Rehabilitation

Some physicians may send you to a physical therapist (PT) within the first few days to begin gentle passive range of motion (ROM) performed by the PT.  When I see my patients in physical therapy, I make it a point to ensure that they understand the meaning of PASSIVE ROM — i.e. when the shoulder moves it is NOT being moved by their shoulder muscles.  It is NOT safe for the patient to attempt to raise or move their arm on their own with their surgically repaired rotator cuff.  As the rotator cuff has just been re-attached, it is not strong enough to handle force that is generated by the individual.  It is generally safe for a physical therapist to move the arm to begin regaining motion very early in the rehabilitation process, but each physician has different protocols so please listen to your PT.  Within the first week or two, you will generally begin very gentle passive exercises at home. These exercises often include pendulum exercises, shoulder blades squeezes, as well as elbow and wrist motion exercises.

Here's one example:

Pendulum Exercise: The patient bends over allowing their injured arm to relax and hang down.  Moving their hips, they allow the hip movement to gently swing their shoulder up and back, then side to side, then circles in both directions.  Do NOT use your arm muscles; allow the pull of gravity and movement of hips to gently move your shoulder.

You will remain in a sling for approximately four to six weeks depending on your procedure and your surgeon's protocols/recommendations.  Around this period of time, there will be a greater emphasis placed on regaining shoulder motion.  This is when you will begin advancing your shoulder motion on your own with various exercises and gentle stretches.  At this time, shoulder blade (scapula) exercises become extremely important.  This exercise requires the patient to squeeze the shoulder blades together.  The patient should feel the muscles at the bottom of their shoulder blade as if they are squeezing a grape.

Many of our patients with shoulder pain have poor posture and tend to shrug their shoulders with most movements; your PT will correct this.  Keep your shoulders down and squeeze back with nearly every exercise and activity you perform.  Shoulder blade weakness is usually the biggest contributor to individuals that injure their shoulder and rotator cuff.  Thus it is essential to increase strength in those muscles following rotator cuff repair.  Exercises vary from among PTs, but often include rowing-type exercises and others that teach control and strength of your shoulder blades.

Physical Therapy will continue until about three to four months after surgery, progressing ROM until you can actively reach your arm overhead again without pain.  You will also progress functional strength so that you can lift objects, reach into cabinets, etc.  The goal is for you to resume normal activities (ADLs) roughly four months after surgery.  You will continue to progress your activity and can generally begin sports, manual labor, and functional activities between six to nine months.  Don't get discouraged if you have minor setbacks or soreness as you progress your activity, it may take about one year until you feel normal again.   Good luck, remember your posture, and squeeze those shoulder blades together!

Reference

1) Mather III, R. C., Koenig, L., Acevedo, D., et al. (2013). The Societal and Economical Effects of Rotator Cuf Surgery. Journal of Bone and Joint Surgery, 1993-2000.

2) Rotator Cuff Injury. (accessed on January 3, 2016). Retrieved from A Nation in Motion from American Academy of Orthopaedic Surgery

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