ROTATOR CUFF REPAIR - Galway Clinic

ROTATOR CUFF REPAIR
POST OPERATIVE PHYSIOTHERAPY PROTOCOL

Welcome to the GalWay clinic
This information booklet has been designed to provide guidelines on the physiotherapy
rehabilitation following surgical repair of the rotator cuff shoulder muscles.
You may further your reading by using the references and the links provided at the end of this
booklet and discuss any queries with your physiotherapist and/or orthopaedic surgeon.
the rotator cuff
The rotator cuff is comprised of four muscles. These individual muscles combine at the shoulder
joint to form a thick “cuff” over the joint.
The shoulder is a ball and socket joint with quite a shallow socket, unlike the hip joint which has a
deep socket. It therefore heavily depends on the rotator cuff muscle for stability as they serve to
control the position of the ball component or humeral head in the socket or cavity.
The Rotator Cuff Muscles:
1. Supraspinatous
2. Infraspinatous
3. Teres Minor
4. Subscapularis
Rotator cuff muscles of shoulder joint, from behind
2
Rotator cuff tendons, shoulder attachment

classification of rotator cuff injuries
Rotator Cuff
Tear
Rotator Cuff Injuries can be classified into two categories
1. Tears of the tendons
2. Inflammation of the structures in the joint
Supraspinatous and infraspinatous are the most commonly injured rotator cuff muscles. Sports which involve
at lot of shoulder joint rotation put these muscles under a lot of stress e.g. bowling in cricket and swimming.
An acute tear can happen following a fall onto an outstretched hand or following a powerful throw.
As a result of a severe tear, outward arm movement may not be possible.
A chronic tear usually occurs as a result of entrapment or impingement where the tendon rubs against the
overlying bone. The rotator cuff tendons are impinged as they pass through the space between the shoulder
blade, the outer collar bone joint above and the upper arm bone below.
Mechanical irritation can occur which causes swelling and damage to the tendons and inflammation of
these structures.
Depending on the degree of tear diagnosed both clinically and through appropriate scanning, repair to the
tear will be performed by your orthopaedic surgeon.
3

PhysiotheraPy Guidelines for Post surGery
rotator cuff tear rehabilitation
The following recommendations are for chartered Physiotherapists treating patients after rotator cuff tendon
repair.
The better you are informed the more likely you will recover and be able to prevent recurrence of your injury.
Part of the role of your chartered physiotherapist will be to translate the following guidelines into a
straightforward format for you to gain from.
Protocol selection will be determined not just by the size of the tear, but also the shape of the tear,
strength of repair and general tissue and joint condition.
It is important to liaise with the orthopaedic surgeon or the Galway Clinic physiotherapy team for
any specific post operative instructions.
GoAl: Gradual increase in RoM
1. Do not force or over stretch. Check for exact tendon repair site and avoid over tensioning e.g.
Supraspinatus - avoid full passive internal rotation and adduction.
Subscapularis - avoid full passive external rotation and abduction
2. No over tensioning before 6 weeks for minor tears and before 8 weeks for larger tears.
3. Minor < 1 cm tear:
May start active assisted movements at 2-4 weeks
4. Medium ~ 1-3 cm and Major >3 cm:
May start active assisted movements at 6 weeks. (Please confirm with consultant).
Shoulder immobiliser (shoulder abduction brace) may be fitted for 3-6 weeks.
Check tear size for duration of wear. To be worn day and night once fitted.
1. Minor tears may be immobilised for three weeks
2. Medium and Major tears for six weeks
4

The shoulder abduction brace should fit snuggly
1. The cushion component is placed in situ and secured with appropriate strapping.
2. The body strap secures the cushion
3. The shoulder strap secures the arm position.
4. Correct fitting is reinforced.
5. Any queries should be dealt with by your Chartered Physiotherapist.
1 - 6 Weeks
1. Minor tears immobilised x 3 weeks
2. Fit shoulder immobiliser as stipulated and remove
after the appropriate time
3. Elbow and hand exercises
4. Teach postural awareness
5. Pendulum exercises
6. Pulleys
7. Commence passive flexion, abduction and external
rotation of the shoulder as per consultant’s instructions
8. Passive flexion in supine with stick (125˚ - 145˚)
9. Passive external rotation in supine with stick
10. May increase abduction to 65˚
11. Scapular setting in sitting
5

6 - 8 Weeks
1. Medium and majors tears immobilised x 6 weeks
2. Passive flexion in standing with stick
3. Passive extension in standing with stick
4. Assisted active to active flexion in supine with elbow flexion, progress to elbow extension -
add weight as tolerated
5. Shoulder shrugs - add weight as tolerated
6. Scapular stability exercises
7. Scapula setting in prone (0° abduction)
8. Isometric internal / external rotation strengthening as comfort allows
6

8 - 10 Weeks
GoAl: Full non-painful RoM
1. Active flexion in standing - add weight as tolerated
2. Active horizontal flexion/abduction in standing - add weight as tolerated
3. Scapula retraction with shoulder extension in prone - add weight as tolerated
4. Horizontal abduction with external rotation in prone- add weight as tolerated
5. Push ups on wall
6. Light theraband (with scapular setting)
7. Weight bearing exercises (on all 4’s with scapular stability)
7

10 - 12 Weeks
GoAlS:
• Maintain full non-painful ROM
• Improve strength and
• Improve neuromuscular control
1. Posterior capsule stretches
2. Hand behind back stretches
3. Increase theraband resistance as tolerated
4. Press ups from chair if tolerated
5. Push ups from knees if tolerated
6. Proprioception exercise with Swiss ball
8

ProGressions
1. Increase Theraband resistance and angle of movement (e.g. IR/ER at 90° abduction)
2. Attention needs to be given to strengthening and setting the scapula
3. Continue strength training of Rotator cuff, include Latissimus dorsi and Biceps
brachii muscles
4. General gym strengthening (military press ups, shoulder bench press, lat pull downs,
biceps/triceps exercises)
21-26 Weeks
An isokinetic test may be performed in the Galway Clinic to help clarify the time to return to
sporting or manual activities.
Isokinetic Testing is a computerised and therefore objective measurement of muscle strength and
endurance.
It will help us assess and therefore address the presence of any potential problems associated with
muscle strength, muscle imbalance, flexibility, posture and patterns of movement that may delay
return to sporting or manual activity.
Isokinetic training is also a useful tool in end stage shoulder rehabilitation as speeds may be set
to reproduce the high speeds that are produced during most upper limb sports, e.g. tennis, golfing,
swimming etc.
9

General Guidelines
• AcTIvITIeS oF dAIly lIvInG - Do not force or stretch the repair before 8 weeks
(6 weeks for minors)
• dRIvInG - Patients are in a sling for 6 weeks (except minor tears) and should not drive for
6-8 weeks. Your consultant will advise you when you can drive.
• lIFTInG - No heavy lifting for approximately 3 months after the procedure, your
physiotherapist will advise you on the appropriate weights to lift.
• ReTuRn To woRk - Depends on your occupation. Minor tears with sedentary jobs may
return in 6 weeks. Major tears may take 12 weeks. Manual workers should be guided by their
orthopaedic consultant
• SwIMMInG - Breast stroke
Minor and Medium repairs - 6 weeks; Major repairs - 12 weeks
• GolF - 3 months
10

eferences
Compiled from data bases courtesy of
1. The Irish Society of Chartered Physiotherapists (ISCP)
2. The UK Chartered Society of Physiotherapy (CSP).
3. Brukner P, Khan K (2009), Clinical Sports Medicine, Third Revised Edition,
McGraw-Hill Sports Medicine
Other useful sites
- National Institute of Clinical Excellence (NICE)
http://www.nice.org.uk
- Best Treatments (British medical journal)
http://www.besttreatments.co.uk/btuk/home.html
Glossary
Flexion Forward movement of the joint
extension Backward movement of the joint
RoM Range Of Motion
Abduction (Abd) Sideward movement of the joint
Adduction (Add) Movement of the joint across body
Passive Complete assistance through the joint movement
Assisted Active Assistance offered through out the movement of the joint.
external Rotation (eR) Rotating the joint outwards
Internal Rotation (IR) Rotating the joint inwards
Scapular Setting Setting the shoulder blades into a centred position
Isometric Strengthening the muscle in a static manner
Prone To lie on your front
Theraband Resistance band in different colours to strengthen the joint muscles
11

The Galway Clinic
orthoPaedic & sPorts chartered PhysiotheraPy
Doughiska, Co. Galway, Ireland
Phone: + 353 (0)91 785 450/457 Fax: + 353 (0)91 785 453 E-Mail: physio@galwayclinic.com
www.galwayclinic.com