PATIENT INFO

GENERAL INFORMATION
 
HIPS
 
KNEES
 
OSTEOARTHRITIS
 
SHOULDERS
 
ELBOW SURGERY
 
VISCOSUPPLEMENTATION

 

Rotator Cuff Repair

wHAT TO eXPECT aFTER sURGERY

Indications: For chronic shoulder impingement syndrome with tear of the rotator cuff.
Procedure: The tendon is first decompressed by an anterior acromioplasty, indicating debridement and/or excision of the bursal tissue. The tendon is then repaired usually by creating flaps and advancing the stub to a trough created in bone where it is sutured.

Post-Operative Care

Instructions to Patient:

EQUAL ICING AND REST/WORK RATIO IS IMPORTANT. PAIN SHOULD NOT OCCUR WITH ANY ACTIVITY, COME ON SOONER, DURING ACTIVITY OR REHAB, OR LAST LONGER AFTER REHAB. IF THIS OCCURS, MODIFICATION OR
RE-EVALUATION NEEDS TO BE UNDERTAKEN.

The arm rests in a sling with the elbow at the side and a strap around the trunk to prevent shoulder extension when supine. When in bed, the elbow may be supported by a small pillow.

Shower: 7-10 days post-op
Time in sling: 4-6 weeks (to come out of sling daily for pendulum exercises
Range of motion returns: 6-8 weeks
Return to full activities: 4-6 months
Initiate physiotherapy: Your surgeon will instruct you.

Motion allowed:

  1. Pendulum exercises daily.
  2. Positioning the shoulder forward to backward around the trunk for comfort.
  3. Passively raising the arm upwards to shoulder height from the sling is safe.
  4. Straightening the elbow while the sling is on, and motion of the hand and wrist is safe.
  5. The sling may be removed as long as the shoulder and arm is supported in abduction, e.g. On the edge of a table while clothes are being changed

Motion to avoid:

No abduction (bringing the arm away from your side to the level of the shoulder) for the first 4-6 weeks.

Rehabilitation Protocol

Instructions to Physiotherapist:

EQUAL ICING AND REST/WORK RATIO IS IMPORTANT. PAIN SHOULD NOT OCCUR WITH ANY ACTIVITY, COME ON SOONER, DURING ACTIVITY OR REHAB, OR LAST LONGER AFTER REHAB. IF THIS OCCURS, MODIFICATION OR
RE-EVALUATION NEEDS TO BE UNDERTAKEN.

The size any type of repair will vary the post-operative program to some extent. Very small tears with secure repairs can be started early and progress vigorously, whereas large difficult repairs may require much greater protection because the strength of repair may remain weak for 4 months or more.

Small tear: Less than 1.0 cm. Y –V plasty to a trough in bone
Moderate to large tear: 1.0 – 5.0 cm. Advance to trough in bone
Large to massive tear: Greater than 5.0 cm. Subscapularis/ infraspinatus advancement; biceps tendon repositioning

LEVEL I
(week 0–4)
Shoulder immobilizer is worn continuously, removed only for dressing, bathing, etc. The wound must be kept dry for the moment until bathing is permitted. Pendulum exercises are to be done 4 times once a day and gentle passive motion in elevation and rotation is permitted. Isometric strengthening of the wrist and hand can be gently.
LEVEL II
(week 4–8)
A program of passive and active assisted flexion and rotation is progressed. Anterior deltoid and cuff healing require further protection until 6 weeks post-surgery, although other groups can be strengthened. There is no active abduction allowed.
LEVEL III
(week 9-12)
Strengthening exercises for all groups may be progressed. During the first 4 months, vigorous strengthening exercises should be avoided since cuff repairs are often surprisingly weak. The main emphasis should usually be on active range of motion.
LEVEL IV
(week 13+)
Strengthening of all groups is permitted and stretching exercises are continued.