Rotator cuff repair is a moderately common orthopedic operation in older people and needs careful physiotherapy management to ensure a successful and functional outcome. The rotator cuff is a group of muscles which originate from the scapula and pass outwards towards the shoulder to insert around the head of the upper arm bone or humerus. The cuff functions to maintain the position of the very large humeral head on the rather smaller shoulder socket or glenoid. As we get older the cuff starts to suffer from degenerative changes in that small tears can develop in the tendinous parts of the cuff near the head of the humerus which can give symptoms of pain and limited movement.
Rotator cuff repairs vary in severity depending on whether the size of the tear is minor or massive and rehabilitation is carefully tailored to the level of repair the surgeon has created. Physiotherapists follow specific protocols which have been agreed with the surgeons and follow these all the way through to the end stage of rehabilitation. Once the operation has been performed the patient will be in a sling, with the type of sling varying from a standard one to an aeroplane type with a large padded piece holding the arm slightly out to the side. If the edges of the cuff needed to be pulled together to be sutured then the arm may need to be kept out to the side to some degree to reduce tension on the repair.
The day after surgery the physiotherapist will check the patient’s operation notes for instructions and then review the patient, checking the sling is correctly applied and that the muscle power and sensibility in the lower arm are normal. Shoulder movements are often restricted for a few weeks and the patient goes home doing elbow, wrist and hand movements. Once the surgeon is happy to progress the patient the physio will instruct them in pendular exercises in a bent forward position so the operated arm can hand freely downwards and move without much force. Active assisted movements, using the unaffected arm to assist, are begun once the repair is sufficiently advanced to take them.
Gradual progression from assisted to active to resisted exercises is guided by the physio to the surgeon’s protocol, with rehabilitation often continuing for some months as the progress is often slow and patients often suffer considerable pain in the earlier stages.