Rotator Cuff Repair - Physiotherapy post-op management
Understanding the Rotator Cuff and Its Role
The rotator cuff is a group of four muscles and their associated tendons that help stabilise the shoulder joint and enable smooth movements of the arm. The main muscles involved include:
Subscapularis: Assists with internal rotation of the humerus at the shoulder joint.
Supraspinatus: Initiates abduction (lifting the arm away from the body) and performs external rotation of the humerus at the shoulder joint.
Infraspinatus: Works alongside the supraspinatus in external rotation of the humerus at the shoulder joint.
Teres Minor: Supports external rotation of the humerus at the shoulder joint.
These muscles work together to keep the shoulder stable during movements like lifting, reaching, and rotating the arm. This is crucial for everyday activities, from lifting objects to performing overhead tasks.
What Causes a Rotator Cuff Tear?
Rotator cuff injuries can occur due to both acute trauma and gradual degeneration:
Acute Tears: These are often the result of sudden injuries, such as a fall or lifting something heavy, and tend to occur more in younger patients. They can cause complete tears, leading to immediate pain and weakness.
Degenerative Tears: These develop over time due to wear and tear of the tendons, making them more common in older adults. Factors like repetitive motions, age, and reduced healing capacity contribute to these types of injuries.
The prevalence of rotator cuff tears increases with age:
Rotator cuff tears account for 30-40% of shoulder complaints.
Approximately 49% of all tears are asymptomatic, where people will experience no issues at all.
About 30% of people over 60 have a rotator cuff tear, even if it is not always symptomatic.
By 80 years old, around 62% of people may experience some degree of rotator cuff tear, whether symptoms are present or not.
Who is at Risk?
Several factors can increase the likelihood of a rotator cuff tear:
Age: The risk increases as we age, particularly after 60 years.
Trauma: Direct injuries to the shoulder, such as from a fall.
Occupational Stress: Jobs that require frequent overhead movements or heavy lifting.
Smoking: Reduces blood supply to the tendons, impairing their ability to heal.
High LDL Cholesterol: Linked to tendon degeneration.
Family History: A genetic predisposition can also play a role
When is Surgery Recommended?
Surgery is generally recommended in cases of:
Complete tears, especially in younger patients who experience a sudden, traumatic injury.
Patients who do not respond to conservative treatments (such as physio and pain management) after 6-12 weeks, particularly if daily function is affected.
For smaller degenerative tears, non-surgical management is often effective. Many patients can see improvements through physical therapy, targeted exercises, and modifying their activities. Studies indicate that 80% of patients can experience significant relief with non-surgical methods, especially when the tear is small to moderate in size.
Types of Rotator Cuff Repair
There are three primary methods for repairing a torn rotator cuff:
Arthroscopic Repair:
This is the least invasive technique, involving small incisions through which a camera and instruments are used to repair the tendon.
It offers benefits such as less pain post-surgery and a faster initial recovery period due to the smaller incisions.
Mini-Open Repair:
This combines arthroscopy to address minor damage with a small incision to repair the tendon directly.
It is less invasive than traditional open surgery while allowing the surgeon to see and repair the tear directly.
Open Repair:
The surgeon makes a larger incision over the shoulder and directly repairs the tendon.
This approach is used for larger or more complex tears.
Post-Operative Recovery: What to Expect from your physio
Recovery from rotator cuff surgery is a gradual process that involves several phases. Here’s a general overview of what you can expect:
Phase 1 (Weeks 0-4):
Focus on protecting the surgical repair and allowing early healing.
You’ll need to wear a sling to immobilize the shoulder and support the healing process.
Gentle passive range of motion (PROM) exercises, such as pendulum movements, may be introduced to prevent stiffness.
It’s essential to avoid using the arm for lifting or overhead activities during this time.
Phase 2 (Weeks 4-6):
Gradual increase in PROM exercises with the help of a physiotherapist.
Begin active-assisted movements to improve range of motion, like shoulder flexion and external rotation within safe limits.
The focus is on regaining scapular stability and controlled movements.
Phase 3 (Weeks 6-12):
Transition towards active range of motion (AROM) exercises.
Initiate light strengthening exercises that help build endurance and support shoulder muscles without overloading the repaired tendon.
Activities will be monitored to ensure that exercises remain pain-free and that you progress at a steady pace.
Phase 4 (12 weeks and beyond):
Progress to more functional exercises and strengthening with weights or resistance bands.
Focus on improving coordination, strength, and endurance of the shoulder muscles.
Depending on your progress, you may begin sport-specific rehabilitation if applicable, or activities tailored to your work or hobbies.
Return to Activities and Long-Term Care
Returning to sports or other strenuous activities should be guided by your physiotherapist or surgeon. Most patients can return to recreational activities around 6 months post-surgery, but this varies based on the extent of the tear, the type of repair, and adherence to the rehabilitation plan.
Things to Keep in Mind:
Recovery time varies: Every patient heals at a different rate, and your progress will depend on factors like the size of the tear, your age, and how well you follow the rehabilitation program.
Patience is key: While you may feel stronger, remember that tissue healing takes time. It’s essential not to rush back into strenuous activities too soon.
Communication is important: Always communicate with your physiotherapist or surgeon about any pain, discomfort, or concerns you may have during your recovery.
Key Factors for a Successful Recovery:
Consistency with exercises as recommended by your physiotherapist.
Avoiding movements that strain the shoulder during the early healing phase.
Patience and gradual progression to more demanding activities
If you have any questions about your surgery or rehabilitation, please don’t hesitate to contact us on info@benjiphysio.co.uk
We're committed to working with you every step of the way to ensure a successful recovery and a return to the activities you love.