Arthroscopic shoulder surgery for the treatment of rotator cuff tears: why, when and how it is done.

Edited By: Christopher J. Wahl, M.D., Suzanne L. Slaney, PA-C, ATC, MMS
Last updated Tuesday, May 16, 2006

Rehabilitation

Physical therapy

Some early motion is important after rotator cuff repair, but unrestricted motion can endanger the success of the procedure. For the first 3 or 4 weeks, the patient is scheduled to see a physical therapist once or twice per week to monitor the progress of healing and to reiterate the proper exercises.

After a few weeks, the sling is removed, and a more comprehensive rehabilitation program is started.  During this period, the therapist works closely with the patient to re-establish a normal range of motion.  The therapist and patient work together, but the patient is expected to do “homework” on a daily basis so that constant improvement is achieved.  Once a normal range of motion is re-established, shoulder strengthening is started.  It takes about 12-16 weeks before the shoulder is completely rehabilitated for the normal activities of daily living, and about 4-6 months before contact athletics, throwing, and overhead sports can be re-started.  A good therapist can work with the patient on “sports-specific” training to re-train the muscles and shoulder for golf, tennis, throwing, and swimming. 

Rehabilitation options

The results of physical therapy are optimized by a competent therapist or certified athletic trainer, familiar with the procedure and the usual expectations, and a compliant patient, who is responsible to do home exercises and is motivated to improve. Most surgeons have a standard “protocol” that they can give to a physical therapist to let them know how to rehabilitate the shoulder.  It is important for a patient to find a therapist with flexible hours and in a convenient location because the therapy will become part of a routine for 3 to 4 months.  The surgeon can recommend a therapist or therapy group with whom he or she is used to working and who is familiar with the procedure.  Therapy is generally done on an outpatient basis, with 2 or 3 visits per week so that the therapist can check the progress and review or modify the program as needed to suit the individual.

Usual response

Patients are almost always satisfied with the range of motion, comfort and function that they achieve as the rehabilitation program progresses. The sense of pain with overhead motions is usually present for several weeks following the surgery and is normal in the course of healing.  Occasionally, persons will have slight decreases in their overall overhead mobility.  These minimal decreases usually do not affect the ability to perform overhead activities or prohibit a return to athletics at the same or a higher level.

If the exercises remain or become painful, difficult, or uncomfortable, the patient should contact the therapist and surgeon promptly.

Risks

There are very few risks to appropriate postoperative therapy. If the therapist and surgeon are not in communication about what exactly what was done and what the short and long term expectations are following this procedure, the therapist can be too aggressive or alternatively too timid about the rehabilitation.  This can result in failure of the procedure (re-tear of the cuff) or excessive shoulder stiffness.  It is uncommon for these problems to occur.

Duration of rehabilitation

Every patient is slightly different. Once the range of motion is acceptable and the strength has returned, the exercise program can be cut back to a minimal level.  Patients who have special needs, such as overhead athletes, swimmers, overhead laborers, and throwers may require sports-specific training with a therapist or athletic trainer.

Returning to ordinary daily activities

In general , patients are able to perform gentle activities of daily living with the operated arm at the side starting 3 to 6 weeks after surgery. Most persons who work at a desk job can return to work during this time.  The patient is strongly encouraged to continue wearing the sling at all times for the first 3 to 4 weeks to remind themselves (and others) that the shoulder is injured and healing, and to limit overhead activities. 

Driving should wait until the patient can perform the necessary functions comfortably and confidently, and the pain in the shoulder is at a minimum and pain medications are not required.  A good question to ask a patient is “Would you want you driving if your 4-year old child was in the car or playing in the street?”   In general it may take longer for a person to drive after the right side has had the procedure because of the increased demands on the right arm for shifting gears, etc

With the consent of their surgeon, a patient may return to activities such as swimming, golf and tennis between 4 and 6 months following the procedure.  More extreme sports (wrestling, pitching, rock climbing, etc) should only be undertaken when the shoulder is extremely comfortable, and the strength is within 90% of the opposite side.

Long-term patient limitations

Patients must avoid impact activities (chopping wood, contact sports, sports with risk of falls) and heavy lifting (overhead labor, lifting heavy weights) until after the strength has returned to normal.

Costs

The surgeon and therapist should provide the information of the usual cost of the rehabilitation program. Most insurances will cover the costs of some or most of the rehabilitation, except perhaps a “copay” that the patient must pay at each visit.  Careful adherence to the home exercises between visits will usually decrease the overall number and frequency of visits required.

Surgery for Rotator cuff tears, arthroscopic, minimally-invasive and open management at the University of Washington

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