Arthroscopic shoulder surgery for the treatment of rotator cuff tears: why, when and how it is done.
Edited By: Suzanne L. Slaney, PA-C, ATC, MMS, Christopher J. Wahl, M.D.
Last updated Tuesday, May 16, 2006
RehabilitationWhat types of physical therapy do patients require after arthroscopic rotator cuff repair and shoulder surgery for rotator cuff tears, arthroscopic, minimally-invasive and open management? 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. What options exist for rehabilitation after arthroscopic rotator cuff repair and shoulder surgery for rotator cuff tears, arthroscopic, minimally-invasive and open management?
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.
What is the usual response to rehabilitation after arthroscopic rotator cuff repair and shoulder surgery for rotator cuff tears, arthroscopic, minimally-invasive and open management?
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.
Are there risks to rehabilitation after arthroscopic rotator cuff repair and shoulder surgery for rotator cuff tears, arthroscopic, minimally-invasive and open management?
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.
How long will rehabilitation after arthroscopic rotator cuff repair and shoulder surgery for rotator cuff tears, arthroscopic, minimally-invasive and open management need to be continued?
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.
How long after arthroscopic rotator cuff repair and shoulder surgery for rotator cuff tears, arthroscopic, minimally-invasive and open management will patients be able to return 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.
After full recovery and rehabilitation from arthroscopic rotator cuff repair and shoulder surgery for rotator cuff tears, arthroscopic, minimally-invasive and open management, what are the limitations on the patient?
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.
How can the costs of rehabilitation after arthroscopic rotator cuff repair and shoulder surgery for rotator cuff tears, arthroscopic, minimally-invasive and open management be anticipated?
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 If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-543-1552 or 425-646-7777 to make an appointment.
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