Physical Therapy

After Rotator Cuff

Repair
By : Simson Sinuhaji, M.Fis
2022
Terminology :
• Partial Rotator Cuff Tears
• Full Rotator Cuff Tears
• Small (lt 2 cm)
• Medium (2-5 cm)
• Large (gt 5 cm)
• Massive (involves 2 or more tendons)
Open Repairs vs. Arthroscopic Larger
incision
• Deltoid detachment
• More post-op pain
• Inpatient stay for pain control
• Smaller incision
• Less post-op pain
• Outpatient procedure
• Pain is not a good guide for rehab
Information essential in designing a
rehabilitation program :
• Nature of injury (type of tear)
• Extent of surgical repair
• Restrictions set by physician
• Restrictions as understood by client
• Concurrent medical conditions
• Pre-op level of function and mobility
Immediate post-operative goals (0-2
weeks):
• Control pain/swelling
• Cryotherapy
• Medications as prescribed
• Use of sling to limit shoulder movement
• Sleep position
Immediate post-operative goals (0-2 weeks) :
• Early protective passive motion
• Pendulums
• Passive elevation (90-120 degrees)
• Table slides
• Pulleys
• Passive external rotation (0-20 degrees)
• Elbow, wrist, hand active motion
• Isometric grip strengthening
• Periscapular isometrics
Immediate post-operative precautions :
• Avoid extension movements beyond
plane of body (4
weeks)
• Avoid any active lifting of the arm
(elevation/abduction 6 weeks)
• Avoid active external rotation (4-6
weeks)
Posture :
• Coracoacromial ligament and attachment to
acromion form a roof under which the
supraspinatus tendon, the biceps tendon and
subacromial bursa must pass during elevation or
abduction of the arm.
• At approx. 70-120 deg of active glenohumeral
elevation, the greater tuberosity approaches the
roof
• Rounded shoulder posture narrows potential space
of the roof, thus making it more likely that
impingement may occur with elevation of the arm
Progressive Rehabilitation (2-4 weeks) :
• Continue pendulums and table slides
• Passive elevation (120-135 deg)
• Passive external rotation (20-35 deg)
• Initiate pulleys
• Tendon tissue healing requires the load
across
the tendon to be minimal for the first 4
weeks
Progressive Rehabilitation (4-6 weeks) :
• Continue passive motion exercises
(elevation135-150 deg, external
rotation30-45
deg)
• Add bilateral extension motion with cane
• Add internal rotation for posterior
capsule
stretch
Progressive Rehabilitation (6-8 weeks)
A.A.R.O.M :
• Gradually introduce controlled stretches
across
the healing tendon during the maturation
process.
Tissues need to see progressively increasing
loads.
• A.A.R.O.M for elevation progression of wall
walking, assisted supine cane exercises, supine

bilateral arm raise

Progressive Rehabilitation (6-8
weeks) :A.A.R.O.M
• A.A.R.O.M for internal rotation cane behind
back, towel stretch, clasp hands behind back
• A.A.R.O.M diagonal supine with cane
• A.A.R.O.M extension standing
• A.A.R.O.M for external rotation (35-55 deg)
• Continued wall walking
• Low level isometrics
Progressive Rehabilitation (8-12 weeks) :
• Continue with range of motion exercises working
towards full functional mobility (mobilization?)
• Should be able to raise arm above head
• Add light resistance (cream/yellow) therabands
• Bilateral extension
• Bilateral forward flexion (30 deg)
• Bilateral external rotation
• Triceps
• Scapular retraction
• Unilateral internal rotation
• Abduction/Adduction
Progressive Rehabilitation (8-12 weeks) :
• Side lying external rotation (light
weights) progressing from arm at side to
arm away from side
• Periscapular prone strengthening with
weights
• Tricep strengthening
• Bicep curls
Advanced Strengthening (12 weeks-6
months) :
• Progression of theraband exercises
• Add closed chain exercises
• PREs for external rotation, elevation,
abduction
Highest Level Strengthening May
Include :
• Full range strengthening activities
• Body blade
• Therapeutic ball activities
• Plyometric activities
• Return to sport drills
Initial Goals
• Control pain (cryotheraphy, medication,
sling)
• Begin gentle, passive/active assistive
range of
motion exercises
• Sleep position
• Rest arm
Goals of Therapeutic Exercise :
• Improve strength of surrounding
musculature in
order to regain functional use of the arm
• Proceed slowly and use pain as a guide.
• Partial RCT can progress to full thickness
tears.
TERIMA KASIH