Question:

Im a physio treating a 66yr old lady for L rotator cuff repair done on the 31Aug 2010. She is c/o pain into upper arm on Abd>90, Flex>120.does one mobilise through pain? what exercises do you recommend to improve strength?

Answer:

From what you tell me the patient is now at about 7 weeks postop? The post op rehab should really depend on what the type of tear it was and how secure the surgeon felt the repair was. The average mobilisation universally for rotator cuff repairs are 4-6 weeks in a sling and during that  time only passive motion should be allowed, not more than about 90 degrees to avoid “squashing” the repaired tendon against the undersurface of the acromioin and damaging the repair. Once the surgeon confirms healing of the repaired tendon ( we usually do an ultrasound to confirm this between 3-4 weeks) active assisted motion can be allowed. You  do not  have to be concerned if the patient has pain when mobilising to the levels you are describing so early in the post op phase, rather go a bit slower .

Additionally many patients develop stiff shoulders after rotator cuff repairs and that is not due to poor rehab, it is inherent in the condition and its surgery. Least of all the rehab should not damage the repair. Once solid healing has taken place you have all the time in the world to gain motion and strength. A very good exercise which can be started very early is seated rowing with squeezing the shoulder blades together when the pulled back position is reached. Rowing does not harm the rotator cuff at all and can really help the scapular stabilisers to be conditioned very early in the rehab period.

In the “safe time” when the tendon has definitely healed ( after 6-8 weeks) you may start with biceps curls, triceps extensions and then  gradual rotator cuff  strengthening : abduction and bench press type of movements with light weights. Do not forget to do resisted external rotation movement which strenghten the infraspinatus and teres minor muscles.

Rotator Cuff Tears

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