Post operative rehabilitation following a rotator cuff tear is complex and requires the input of an experienced physiotherapist. Typically for the first 6 weeks following the surgery the shoulder is immobilised in a sling. Light exercises will be undertaken under the supervision of the physiotherapist. This includes light range of motion exercises which avoid any pressure being placed on the shoulder or any strain on the rotator cuff tear repair.
After the initial period of immobilisation the sling will normally be discarded and the exercises for the shoulder will be increased. Light exercises involving active lifting of the arm will be commenced and the initial aim will be to restore the range of motion to the shoulder.
At approximately 12 weeks following the initial surgery light strengthening exercises will generally be started. The aim of the rehabilitation protocol is to have a return of normal function to the shoulder within 6 months from the time of surgery. Function will often be regained as early as 3-4 months following the surgical procedure, however it will normally be 6 months before normal work activities and recreational involvement can be restarted. Normally it will not be possible to return to sport until 6 months following the surgical procedure.
RESULTS OF SURGERY FOR A ROTATOR CUFF REPAIR
Repair of the rotator cuff will achieve a good to excellent result in 90-95% of patients. The issues that can affect the success of the surgical repair include thinning and degenerative weakening of the tendon and the size of the tear can be significant.
Larger tears mean that more strain is placed on the sutures to reattach the torn tendon to the bone. Larger tears can also be technically more difficult to repair back to the bone. With time, torn tendons tend to retract away from where they normally attach onto the humerus (upper arm bone) and can eventually become so scarred up that it’s not possible to stretch them back from where they have ruptured from.
Tendon tears that have been left for a long period of time can result in atrophy or wasting of the muscle to which they attach and this can be extensive. The final phase of atrophy involves replacement of the muscle with fatty fibrous tissue and once this occurs the muscle has a very poor chance of functioning again. Long standing tears can also result in arthritic change in the shoulder and once arthritis has set in, the rotator cuff tear repair will often not be successful in relieving the symptoms of pain and dysfunction. Significant arthritic change will often be a contra-indication to performing a repair of the rotator cuff.
Patient compliance can also be a factor. The repair is a temporary reattachment of the tendon to the bone and long term success of the repair relies of the healing process to occur between the tendon and the bone. If the repair of the tendon is subjected to too much stress then it can fail as with any mechanical structure. The repair relies on sutures to reattach the tendon to the bone, these sutures can break if they are put under too much strain or they can dislodge from the bone or tear through the tendon itself. Close observation of the recommended precautions following surgery is important to prevent failure of the surgical repair.
Normally improvement in pain and function of the shoulder is experienced by 6 months following the surgical procedure, occasionally it takes longer.