Strengthening after Rotator Cuff Surgery

First of all, let’s discuss what the rotator cuff muscles are. These are a group of four muscles that originate from the shoulder blade and attach to your upper arm bone otherwise known as the humerus. Their names are Supraspinatus (helps with moving your arm away from your body), Infraspinatus/Teres Minor (helps with rotating your arm away from your body), and Subscapularis (rotating your arm towards your body).

When is surgery indicated and what types of surgeries are out there?

There are many factors to consider when thinking about undergoing rotator cuff surgery. Some of these include:

• Failure of conservative management to relieve symptoms and restore function
• Severity of rotator cuff injury
• Level of pain and functional limitations
• Overall goals and expectations of the client
• Age and health status

It’s important to note that the decision to undergo rotator cuff surgery is individualized and should be made in consultation with an orthopedic surgeon. They will evaluate all of the above factors and discuss the potential risks and benefits of surgery to determine the most appropriate course of treatment.

There are typically three types of surgeries patients undergo:

1. Open Rotator Cuff Repair
   • Open surgical incision
   • Recommended for those with large or complicated tears
   • During this procedure the surgeon may also remove bone spurs, which are signs of osteoarthritis and can sometimes contribute to shoulder pain or affect shoulder joint function
2. Arthroscopic Rotator Cuff Repair
   • Often used for patients with small to medium-sized tears
   • Most common and least invasive option
   • Involves small incisions which usually means less pain and decreased risk of complications
3. Mini-Open Rotator Cuff Repair
   • Uses both arthroscopic and open surgery techniques.
   • Arthroscopy is used to evaluate the injury, trim away bone spurs, and remove loose cartilage. Open incision is then used to allow the surgeon direct visual access to repair the tear.
   • Recommended for those who have torn more than one rotator cuff tendon

Which surgery is best?

• Many factors go into play when determining the best surgical approach such as:
  • Size of tear
  • Patient’s anatomy
  • Condition of the patient’s tendons, tissues, and bones
  • The surgeon’s experience and familiarity with treatment options

Rotator cuff repair exercises play a crucial role for post-operative shoulder rehabilitation. However, it’s important to note that the specific exercises and progression should be determined by your surgeon and physiotherapist based on the severity of your injury and your individual needs. Here are some examples of common strengthening exercises that may be included in a rotator cuff rehabilitation program.

Sample case:

A 40-year-old female presented to the clinic one week after falling down the stairs and grabbing the railing with her right arm to break the fall. She immediately felt and heard a snap in her right shoulder. She had severe pain when lifting her arm and underwent an ultrasound which confirmed a medium-sized supraspinatus tear. In consultation with an orthopaedic surgeon, she underwent an arthroscopic rotator cuff repair. Her goals are to return to gardening and recreational sports.

We are now 12 weeks post-op and are ready to begin rotator cuff strengthening exercises.

Shoulder Internal Rotation with or without a band

• This exercise is important since it helps to strengthen the subscapularis muscle which is important for gardening and sports activities.
• It can be performed isometrically against a doorframe (standing with your surgical arm perpendicular to the doorframe. Keep your elbow bent to 90 degrees and your wrist just past the doorframe. Rotate your arm towards your body by pressing into the frame and hold for 10 seconds, and then relax. Intensity should be determined by your therapist).
• It can also be performed with a resistance band (Attach a resistance band to a fixed object at waist level. Stand with your affected side facing the band and hold the other end with your elbow bent at 90 degrees. Keep your elbow against your side and slowly rotate your forearm inwards, maintaining control. Return to the starting position and repeat for the prescribed number of repetitions determined by your therapist).

Shoulder Abduction with or without a weight

• This exercise is important since it helps to strengthen the supraspinatus muscle which was initially torn and very important for gardening and sports activities.
• It can be performed isometrically against a wall (standing with your surgical arm perpendicular to the wall. Keep your elbow straight and press into the doorframe and hold for 10 seconds. Relax and repeat. Intensity should be determined by your therapist).
• It can also be performed with a light dumbbell (Hold onto a dumbbell determined by your therapist with your arm down to your side. Slowly raise your arm out to the side until it gets to shoulder height, then return it back down to your side. Ensure you do not hike your shoulder up. Repeat for the prescribed number of repetitions determined by your therapist).

Conclusion

• Several different factors determine whether rotator cuff surgery is the best option to explore. Regardless of whether surgery is indicated, it is best to be evaluated by a physiotherapist to determine your goals and limitations. From there, an individualized shoulder rehabilitation program can be designed to address your needs.
• The rotator cuff muscles are very important for shoulder rehabilitation. Even prior to surgery, it is important to keep the rotator cuff muscles as strong as you can with specific shoulder rehabilitation exercises prescribed by a physiotherapist. The research has shown that post-surgical outcomes are improved if you can maintain shoulder function and strengthen the rotator cuff muscles as best as you can, which shoulder rehabilitation aims to address.

FAQs:

1. What are the rehabilitation guidelines after rotator cuff repair?
   • Typically after rotator cuff surgery you will be immobilized in a sling for a period of 6-weeks. During those 6 weeks a physiotherapist will instruct you on range of motion exercises for your neck, elbow, hand, and wrist so that you do not lose mobility in those joints. In addition, your physiotherapist will teach you scapular mobility and passive shoulder range of motion exercises to get the ball rolling.
   • From 6-12 weeks, your physiotherapist will work of progressing your range of motion exercises from passive to active and begin isometric strengthening of your shoulder
   • From 12 weeks and onwards, your physiotherapist will continue to progress shoulder strengthening exercises and eventually functional/sport specific exercises.
2. What exercises can I do after reverse shoulder replacement?
   • Always follow the guidance of your surgeon and physiotherapist. Typically you will begin with active range of motion of your neck, elbow, wrist, and hand so that those joints do not stiffen up. For the first 6 weeks you will start with passive range of motion of the shoulder. From 6-12 weeks you will progress towards active range of motion of the shoulder and begin with isometric strengthening of the shoulder. After 12 weeks you can begin resistance strengthening and eventually towards sport/work related tasks.
3. What exercises can I do 12 weeks after rotator cuff surgery?
   • Rotator cuff repair exercises that you can be initiated at 12 weeks post-op include active range of motion and light resistance strengthening of the shoulder.
4. What exercises to avoid after rotator cuff repair?
   • Some general exercises and activities that are commonly advised to be avoided during the initial stages of recovery after rotator cuff repair include:
     • Heavy lifting
     • Overhead activities
     • Sudden or forceful movements
     • Excessive stretching
     • Unsupported use of your shoulder
5. How can I rehab my rotator cuff at home?
   • It is important to consult with a healthcare professional who will be able to design an individualized rehabilitation program for your rotator cuff injury. Based on your goals and limitations, some of the exercises may include pendulums, passive/active-assisted/active range of motion, isometric/resistance strengthening, scapular strengthening, and stretching of muscles around your shoulder.
6. What exercises can I do to heal rotator cuff?
   • There are several exercises for shoulder rotator cuff injury recovery, but it is important to consult with a healthcare professional to provide you with an individualized rehabilitation program. Based on your goals and limitations you may be instructed on range of motion, stretching, and strengthening exercises to help you recover.
7. What is the best recovery for rotator cuff injury?
   • The best recovery approach for a rotator cuff injury depends on the severity of the injury, goals and limitations, and several individual factors which should be discussed with your healthcare provider.
   • Seek a physiotherapist who will discuss your goals, explore your limitations, and create a rehabilitation program that will get you back to the activities/sports you love.
8. Should you exercise a rotator cuff injury?
   • It is usually best to book an appointment with a physiotherapist to determine the extent of your rotator cuff injury and explore your goals in order to create an individualized rehabilitation program. Once your goals and limitations have been established your physiotherapist will start you on exercises to assist your recovery.