Preventing Shoulder Stiffness After Rotator Cuff Repair Surgery

I think that stiffness following any surgery, especially rotator cuff repair, is a common problem that we face in physical therapy. I found a great blog today by another physical therapist, Rod Henderson. As I was reading I noticed that we shared some similar interests and taste for good research! He did an excellent job reviewing a research article on postoperative stiffness following rotator cuff repair. The article was published in 2005 in CORR – Clinical Orthopedics and Related Research.

To summarize, it appears that if you are tight going into surgery, you are going to be tight coming out of surgery. Makes sense. Also, patients that are stiff during the first 4-6 weeks postop will eventually catch up. But I have to think that they are much less satisfied during the first 3 months after surgery than the patients that did not develop stiffness. And isn’t satisfaction really what we are trying to achieve?

This is an important topic as I hear questions about this frequently at meetings and seminars. I also feel that stiffness can be prevented by one of two ways:

  1. Get the patients into rehabilitation quickly after surgery. Unfortunately delaying the start of PT is a trend that I don’t like from orthopedic surgeons. There is still a lot of debate over the safety and efficacy of postoperative rehabilitation programs following cuff repair. With full open repairs (and detachment of deltoid tissue) there was a need for delayed rehab, but as we transition from open to mini-open to full arthroscopic repairs, our rehabilitation should progress in parallel. Fixation strength of arthroscopic repairs have been shown to be as strong as mini-open repairs so I am not sure why the delay. I don’t think all surgeons share our thought that that gentle, controlled therapy can be safe and enhance patient satisfaction. This is a hot topic now at all the national meetings and I am involved in a group of all the top PTs in the USA in drafting a consensus statement on postop cuff rehab. Hopefully we will start to make an impact over time.
  2. Begin early passive range of motion. While internal rotation, adduction, and extension are all potentially harmful for a rotator cuff repair, passive flexion and external rotation have actually been shown to reduce tension on a rotator cuff repair. You want to get your cuff patients moving quickly in these directions because there is often scarring in the subacromial space (especially with a concomitant subacromial decompression) and a chance to develop inferior capsular restrictions.

Rather than rehash the entire information, click here to read the full review on Rod’s blog or click here to view the abstract from CORR.

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4 Responses to “Preventing Shoulder Stiffness After Rotator Cuff Repair Surgery”

  1. Trevor Winnegge PT,DPT,MS,OCS,CSCS Reply September 24, 2008 at 5:56 pm

    anyone have any thoughts on the use of dynasplints for the post op shoulder with stiffness? Had the rep come in for a luncheon to my clinic last week (mostly for the free lunch!!!). She demonstrated the use of dynasplint to increase IR. Unfortunately the humeral head was elevated, the scap protracted. Did not look comfortable for my co-worker who does not have pain, so i can only imagine how it feels in a post op stiff shoulder! any thoughts????

  2. Trevor, agree, I must say I am not a fan, sounds like for the same reason you are stating. People just are not comfortable in a dynamic splint. I prefer a static progressive splint, like a JAS (Joint Active System) brace. The patient can gradually dial in their ROM as they relax and get comfortable with stretch. Not as much guarding with the passive mobility.

  3. Patrick Willson PT, COMT, CSCS Reply September 26, 2008 at 6:21 pm

    The dynasplint product i agree with you both is horrible. The JAS brace is much better and the patient is also in a sitting position so the ease of use for them is greater. Trevor I think if you spent more time utilizing joint mobilization and ROM vs ultrasound and kinesiotaping you would find greater success.

  4. @ Patrick – good point regarding the sitting position. That is very true. I must admit I haven’t used a lot of kinesiotape. What is your experience? What are your goals and what do you think it is accomplishing for a stiff shoulder? I am interested. Thanks for commenting.

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