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:
- 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.
- 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.