There continues to be great debate over the most appropriate rehabilitation progression following rotator cuff repair. Although our surgical techniques have gradually progressed from full open repairs, to smaller mini-open repairs, to the current standard all-arthroscopic repairs, many clinicians continue to utilize the same rehabilitation guidelines from past invasive procedures.

Protocols can vary as drastically as beginning gentle passive range of motion and isometric exercises post-operative week 1 to delaying 12 weeks for the initiation of similar exercises. I posted about this briefly while reviewing a research report on stiffness following rotator cuff repair. Unfortunately, part of the problem is the lack of randomized control trials documenting the safety and efficacy of rotator cuff repair rehabilitation guidelines.

I want to share the postoperative protocol that I have developed with Kevin Wilk and James Andrews

It details the postoperative guidelines that we have used since the shift to arthroscopic rotator cuff repairs almost 10 years ago. While there is still a lack of efficacy studies, these guidelines have proven to us to be both safe and effective in the rehab of 1000's of patients at our centers.

I also am currently involved in the very early phase of the development of a consensus statement on the preferred postoperative guidelines following rotator cuff repair. This groups consists of many of the leaders of physical therapy, such as Kevin Wilk, George Davies, Todd Ellenbecker, Bob Mangine, Tim Tyler, and many, many more. Our goal is to develop and educate others, uncluding physical therapists and orthopedic surgeons, on what we have been doing for years as part of our rehabilitation programs.
 

Before downloading the protocol, I want to explain the goals of rehabilitation and what I believe are the 3 keys to rehabilitation. These principles are the cornerstone behind the protocol you are about to download.

Goals of Rehabilitation Following Rotator Cuff Repair

• Protect the integrity of the rotator cuff repair
• Minimize postoperative pain and inflammattion
• Restore passive range of motion
• Restore strength and dynamic stability of the shoulder
• Restore active range of motion
• Return to functional activities

The 3 Most Important Keys to Rotator Cuff Repair Rehabilitation

1. Restore full passive ROM quickly. It is extremely easy to lose motion following surgery. In my opinion this is caused by scarring in the subacromial space as well as loss of the reduncy of the inferior capsule with immobilization. This is one of the common "rookie mistakes" I see with students and new graduates. Passive range of motion should be initiated immediately following surgery in a gradual and cautious fashion. Studies have shown that passive range of motion into flexion and external rotation actually decreases strain in the rotator cuff repair (still need to be cautious with adduction, extension, and internal rotation).
2. Restore dynamic humeral head control. This is likely the most important goal of postoperative rehabilitation, other than maintaining the integrity of the repair. What this means is to restore the rotator cuff's ability to center the humeral head within the glenoid fossa. Have you ever seen a patient following repair that had a shoulder "shrug" sign? That is caused by the inability of the cuff to compress the humeral head and the resultant superior humeral head migration. This is why it is imperative to begin gentle isometrics, rhythmic stabilization drills, and other drills to re-educate the rotator cuff.
3. Maximize external rotation strength. I often refer to external rotation as the key to the shoulder. Weakness of ER is common in almost every pathology and strengthening of the area is extremely important to balance the anterior and posterior balance of cuff. Several studies have shown that ER strength takes the longest amount of time to restore after rotator cuff repair. The longer this area is weak, the more difficult it will be to stabilize the joint.

Below is a video demonstration of some of the manual rhythmic stabilization techniques you can perform to enhance dynamic humeral head control.

This protocol is a part of a series of protocols that I have developed with Kevin Wilk and Jim Andrews with the Advanced Continuing Education Institute. If you like this protocol, there are over 30 more just like this on the Shoulder Rehabilitation Protocol CD and also video demonstrations of the surgical and rehabilitation techniques like the one above on the Interactive Protocol: Rotator Cuff Repair CD. Remember to use coupon code "Reinold" to save $10 for being a reader of my blog. In exchange, all I ask is that you subscribe to my blog, you'll get my latest posts delivered to your email of RSS reader.



I would love to hear your thoughts and experiences on postoperative rotator cuff repair rehabilitation. Click the comment link above. What guidelines do you follow? What week following surgery do you see your RTC repair patients? When can you begin passive ROM? When can you begin strengthening exercises?

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