Rotator Cuff Surgery: What to Expect in Physical Therapy

Rotator cuff tears are present in approximately 30% of the population over the age of 60.  Some rotator cuff tears can be treated conservatively with physical therapy.  However, many will require arthroscopic repair of the torn tendons.  Nearly 500,000 rotator cuff repair surgeries are performed each year in the United States.  Postoperative physical therapy is crucial for patients to achieve a successful long-term outcome following surgery.

Early Physical Therapy After Rotator Cuff Repair

Re-tearing of the surgically repaired rotator cuff tendon is a common complication following surgery.  Most re-tears occur within the first 3 to 6 months following surgery.  Another potential complication is postoperative stiffness or loss of motion in the shoulder.  Appropriate exercise prescribed by your physical therapist will minimize the risk of re-tearing the repair and help reduce stiffness.

Some surgeons recommend a 6-week period of strict immobilization in a sling without any physical therapy.  Other surgeons allow protected motion and passive exercise within 2 weeks following surgery.  Research suggests most patients can safely begin physical therapy early after surgery. This minimizes stiffness of the shoulder and loss of muscle size in the rotator cuff.  However, patients with larger tears may benefit from delaying physical therapy for 4 to 6 in order to protect the healing repair.

Protection and Early Motion

Most patients are instructed to immobilize the shoulder in a sling for the first 4 to 6 weeks following surgeryDuring this period, very low load exercises can be safely initiated by your physical therapist.   These exercises require low activation of the rotator cuff muscles.  This approach protects the healing repair, reduces stiffness, reduces pain, and minimizes muscle loss.  Some of the following 7 exercises may be prescribed based on the size of your tear, surgeon preference, and other individual factors.

Forward Bow

Begin standing with the hand of the involved arm resting on a table top or counter.  Relax the shoulder and neck muscles.  Slowly step backwards while keeping the hand on the table or counter.   When a mild stretch is felt, pause and hold the position for 5 to 10 seconds.  Avoid exercising through pain.

Table Slides

Stand holding a towel with the hand of the involved arm resting on a table top or counter.  Relax the shoulder and neck muscles.  Slowly lean forwards and slightly out to the side (a 45 degree angle) while sliding the hand on the table or counter.   When a mild stretch is felt, pause and hold the position for 5 to 10 seconds.  Avoid exercising through pain.

Ball-Assisted Scapular Protraction

Begin standing with the hand of the involved arm resting an exercise ball on a table top or counter.  Relax the shoulder and neck muscles.  Slowly roll the ball forward and slightly to the side (a 45 degree angle).   When a mild stretch is felt, pause and hold the position for 5 to 10 seconds.  Avoid exercising through pain.

Wall-Assisted External Rotation

Stand facing the corner of a wall.  Place a small towel roll under the arm.  Bend the elbow and rest the hand of the involved arm on the corner of the wall.  Slowly step and turn the body away from the wall.  Maintain the elbow tucked to the side and hand on the wall.  When a mild stretch is felt, pause and hold the position for 5 to 10 seconds.  Avoid exercising through pain and avoid overstretching the shoulder into external rotation.

Cane-Assisted External Rotation

Begin lying on the back with a small pillow or towel roll under the upper arm.  Hold a cane, golf club, or similar object with both hands.  Use the uninvolved arm to passively rotate the involved arm out to the side.  The elbow of the involved arm should be maintained at a 90-degree angle throughout the exercise.   When a mild stretch is felt, pause and hold the position for 5 to 10 seconds.  Avoid exercising through pain and avoid overstretching the shoulder into external rotation.

Washcloth Press-Up

Lie on your back with the knees bent.  Hold a small towel with the hands close together.  Use the uninvolved arm to assist lifting the involved arm straight up to the ceiling.  When the elbow reaches full extension, pause and hold the position for 5 to 10 seconds.  Avoid exercising through pain.   This exercise can be safely progressed by performing it in a slightly reclined position.

Supine Self-Assisted Flexion

Begin lying on the back with the hips and knees bent.  With the uninvolved hand grasp the wrist of the involved side.  Use the uninvolved arm to passively lift the involved arm overhead.  Maintain a straight elbow.  When a mild stretch is felt, pause and hold the position for 5 to 10 seconds.  As pain begins to diminish the exercise can be progressed by increasing the duration of the stretch up to 30 seconds.

Closing Thoughts

Rehabilitation following rotator cuff surgery begins with a staged introduction of protected range of motion exercises.  The exercises above are commonly utilized during this phase.  At approximately 6 weeks after surgery, the focus shifts to restoration of active range of motion without resistance or weights.  Progressive strengthening exercise usually begins at postoperative week 12.  Future articles will address these phases of rehabilitation.  If you want to learn more about rehabilitation and recovery from rotator cuff surgery, contact your physical therapist today.

References

  1. Edwards PK, Ebert JAYR, Littlewood C, Ackland TIM, Wang A. A systematic review of electromyography studies in normal shoulders to inform postoperative rehabilitation following rotator cuff repair. J Orthop Sport Phys Ther. 2017;47(12):931-945.