Shoulder Rotator Cuff Repair

what are the commonly affected populations of rotator cuff repairs?

• middle aged adults (68% of pts undergoing repair were between 50-69)

• physically active adults

• individuals doing consistent heavy labor

• previous shoulder trauma

what are the mechanisms of injury that lead to rotator cuff repairs?

• traumatic tears usually in younger and physically active individuals

• degenerative tears that are age related

what are the indications for rotator cuff repairs?

• full thickness or partial thickness tear involving greater than 50% of tendon depth

• neer stage II or III lesions that continue to be symptomatic

• traumatic tear

• pain that is persistent or weakness despite conservative treatment

• significant loss of shoulder function

what are the different surgical approaches for rotator cuff repairs?

• all-arthroscopic

• mini-open

what is an all-arthroscopic approach vs a mini-open?

minimally invasive portals, completely preserves deltoid origin to minimize tissue trauma and early post-op pain vs mini open involves arthroscopic joint inspection and decompression followed by a small splitting incision to secure the tendon

what are the contraindications to rotator cuff repairs?

• active GH joint infection, medical contraindications to anesthesia, irreversible deltoid paralysis

• massive tear with severe fatty infiltration, severe GH OA, non-compliance with immobilization

what is the general timeframe for immobilization after RTC repairs?

• small tears: sling for 1-2 weeks

• medium to large tears (1 cm to 5 cm): sling or abduction orthosis/pillow for 3-6 weeks

• massive tears (over 5 cm): sling or abduction orthosis/pillow for 4-8 weeks

can the sling be removed during the protective phase to do rehab?

yes, removal of sling day of for small tears, 1-3 days after for medium to massive tears

what are the criteria for advancement to the next phase from protective?

• incision well healed

• assisted shoulder motions produce minimal pain

• progressive ROM improvements

contraindications during the protective phase?

ER shoulder not be preformed in greater than 45 degrees of abduction, only use passive non-assisted ROM for 6-8 weeks

interventions for the protective phase?

• passive ROM of the GH joint

• active ROM of the surrounding joints

• submaximal isometrics

what is the general timeframe for the controlled motion phase?

begins around 4-6 weeks and continues for about 6 weeks

what are the contraindications during the controlled motion phase?

• did not pass requirement for completion of protective phase

• large of massive tears that require more time before entering phase

• persistent resting pain

• significant joint stiffness or pain with PROM

what is the criteria for advancement to return to function?

• full, pain free PROM

• increasing improvement of strength and endurance of shoulder musculature

  • stable GH joint

what are the goals of the controlled motion phase?

• restore full or nearly complete and pain free PROM

• increase strength and endurance of shoulder musculature

• reestablish dynamic stability

what are interventions that can be used for the controlled motion phase?

• glenohumeral AROM

• glenohumeral strengthening

• use of UE for light functional activities

what is the criteria for discharge?

• goals fully met

• functional plateau

• can fully return to work, sport, prior level of function

what is the timeframe for the return to function phase?

• phase begins no earlier than 12-16 weeks and may continue for 6+ months depending on pt activity level

• may begin at 16 weeks of later for more tenuous tears

what are the precautions for the return to function phase?

• compensatory patterns

• generally, not allowed to return to high demand activities until 6 months to 1 year post-op

• avoid high velocity, high loading movements until shoulder at least 80% symmetrical strength compared to unaffected side

• exercise should not produce sharp, radiating pain

interventions for return to function phase ?

• shoulder dynamic stability (needs 75-80% of strength before initiating)

• UE force coupling strengthening

• strengthening through ROM