Rehabilitation after Rotator Cuff Repair

Abstract

Background:Rotator cuff tears are a very common condition that is often incapacitating. Whether non-surgical or surgical, successful management of rotator cuff disease is dependent on appropriate rehabilitation. If conservative management is insufficient, surgical repair is often indicated. Postsurgical outcomes for patients having had rotator cuff repair can be quite good. A successful outcome is much dependent on surgical technique as it is on rehabilitation. Numerous rehabilitation protocols for the management of rotator cuff disease are based primarily on clinical experience and expert opinion. This article describes the different rehabilitation protocols that aim to protect the repair in the immediate postoperative period, minimize postoperative stiffness and muscle atrophy.Methods:A review of currently available literature on rehabilitation after arthroscopic rotator cuff tear repair was performed to illustrate the available evidence behind various postoperative treatment modalities.Results:There were no statistically significant differences between a conservative and an accelerated rehabilitation protocol . Early passive range of motion (ROM) following arthroscopic cuff repair is thought to decrease postoperative stiffness and improve functionality. However, early aggressive rehabilitation may compromise repair integrity.Conclusion:The currently available literature did not identify any significant differences in functional outcomes and relative risks of re-tears between delayed and early motion in patients undergoing arthroscopic rotator cuff repairs. A gentle rehabilitation protocol with limits in range of motion and exercise times after arthroscopic rotator cuff repair would be better for tendon healing without taking any substantial risks. A close communication between the surgeon, the patient and the physical therapy team is important and should continue throughout the whole recovery process.

The Effects of Exercise Rehabilitation on Shoulder Range of Motion, ASES Score and VAS After Rotator Cuff Repair

“…Raschhofer et al reported that early isometric exercise group was more effective in improving shoulder function and reducing pain after manual rotation and early isometric exercise group after rotator cuff repair [11]. Nikolaidou et al noted that early manual passive range of motion is helpful after repair, but muscle movement can damage on the surgical site [5]. Houck Da et al found that the group that allowed early movement and the group that allowed early movement to move earlier showed better range of motion and shorter time to return than those who did not [10].…”

“…Although non-surgical therapy is mainly used with shock wave therapy, medication and physical therapy. But surgical treatment is often used because it is difficult to expect a functional improvement eventually [5,6]. The main goals of rehabilitation exercise after rotator cuff repair are return to daily activities, control of pain and inflammation, healing of tendons, movement of subacromial structures and flexibility of the complex including joint ligaments [7].…”

The Effects of a Standard Postoperative Rehabilitation Protocol for Arthroscopic Rotator Cuff Repair on Pain, Function, and Health Perception

“…Postoperative rehabilitation protocols may vary in terms of timing, intensity, duration of immobilization, and time of return to working status, definitively dividing in accelerated and traditional protocols. 17…”

Cost-Effectiveness of Supervised versus Unsupervised Rehabilitation for Rotator-Cuff Repair: Systematic Review and Meta-Analysis

“…An efficient rehabilitation protocol may reduce the economic implications of the postoperative treatment of RC surgery [3,15,16]. Indeed, several studies were designed to realize a program that is as short as possible, allowing patients to return to their daily activities as soon as possible [17][18][19][20][21].…”