Our Summary

This research paper is trying to figure out whether starting physical movement (referred to as “active range of motion”, or ROM) soon or later after surgery to repair a torn rotator cuff (a group of muscles and tendons in the shoulder) impacts the healing process. The researchers looked at studies published between 2004 and 2014 and compared the outcomes for patients who started active ROM before 6 weeks after surgery versus those who started after 6 weeks.

The results showed that for smaller tears (up to 3 cm) and larger tears (more than 3 cm), patients who started active ROM sooner were more likely to have a structural defect in the tendon. This was especially true for patients with very large tears (more than 5 cm) who underwent a specific type of repair method (known as “suture bridge repairs”).

The researchers concluded that starting active ROM early after rotator cuff repair surgery may increase the risk of a structural defect in the tendon, so it might not be the best approach. This was especially true for patients with small and large tears.

FAQs

  1. Does starting physical movement soon after rotator cuff repair surgery impact the healing process?
  2. What impact does starting active ROM early after rotator cuff repair have on patients with smaller and larger tears?
  3. What is the risk associated with starting active ROM early after rotator cuff repair surgery?

Doctor’s Tip

A helpful tip a doctor might give to a patient about rotator cuff repair is to follow the recommended post-operative rehabilitation protocol closely. This may include avoiding certain movements or activities that could put strain on the healing tendon, as well as gradually increasing range of motion and strength exercises under the guidance of a physical therapist. It is important to allow the tendon to properly heal and strengthen to prevent re-injury or complications. Always consult with your healthcare provider for personalized advice and recommendations.

Suitable For

Typically, patients who are recommended for rotator cuff repair surgery are those who have a torn rotator cuff muscle or tendon that is causing significant pain, weakness, and limited range of motion in the shoulder. These tears can occur due to injury, overuse, or degenerative changes in the shoulder joint. Patients with rotator cuff tears may experience symptoms such as difficulty lifting the arm, pain when reaching overhead or behind the back, and weakness in the shoulder.

In general, patients who do not respond to conservative treatments such as physical therapy, anti-inflammatory medications, and corticosteroid injections may be recommended for rotator cuff repair surgery. The decision to undergo surgery is typically made based on the severity of the tear, the patient’s level of pain and functional limitations, and their overall health and activity level. Patients with larger tears, chronic tears, or tears that are causing significant functional impairment are more likely to be recommended for surgery.

It is important for patients to discuss their symptoms and treatment options with their healthcare provider to determine the best course of action for their individual situation. Rotator cuff repair surgery can help to relieve pain, improve shoulder function, and prevent further damage to the shoulder joint. However, it is also important for patients to follow their healthcare provider’s recommendations for post-operative care and rehabilitation to achieve the best possible outcomes.

Timeline

Before rotator cuff repair surgery, a patient typically experiences pain, weakness, and limited range of motion in the affected shoulder. They may have tried conservative treatments such as physical therapy, rest, and anti-inflammatory medications without success.

After rotator cuff repair surgery, the patient undergoes a period of immobilization with a sling to protect the repair. Physical therapy usually begins within a few days to weeks after surgery to regain strength and range of motion in the shoulder. The timeline for returning to full activities varies depending on the size of the tear, the type of repair, and the patient’s individual healing process.

Overall, the timeline for a patient before and after rotator cuff repair surgery involves experiencing symptoms of a torn rotator cuff, undergoing surgery to repair the tear, and then participating in a structured rehabilitation program to regain function in the shoulder.

What to Ask Your Doctor

Some questions a patient should ask their doctor about rotator cuff repair, particularly in relation to the timing of starting active range of motion after surgery, include:

  • What is the typical protocol for post-operative care and rehabilitation after rotator cuff repair surgery?
  • Are there any specific guidelines or recommendations for when to start active range of motion exercises after surgery?
  • What are the potential risks or complications associated with starting active ROM too soon after surgery?
  • How does the size of the tear in the rotator cuff impact the timing of starting active ROM?
  • Are there any alternative rehabilitation approaches that may be beneficial for promoting healing and minimizing the risk of structural defects in the tendon?
  • How will my progress be monitored and assessed during the rehabilitation process?
  • What signs or symptoms should I watch for that may indicate a problem with the healing process?
  • Are there any specific exercises or activities I should avoid in the early stages of rehabilitation to protect the healing tendon?
  • Will I need any additional imaging or follow-up appointments to assess the healing of the rotator cuff following surgery?
  • What are the long-term implications of starting active ROM early versus later in terms of the overall success and function of the repaired rotator cuff?

Reference

Authors: Kluczynski MA, Isenburg MM, Marzo JM, Bisson LJ. Journal: Am J Sports Med. 2016 Mar;44(3):785-91. doi: 10.1177/0363546515582032. Epub 2015 May 5. PMID: 25943112