Rotator Cuff Repair and Subacromial Decompression

What is rotator cuff repair surgery?

Rotator cuff repair surgery is indicated for painful symptomatic rotator cuff tear. The surgery may be done arthroscopically or as an open procedure.

What is involved and what to expect with rotator cuff repair surgery?

Before surgery

As part of a ‘pre-habilitation’ program to prepare you for surgery, your therapist will teach you some range-of-motion exercises. The aim of these is to maximise the strength of the deltoid muscles, intact cuff muscles and the scapula stabilisers.

Day 1 to 3 weeks after surgery

Wearing a polysling with a body belt (fitted straight after surgery), you will begin your rehabilitation program. This will consist of:

  • wrist, hand and finger exercise
  • elbow flexion and extension, and rotation
  • scapula setting exercises
  • pendular exercises
  • passive range of motion in all directions, as tolerated

After 3 weeks, you may be able to return to work, if you have an office-style job.

3–6 weeks

At this stage you will start to wean off wearing the sling and your therapy will involve:

  • gentle isometric exercises in neutral as pain allows
  • active assisted exercises ensuring glenohumeral movement, not scapulothoracic

It’s important not to force movement or stretch your shoulder.

By 4 weeks, you will be aiming to have regained at least 50% of the passive range of motion you had before surgery. By 6 weeks, your active assisted range of motion should be equal to level you had before surgery and should will probably be able to start driving again. You may also be able to start swimming breaststroke.

6–12 weeks

Your therapy will now progress to:

  • full active exercises in all ranges
  • rotator cuff strengthening
  • closed chain exercise
  • starting to stretch the capsule
  • proprioception exercises.

By 12 weeks you can start swimming freestyle, playing golf and lifting objects. You may also be able to return to manual-type work, but your surgeon will advise you about this at the time.

Anterior deltoid exercises for massive rotator cuff tears

As a result of prolonged overuse and wear and tear, the muscles arising from the shoulder blade and attaching to the top of your humerus (arm bone) the rotator cuff muscles have become completely torn (massive rotator cuff tear). This means you are no longer able to easily lift your arm.

However, there is another powerful muscle on the outside of your arm the deltoid muscle that may be re-educated to compensate for the torn rotator cuff.

The following exercises should be done three to five times a day to strengthen your deltoid muscle. By doing them, you can reduce your pain and improve the range of movement and functionof your arm. These exercises must be done for at least 12 weeks. At least initially, they must be doneunder the supervision of a qualified physiotherapist and while lying down.

Exercise 1: Supine active assisted

Lie down flat on your back, with a pillow supporting your head.

Bend your elbow as far as possible. Then raise your arm to 90 degrees vertical, using the stronger arm to assist if necessary. Once you have got to 90 degrees, you can straighten your elbow.

Hold your arm in this upright position with its own strength.

Add-ons:

  • circles – with your fingers, wrist and elbow straight,slowly move the arm in small circular movements clockwise and counterclockwise. Gradually increase the circle as comfortable (this may take a few weeks to increase to bigger and bigger circles)
  • move the arm forwards and backwards in line with the outside leg (gentle movement from both sides of the arm upright position)

Keep the movements smooth and continuous for 5 minutes or until fatigue.

As you get more confidence in controlling your shoulder movement, gradually increase the range of movement until your arm will move from the side of your thigh to above your head, touching the bed, and return.

Exercise 2: Progress to light weight

As you get more confidence in controlling your shoulder movement, a lightweight (eg a tin of beans or small paperweight), should be held in the affected hand.

Repeat as exercise 1.

Exercise 3: Progress to sitting and standing

Having more confidence in controlling your shoulder movement, gradually go from lying down to sitting and eventually standing.

At this stage you may recline the head of your bed or put some pillows underneath your back to recline your position.

Repeat the same exercise again, this time against some gravity.

Start again from holding your arm in the upright position with its own strength

Repeat as above.

Start first without any weights and progress to use the same lightweight you used before in the lying down position.

Exercise 4: Resisted exercise

For re-education of concentric contracture of the deltoid muscle.

Make a fist with the hand of the affected side. The flat hand of the opposite side is providing resistance. Push your affected side hand against resistance from the other hand. Whilst doing this, you will notice that you can fully elevate your arm (above your head).

Repeat these exercises in order to ‘learn’ and re-educate your deltoid muscle to perform this ‘concentric contracture’ even without pushing against your other arm.

Notes:

You should repeat each exercises 10 times in a session, with 3 to 5 sessions per day.

Stop exercising if your pain increases or you feel unwell.

You should expect to see some improvement by 6 and 12 weeks.

What is subacrominal decompression?

Subacromial decompression is the removal of bone from the acromion and partial resection of the coracoacromial ligament. It is a treatment for shoulder impingement.

The acromioclavicular (AC) joint is usually left intact unless excision is required due to pain, in which case, the distal clavicle and part of the acromion is removed. The superior AC ligament remains intact so that the joint remains stable.

What is involved and what to expect with subacromial decompression?

In hospital

Before you go home after having your surgery, your therapist will start you on your rehabilitation program. This will involve:

  • some exercises, including active (assisted) glenohumeral movement in all planes
  • teaching you postural awareness and scapular setting

When you go home from the hospital, you will be wearing a sling to immobilise your shoulder. After 2–3 days, this will be removed.

At home

You will need to continue physiotherapy as an outpatient. Your program will include:

  • isometric strengthening (progress using pain and range of motion as the limiting factor)
  • rotator cuff strengthening
  • exercises for posterior capsular tightness (sleeper stretch and cross-chest adduction)

It’s important to be guided by your physiotherapist as over-zealous activity or repetitive sustained overhead movements could lead to delayed healing and pain.

4 weeks

By 4 weeks after surgery you should be able to resume driving and start swimming breaststroke for exercise.

6 weeks

After 6 weeks most people have an active range of motion equal to the level they had before surgery. At this stage you may also be able to return to work (if you have an office-style job) and resume functional activities. If you experience any significant increase in pain or decrease in range of motion, arrange a visit with your surgeon.

12 weeks

You can expect 80% improvement by 3 months. By this time, you may be able to resume some manual work, swim freestyle and play golf. Your surgeon will advise you on this based on your recovery.

You may also be able to start playing sports that involve repetitive overhead movements or contact sports. Again, your surgeon will guide you.

Full recovery can take 6–9 months.