The rehabilitation plan is based on the arthroscopic procedure, the type, size and degree of medial retraction of the tear, the firmness of the repair, and the “safe” range of motion. The rehabilitation program consists of the following 3 stages.
I. Phase 1 (0-6 weeks)
Limitations:
1. No active mobility exercises. The size of the rotator cuff tear should determine when to start active mobility exercises for the shoulder joint. Tearers with medial retraction should avoid similar large and wide tearing movements.
2. The time limit for assisted activity is consistent with active activity.
3.Passive exercises can be done within the safe range of mobility, i.e. 140° of forward flexion, 40° of external rotation with the arm on the side of the body, and 60° of abduction without rotation.
4. No strength and resistance exercises until 12 weeks postoperatively. For individuals who heal more easily (small tears, acute, age less than 50 years, non-smokers), isometric strength exercises can be started at 8 weeks and gradually progress to therapeutic band exercises.
Fixation: The fixation depends on the angle of abduction to ensure that there is little or no tension in the rotator cuff repair.
1.Sling: to ensure minimal or no tension at the repair when the arm is on the side of the body.
2. Abduction correction: Minimal or no tension at the repair with the arm in 20° to 40° of abduction.
Pain control: Reduction of pain and discomfort is essential for rehabilitation.
1.Medication:Narcotics (1-3 days after surgery),.
2.Physical therapy: ice, electrical stimulation; hot packs before activity, ice packs after activity.
Shoulder joint activities:
1.Passive activities only, can move to 140° of forward flexion, 40° of external rotation, 60° of abduction (patients who have fixed the abduction booth do not need to do abduction exercises; start exercises above the level of abduction).
2. Exercises: Start early activities from pendulum exercises.
Elbow movement: gradually transition from passive to active movement, ranging from 0° to 130° of flexion and extension, anterior rotation and posterior rotation under pain tolerance.
Muscle strength exercises:
1.Only grip strength exercises.
2.If it is a partial or small tear of the supraspinatus tendon, you can do internal and external rotation exercises of the arm on the side of the body and internal and external rotation isometric strength exercises.
Phase 2 (6-12 weeks)
The criteria for progressing to stage 2:
1. At least 6 weeks of rehabilitation exercises.
2. Pain-free passive mobility up to 140° of forward flexion, 40° of external rotation and 60° of abduction is possible.
Restrictions.
1, no active and resistance strength exercises of the shoulder joint until 12 weeks postoperatively.
2. No active mobility exercises for those with 125px tears.
Immobilization:Continue immobilization with a sling or abduction brace.
Pain control:
1. non-steroidal anti-inflammatory drugs for patients with persistent postoperative discomfort.
2.Physical therapy (ice packs, electrical stimulation).
3.Heat packs before activity and ice packs after activity.
Shoulder joint activities:
1.Objective: Progression of anterior flexion from 140° to 160°; progression of external rotation from 40° to 60°; progression of abduction from 60° to 90°.
2. Exercises: continue passive exercises to achieve the above goals; start assisted exercises to achieve the above goals; active mobility exercises after full range of assisted mobility is achieved; light passive stretching to the end of the mobility.
Muscle strength exercises: for small non-displaced tears, perform internal and external rotation muscle strength exercises with therapeutic bands; begin strength exercises for the scapular stabilizer muscles with the arm on the side of the body.