Rotator cuff injury repair has evolved from open surgery, microincision surgery, arthroscopically assisted microincision surgery and arthroscopic suturing in the past. Many scholars began to apply arthroscopic rotator cuff suturing to treat rotator cuff injuries with satisfactory results. However, regardless of the surgical method, there is a risk of shoulder stiffness or even secondary surgery if postoperative rehabilitation exercises are not paid attention to. Factors that affect the progress of rehabilitation after rotator cuff repair include the surgical technique, the condition of the repaired tissue, and the size and location of the tear site. Physical conditions (rheumatoid arthritis, diabetes), old tears, a history of previous surgery or repeated local injections, or a history of long-term hormone use can increase the risk of tearing of the suture. Likewise, the extent (e.g., partial or complete tear) and location of the tear have important implications for the recovery of shoulder function, and these factors must be fully considered during the rehabilitation process. Patients should therefore adjust their rehabilitation program at any time after surgery under the guidance of their clinician and according to their own condition.
Rehabilitation training procedures.
Phase training I (0-6 weeks after surgery, maximum protection period)
During this phase, an external fixation brace is given to immobilize the shoulder joint. This is because tendon I bone healing generally takes 6-8 weeks and the shoulder joint is generally placed in an abduction rest position, usually 3O°-45° of abduction, for at least 4 weeks and preferably 6 weeks after surgery. The abduction position reduces the tension on the suture site, allowing for better healing. However, joint adhesions may occur if joint mobility exercises are not performed until 2 weeks postoperatively. Therefore, the main objective of this phase of rehabilitation is to protect the surgical repair site, reduce pain and inflammatory response, and gradually increase shoulder mobility. The content mainly includes active movement of the elbow and wrist joint, passive movement of the shoulder joint and scapular stability exercises.
1. Postoperatively, the affected shoulder should be braked and cold compresses should be applied 6-8 times a day for 20 minutes each time. At night, a pillow can be placed behind the upper arm to support the shoulder in the most comfortable position when sleeping. Active movement of the wrist and elbow joint on the 1st postoperative day.
(1) Palm flexion and dorsal extension: Slowly extend the wrist joint of the affected limb dorsally to the limit, and then slowly flex it to the limit, one extension and one flexion is one movement, 12-36 movements each time, 2-3 times a day.
(2) Left and right palm swinging: Straighten the five fingers of the affected limb and swing the palm back and forth to the ulnar and radial sides. One back and forth is 1 stroke, 12-36 strokes each time, 2-3 times a day.
(3) Elbow flexion and extension: support the upper arm of the affected limb with the healthy hand to brake the affected shoulder, and gradually extend and flex the elbow, one extension and one flexion is 1 stroke, 12-36 strokes each time, 3-5 times a day.
2.According to individual condition, in the 3rd week after surgery, remove the brace during training and practice passive shoulder joint and scapular stability exercises.
(1) Pendulum exercise: the patient’s body is bent forward (stooped), hands are down (or healthy hands are holding the table), do backward and forward swing and clockwise and counterclockwise circles, 5-10 times/day. Make sure the exercise is passive, initiated by the trunk and drive the shoulder joint in different planes to do small arc movements.
(2) Passive forward flexion exercise: supine position, with the affected upper limb in 30°-45° of abduction, the healthy hand grasps the affected forearm and passively elevates the affected limb with the assistance of the healthy upper limb, 3-5 times a day for mobility exercises, avoid pain during training.
(3) Passive external rotation exercises: lie on your back with the affected upper limb in 30°-45° of abduction, place a towel roll under the upper arm to keep the humeral head in the scapular plane, and hold the treatment stick across the healthy upper limb to assist the affected shoulder in external rotation activities, this exercise must be performed within a pain-free and restricted mobility.
Phase 2 (6-8 weeks postoperative, moderate protection period)
The main objective of this phase is to continue the exercises of the first stage, improve joint mobility, reduce postoperative pain and start gentle active activities of the rotator cuff muscles and deltoid. The activities are mainly anterior flexion and external rotation, avoiding active arm elevation.
1.Active forward flexion exercises: supine position, the affected upper limb is in abduction 30°-45°, active lifting of the affected limb, if the effort can be placed above a pulley, lifting the affected limb with the help of the pulley or the healthy limb, 3-5 times a day, gradually increase the exercise activity, avoid pain during training
2, wall climbing exercises: stand facing the wall, the affected side of the hand holding the wall, fingers upward climbing, step by step. Each time 10-20 round trips, 3-5 times a day.
3.Isometric contraction of the rotator cuff muscle group: The patient is supine, the shoulder joint is abducted 30°-45°, a pillow or a folded towel is placed under the distal end of the upper arm, a gentle resistance is applied to the forearm in all directions, so that the patient can perform rhythmic stability exercises against unarmed resistance, triggering a mild isometric contraction of the rotator cuff muscle group.
4. Deltoid isometric contraction exercises: standing position, a towel roll under the inner axillary elbow, so that the arm has a gentle abduction (modified neutral position), bending the elbow 90° side shoulder against the wall, resistance wall resistance abduction, resistance isometric contraction of deltoid and rotator cuff muscle groups.
Phase 3 of training (8-12 weeks postoperatively, early functional exercise and muscle strength building period)
At this stage, the abduction brace of the affected limb has been removed and the full range of shoulder mobility is restored, but all training is kept below the plane of the shoulder joint and the patient can perform the following exercises.
1. Elbow flexion and shoulder extension: With the upper arm as the axis of rotation, the forearm is inward and outward along the horizontal position as much as possible. One contraction and one extension is 1 stroke, 12-36 strokes each time, 3-5 times a day.
2. Inward shoulder exploration: flex the elbow of the affected limb, support the elbow of the affected limb with the healthy limb, make the affected limb inward, probe the healthy shoulder as far as possible with the affected hand, and gradually probe the healthy scapula backward, and repeat the above action after restoration. Repeat the above action after restoration. 12-36 times each time, 3-5 times a day.
3.Abductor pointing: straighten the affected limb and lift it forward to a horizontal position, then abduct it 90° and restore it, 12-36 times each time, 3-5 times a day.
4.Wall climbing exercise: stand facing the wall, the affected side hand holding the wall, fingers climbing upward, step by step. Each time 10-20 round trips, 3-5 times a day.
5.Passive abduction and external rotation: Lie on your back with the upper limb on the affected side at 90° of abduction, with a towel roll under the upper arm to keep the humeral head in the scapular plane (about 30° angle with the bed), and the upper limb on the healthy side holding the treatment stick horizontally to assist the affected shoulder in external rotation activities.
Phase 4 (after 12 weeks postoperatively, late muscle strengthening period)
The goal of this phase of rehabilitation is to address residual mobility and to achieve normal levels of muscle strength and flexibility, with particular attention to posterior joint capsule distraction exercises. Overhead exercises should be attempted only after the flexibility and stability of the joint capsule and ligaments have been restored. Resistance exercises can be performed as early as 12 weeks after surgery, and resistance and stretching exercises should be continued until 1 year after surgery to maximize muscle strength and obtain optimal results. Combined movement exercises for shoulder joint mobility.
1.Continue the posterior joint capsule stretching: The patient lies on his side, the shoulder joint is flexed forward 90°, the healthy hand grasps and stabilizes the affected limb, and the posterior joint capsule stretching is performed by body gravity, the force gradually increases, so as not to induce serious pain.
2.Rowing action or swimming action: this action can be used to practice the movement of the shoulder joint by combining various actions, such as internal contraction, abduction, internal rotation, external rotation, forward flexion, back extension and supination. 3 times / d, 20 minutes / time.
3.Dumbbell exercise: Hold a 1kg dumbbell on the affected limb to perform shoulder abduction and supination exercises, you can exercise with the rhythm of music, 8 sessions as a group, 1 or 2 times a day.
Note: Depending on the patient’s occupation (athlete or non-athlete), injury and surgery, the rehabilitation plan is individualized, so this article is for reference only.