Post-operative rehabilitation program for rotator cuff repair (small to medium tears).
Tear size is: small tear: 〈1cm; medium tear: 1-3
cm range
1.0-2 weeks after surgery
The postoperative period of 0-3 weeks is protected by suspension in a comfortable position with a triangular scarf, and no weight bearing or excessive force should be applied. Otherwise, it will affect the tissue healing and functional recovery. The duration of triangular towel protection depends on the pain and muscle strength.
On the day of surgery.
(1) After the anesthesia subsides, start moving the fingers and wrist joints. (The movements are simple and easy to understand without much explanation.) Place a pillow under the arm on the operated side while lying in bed to keep the arm in a slightly forward-flexed position to reduce pain.
1 day after surgery.
(1) “Open hand and fist” exercise.
Open the palm of your hand as wide as possible, slowly and forcefully, and hold it for 2 seconds, then make a fist with force and hold it for 2 seconds. (It is important to promote circulation, reduce swelling and prevent deep vein thrombosis)
3 days after surgery.
(1) Depending on the situation, decide to start “swing exercises”.
Bend your body forward (bend over) until your upper body is parallel to the ground, and swing your arm under the protection of a triangular scarf and your healthy hand. The first is the front and back direction, after adapting to the basic pain-free increase in the left and right lateral direction, and finally increase the ring (circle) movement, gradually increasing the range of motion, but not more than 90 °, each direction 20-30 times / group, 1-2 groups / day, immediately after the exercise ice 15-20 minutes.
(2) Shoulder shrugging exercise: shrug your shoulders to the maximum force tolerated, hold for 2 seconds, relax and repeat, 30 reps/group, 3-4 groups/day.
(3) and “chest enlargement” and “chest containing” exercises for muscle strength around the shoulder joint (see Chapter 13, Section 6: 101, 102).
Hold for 2 seconds until the maximum force tolerated, relax and repeat, 30 reps/set, 3-4 sets/day.
1 week postoperatively.
(1) Start moving the elbow joint.
Protectively remove the triangular scarf and actively, slowly and forcefully flex and extend the elbow joint at full range, 20-30 times/group, 2 groups/day. Wear a triangular scarf for protection immediately after the exercise.
(2) Passive joint mobility exercises (some patients may start 3 days after surgery depending on the situation).
Shoulder anterior flexion exercises.
Lie flat on your back, remove the protection of the triangular scarf, and hold the affected elbow with the healthy hand (the affected limb is completely relaxed, and the healthy side will complete the movement with force!) Raise the affected arm vertically upward via the front of the body. The angle is controlled within 90°. Hold and tremble gently for 1-2 minutes until pain is felt, 3-5 times/group, 1-2 groups/day. And gradually increase the passive activity angle.
Shoulder abduction exercises.
The posture and requirements are the same as before. Raise the affected arm in the horizontal direction on the side of the body. The angle should be controlled within 90°. Hold and tremble gently for 1-2 minutes until pain is felt. 3-5 times/group, 1-2 groups/day. And gradually increase the passive movement angle.
External rotation of shoulder joint at 0°.
Lie on your back, upper arm against the side of the body, bend the elbow 90°, the healthy side hand holds the wrist of the affected side, (the affected side of the limb is completely relaxed, the healthy side of the force to complete the action!) Push the small arm of the affected side outward in the vertical direction at the front of the body. The angle is controlled within the range of 45-60°. Hold and tremble gently for 1-2 minutes until pain is felt, 3-5 times/group, 1-2 groups/day. And gradually increase the passive activity angle.
Posterior shoulder extension.
Lie flat on your back, hold the wrist of the affected side with the hand of the healthy side, and gradually lower the small arm to the bed surface on the body side. Hold and gently tremble for 1-2 minutes until pain is felt, 3-5 times/group, 1-2 groups/day. And gradually increase the passive activity angle.
2.2-3 weeks after surgery.
(1) Muscle strength exercises.
Shoulder joint forward flexion muscle strength exercises.
Front planks.
Bend the elbow 90°, lift the arm in front of the body to a pain-free angle, do not shrug the shoulder! Static exercises are the main focus, hold in the highest position for 2 minutes, rest for 5 seconds, 10 consecutive times for 1 group, 2-3 groups / day. Strength is increased by straightening the arm to perform.
Shoulder abduction muscle strength exercises.
Lateral planks.
Raise the arm on the side of the body to a pain-free angle, without shrugging the shoulder! Static exercises, hold in the highest position for 2 minutes, rest for 5 seconds, 10 consecutive times for 1 set, 2-3 sets/day.
Weighted “shrugging” exercise.
Same as the above description of “shrugging” exercise: lift weights, 30 times/group, 3 seconds rest between groups, 2-4 groups in a row, 1-2 exercises/day.
(2) Mobility exercises: Continue and strengthen the above exercises, gradually increase the passive mobility angle.
3.3-6 weeks after surgery.
(1)Continue and intensify the above exercises. Exercises that are basically painless or do not feel fatigue during the exercises can be discontinued.
(2) Shoulder abduction 45° position internal and external rotation exercises.
Shoulder abduction is 0° when the arm is pressed against the side of the body, and shoulder abduction is 90° when the arm is lifted to the flat side.
Lie flat, bend the elbow 90°, place the abduction 45° position, the healthy side hand hold the affected wrist, (the affected limb completely relaxed, by the healthy side force to complete the action!) Press down in both internal and external directions. The angle is controlled within the range of 60°. Hold and tremble gently for 1-2 minutes until pain is felt, 3-5 times/group, 1-2 groups/day. And gradually increase the passive activity angle.
(3) Continue and intensify the exercise method described above. Increase the load and reposition the power form exercises, i.e., choose the appropriate weight of load, 30 times/group, 30 seconds of rest between groups, 2-4 groups in succession, 1-2 exercises/day.
(4) resistance internal rotation muscle strength exercises.
Resistance internal rotation.
Hands hold one end of an elastic band, the other end of the band is fixed somewhere, pull the band hard to the inside, so that the hand close to the body. To the maximum angle to maintain a certain time or complete the action for 1 time. Can be adjusted by the tightness of the belt resistance, 30 times / group, 30 seconds between groups, 2-4 groups in succession, 1-2 exercises / day.
(5) resistance to external rotation muscle strength exercises.
Resistance external rotation.
Hands hold one end of an elastic band, the other end of the band is fixed somewhere, pull the band to the outside with force. To the maximum angle to maintain a certain time or complete the action for 1 time. You can adjust the amount of resistance through the elastic band, 30 times / group, 30 seconds break between groups, 2-4 groups in a row, 1-2 exercises / day.
4.Functional recovery period (7-12 weeks after surgery)
Objective: pain-free total joint movement; improve muscle strength; increase functional activity; reduce residual pain
(1) Continue to strengthen the mobility exercises: the method is as described above. Forward flexion angle gradually to 170-180°. This is close to normal.
Shoulder abduction 90° position internal and external rotation exercises
Lie on your back, shoulder abduction 90°, i.e. lateral planks position, bend the elbow 90°, the healthy side hand holds the wrist of the affected side, (the affected limb is completely relaxed, the healthy side completes the movement with force!) Push the affected arm inward and outward in the vertical direction on the side of the body. When the angle is larger, use the treatment stick (any thick and thin 1m long stick can be used instead) to hold the ends to help the healthy side hand to complete the exercise at a larger angle.
Hold and gently tremble for 1-2 minutes until pain is felt, 3-5 times/group, 1-2 groups/day. And gradually increase the passive activity angle. Control the angle within 75-90° of external rotation and 75-85° of internal rotation.
5.8-10 weeks after surgery
Intensify the above described joint mobility exercises to achieve full range of motion at 10 weeks after surgery. You can use the healthy arm for comparison, and the range of motion is basically the same, which is considered normal.
10-12 weeks postoperatively.
Strengthen the muscles, using the exercises described above and gradually increasing the load. Absolute strength exercises are the main focus. Choose a medium load (the amount of load to complete 20 movements that feel fatigue), 20 times / group, 2-4 sets of continuous exercises, 60 seconds rest between groups, 2-3 exercises / day.
6.13-21 weeks after surgery
(1) Intensive muscle strength exercises.
Supine “flying bird”
Choose a medium load (the amount of load to complete 20 movements that is fatigue), 20 times / group, 2-4 sets of continuous exercises, rest 60 seconds between sets, 2-3 exercises / day.
Prone “flying bird”
Choose a medium load (to complete 20 movements that fatigue load), 20 times / group, 2-4 sets of continuous exercises, rest 60 seconds between sets, 2-3 exercises / day.
Prone front planks
Can be empty-handed, one-handed or holding a heavy resistance exercise. Choose a medium load (the amount of load to complete 20 movements that feel fatigue), 20 times / group, 2-4 groups of continuous exercises, rest 60 seconds between groups, 2-3 exercises / day.
(2) Start to try physical work or sports activities 18-21 weeks after surgery.
(3) Continue strength and mobility exercises at 21-26 weeks postoperatively. Review at the same time to decide if you can resume sports or physical work.