Communication

These are very good questions, but how will you use them?

How will the size of the tear affect your rehab program?

What part will the quality of the tissue play?

If the surgeons confidence level in the repair is low, will you be apprehensive in your rehab program?

Thanks Chris.
(1) Typically the larger the tear, the more sutures needed to repair, and therefore a greater amount of healing tissue is at risk.
With regard to quality of tissue, if the tissue had little integrity or poor blood flow, healing time will be delayed, and you may exercise caution.
With regard to surgeon’s confidence in repair, the importance of communication here is very important to give the patient realistic goals and expectations. Chris may expand on this more.

On another note, I have also had referrals from physicians without specifying which muscle, which is important information to know. For example with subscapularis repair, you need to be particularly careful with passive external rotation.
When such communication is delayed (as the physician doesn’t also come to the phone, fax machine isn’t working etc etc, is important to remember general principles that in the early post op phase.
Relax the tissues around the cervical and thoracic spines, this will also improve scapula position, improve blood flow and facilitate healing. More often than not, patients are so guarded, that pain is increased and blood flow restricted.
An aproace I’ve had very good results with is to facilitate proprioceptive input into the periphery (have them stand on an uneven surface or BOSU ball (only if you’ve adequately gained the trust of the patient and are giving support. Encouraging them to activate their gluts and core which will reduce the tension in their upper body)

Check out the following link which gives a good summary of post op rehab;
http://www.shoulders.md/PDFs/ScopeRepairRehab.pdf

Thanks for the post and comments

Chris,

Thanks for you response and for taking the time to check out The PT Project. I think Luke probably shed some light on a good portion of your questions but I just wanted to follow up on things. The size of the the tear dictates when you would want to initiate strengthening. For example, if you have a massive tear with retraction that has fatty infiltration that the surgeon lacks confidence in then you would most likely want to delay strengthening for a couple weeks. This brings us to your next question with regards to tissue quality. Ideally anyone undergoing a rotator cuff repair would want beefy, red, robust tissue. This may well be the case in younger individuals who sustain a traumatic type injury though it is most likely not the case in an older individual (i.e. 60+ years old) who are dealing with a tear that is degenerative in nature. In addition to tissue quality it is also helpful to know if the distal clavicle was excised (distal clavicle excision/mumford resection) or if there was an acromioplasty that was performed. Oftentimes, there may also be a degenerative labral tear that may or may not have been addressed. These are all considerations that should weigh in on the rehab program but require separate attention which I may go in to in later posts. Fatty infiltration into the rotator cuff tissue, however, is a major concern as anectodotally these patients seems to have residual strength issues based on my experience completing follow up testing on hundreds of patients. Lastly, if a surgeon lacks confidence in the repair, you better believe that I am going to do everything in my power to protect the healing tissues from deleterious forces. This may result in me being more conservative with their rehab progression (not “apprehensive” as this suggests a sense of fear). I should also mention that I am working with incredibly talented surgeons who are generally confident in their work so if they express any concerns about the repair, this puts things into perspective. Hope this helps and thanks again for reaching out Chris

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