Pre- and Post-Surgery Physical Therapy for Rotator Cuff Repair

Pre- and post-surgery physical therapy for rotator cuff repair is necessary to reduce the risk of complications, reduce recovery time, and ensure a full recovery.

What is the Rotator Cuff?

The rotator cuff holds the shoulder in place and allows an individual to lift their arm and reach up. The rotator cuff is made up of muscles and tendons that may become injured as a result of a tear, repetitive activities, or aging.

Symptoms of a rotator cuff tear may include:

• Weakness in the top of the shoulder
• Pain in the top of the shoulder
• Loss of motion in the shoulder
• Crackling sound in the shoulder

Who Needs Surgery?

Patients may need to undergo surgery to:

• Shave bone spurs pinching the shoulder
• Repair torn tendons or muscles
• Restore the function and flexibility of the shoulder
• Eliminate inflammation of the bursa in the shoulder
• Eliminate inflammation of the tendons in the shoulder
• Relieve pain

The risks of surgery include bleeding, infection, blood clots in the legs or lungs, sensory changes, increased pain, stiffness or decreased mobility, impaired healing, and other risks, depending on the patient’s specific medical condition.

What to Expect During Physical Therapy

Physical therapy after a rotator cuff surgery is designed to restore muscle strength, coordination, and range of motion. The five stages of rehabilitation following rotator cuff repair surgery are immobilization, passive motion, active-assisted motion, active motion, and strengthening.

During immobilization, patients are instructed to rest their arm for four to six weeks after surgery. This rest period may be intermittent, with a physical therapist guiding slight motions to help keep the patient’s joint from becoming stiff.

In the second stage, the physical therapist will instruct the patient to perform passive motion exercises, which may include the use of pulleys, stretch straps, and table stretches.

Once the patient is able to perform passive motions, the therapist will instruct the patient to perform pendulum exercises that rely on gravity and momentum to move the arm.

During the active motion phase, the patient’s arm is able to carry its own weight but is unable to lift, push, or pull objects. The physical therapist will guide the patient in performing safe motion patterns of the shoulder and shoulder blade.

In the final stage, the patient’s muscles are relearning how to function. Exercises will be designed to improve the arm’s strength and flexibility.

Post-surgery, patients will be instructed to perform a combination of the following exercises:

These exercises are designed to target the following muscle groups:

• Deltoids
• Trapezius muscles (in the upper back)
• Rhomboid muscles (in the upper back)
• Teres muscles
• Supraspinatus
• Infraspinatus
• Subscapularis
• Biceps
• Triceps

During PT, the physical therapist will give the patient tips on shoulder exercises and movements to avoid, such as:

• Overhead arm positions (because they can cause shoulder pain)
• Sleeping on the side with arms stretched overhead (this may cause rotator cuff damage over time)
• Carrying heavy objects on your side (this could strain the cuff muscle)
• Smoking (this could decrease blood flow to the rotator cuff muscle)