Why is the rotator cuff important?
The primary joint of the shoulder is the glenohumeral joint, a ball and socket joint which allows the shoulder to have a large range of movement. To allow this movement the socket (glenoid), which articulates with the upper arm (humerus) is very shallow compared to other ball and socket joints such as the hip. Hence to keep the ball centred in the socket there are a group of four muscles and tendons known as the rotator cuff which serve to keep the humeral head stable in the glenoid during movement. These four muscles include:
- Infraspinatus: is positioned at the back of the shoulder joint and assists in externally rotating the arm, for example the backward motion of throwing a ball.
- Teres minor: has a similar function and anatomical position to the infraspinatus and also assists with external rotation.
- Supraspinatus: is the most superior rotator cuff muscles and helps move the arm to the side.
- Subscapularis: is the most anterior rotator cuff muscle, located at the front of the shoulder. It helps with internal rotation of the shoulder
Why is rehabilitation important?
Following rotator cuff surgery, it is important that we move the shoulder to avoid stiffness in the shoulder. This stiffness can progress to a frozen shoulder (adhesive capsulitis) if sufficient movement is not obtained in rehabilitation. However, we also know that if there is too much movement following surgery, we are going to have higher failure rates and poorer outcomes. Consequently, it is essential that you follow a rehabilitation protocol under the guidance of a physiotherapist to maximize the integrity of the repair sight, while also reducing the risk of post-operative stiffness.
How long does it take to recover from rotator cuff surgery?
Day 1-3 weeks
During this acute period following the operation, there is not a lot of active therapy and you will usually present to physiotherapy 3-6 weeks following your operation. You will generally be in your sling for the first 6 weeks and during this initial 3-week period will only be able to remove it to complete gentle movements of the elbow and wrist and to dangle your arm by your side. You should also avoid aggravating activities such as laying on the affected shoulder when sleeping.
3 weeks to 6 weeks
You can still expect to be in your sling, however, regularly seeing a physiotherapist become a higher priority. Your physiotherapist will progress your exercises as necessary, however at this stage of rehabilitation they will still be passive movements of the shoulder, not involving active recruitment of the shoulder muscles. Manual therapies will also be commenced to address muscle tightness which occurs secondary to prolonged immobilisation of the shoulder in a sling.
6 weeks to 12 weeks
At the 6 weeks post-operative period your surgical review will likely result in you being removed from your sling. At this point your physiotherapist will progress your exercises to begin gentle active assisted movements, which involve a small amount of recruitment of your shoulder muscles. Over the next 6 weeks your physiotherapist will progress your exercises with the goal to have full active range of motion 12 weeks post-operation, however this can often take longer to achieve. Your physio will also continue to progress manual treatments to include passive mobilisation of the shoulder and thoracic spine and prescribe appropriate exercises to address secondary stiffness of the joints and muscles of the upper back and neck.
14 weeks to 6 months
At this stage of rehabilitation, the tendon, and the bone it attaches to should have consolidated, allowing for strengthening to begin. Most of the exercises will consist of strengthening of the rotator cuff and scapular muscles, which are key for smooth, pain free shoulder movement. As these muscles become quite weak after a long period of immobility rehabilitation can take anywhere from 11-18 months, and it is important that you continue adhering to your graded exercise program throughout this period. Your physiotherapist will also continue to use manual treatments during this strengthening phase of the rehabilitation to maintain range of motion and address any secondary muscle tightness that may result from increased load on the shoulder joint musculature.