Surgery may be required to repair the torn tendon. An arthroscope (a thin instrument containing a miniature video camera) is inserted into the shoulder through a small incision, this allows the surgeon to see inside the shoulder joint. Through another small incision an instrument is used to access the torn end of the tendon for reparability. If repairable, stitches are used to connect the torn tendon back to the bone. If irreparable, the torn end is trimmed AND freed up to prevent clicking and catching. This procedure can take approximately 2 hours. You may be able to go home the same day or possibly stay overnight in hospital.
The majority of patients report improved shoulder strength and movement, AND less pain after surgery.
You will be advised to wear a sling for two to six weeks depending on the size of the tear. The sling should be worn at all times and only removed for exercises. The “resting period” in the sling is necessary to allow the tendon repair to heal. Physical therapy will be started immediately after surgery and rehab guidelines/protocols should be followed. Return to sports and other specific activities are generally no sooner than six months.
The main risks associated with this surgery:
- Excessive stiffness or loss of motion
- Damage to the nerve that activates your shoulder muscle
- Tendon re-tear
Instructions for AFTER the surgery
- All wounds are closed with “dissolving “ stitches and covered with waterproof dressings.
- Leave bulky dressing undisturbed for 48 hours.
- Remove bulky dressing after 48 hours.
- Leave waterproof dressing on till review by Dr Sim in two weeks.
- Sling ON at all times (including sleeping)
- Remove for daily shower/hygiene and exercise.
- You will need to book physiotherapy, this should commence 2-3 days after surgery.
- Do hand and wrist exercises as much as possible whilst in the sling.
- Refer to Rotator cuff rehabilitation protocol handout.
- Swelling. This may track all the way down your arm to your fingers due to gravity.
- Clear / Blood Stained discharge from wound. THIS IS NORMAL for the first few days.
- Pain. You will receive a prescription for pain medication on discharge. Pain relief medication works best if taken REGULARY.
- Excessive persistent pain
- Pus discharge from wound
Should any of these symptoms persist, contact Dr Sim’s rooms or after hours emergency.
Passive Range Of Motion (PROM)
(Movement to the joint by a physio, with no effort from the patient)
- Decrease pain and swelling
- Prevent post operative stiffness
- Posture, positioning
- Keep sling ON at all times (including sleeping)
- Remove for daily shower/hygiene AND exercises
- In the first six weeks avoid lifting, carrying, pushing, pulling, driving
Your first physio appointment should be within 3 days after surgery
- Posture awareness/exercises
- Ball/theraputty squeezes
Scapula (with sling on):
- Elevation (bring the shoulder blades up) / depression (move the shoulder blades down)
- Retraction (move shoulder blades towards the spine) / protraction (move shoulder blades forward – away from the spine)
Elbow & Wrist:
- Active and passive – flexion, extension, pronation (rotate the hand so the palm faces down), supination (rotate the hand so the palm faces up) – (avoid elbow flexion if biceps repair/tenodesis)
- General range of motion (ROM) if needed
- Passive motion in supine position (lying on your back) through a comfortable range (MUST be supervised/guided by pyhsio)
- Pendulum exercises
Do not progress to Stage 2 until goals are met
Active Assisted (AAROM) –> Active Range of Motion (AROM)
(Movement to the joint with partial assistance by a physio.
- Ensure adequate mobility
- Active-assisted ROM with progression to active ROM exercises to progressively restore motion
- Considerably decrease resting pain
- Initiation of functional activities of daily living
- Do not load, lift, push or pull with affected arm
- No Rapid movements/gestures (excessive muscle contraction)
- Slowly wean yourself off the shoulder sling
- Start driving when you can turn the steering wheel WITHOUT any pain in the shoulder. Most patients take at least 8 weeks before they are SAFE to drive.
PROM & AAROM
Must be supervised /instructed by Physio
- Use cane/stick (PROM) progressions: supine – 45º, semi – reclined – sitting/standing – pulleys (=AAROM)
- E.g. cane/stick exercises, pulleys
- Be guided by physio e.g. wall slides
- Continue with protraction, retraction, elevation, depression
- Therapist guided advanced exercises for scapula
- Stationary bicycles
- Elliptical trainer (no arms), walking
DO NOT PROGRESS TO STRENGTHENING UNTIL FULL, PAIN FREE ACTIVE RANGE OF MOTION ACHIEVED
- Non painful normal range of motion
- Progression of functional activities/heavier activities of daily living below shoulder height
- Address specific deficits of the affected upper extremity
- Avoid excessive overhead loads with affected arm
- Avoid activities, which cause pain
- MUST continue with AROM exercises to MAINTAIN movement
Muscle Strength and Endurance
- Progression is endurance THEN strength. Exercises should have high repetition ( 3 sets x 30 reps) before adding resistance. Closely monitor shoulder/postural mechanics and pain throughout all exercises.
- BE guided by Physio – e.g. resistance bands/tubes
- Be guided by Physio – e.g swiss ball stabilization exercises
- Continue with stationary bicycle
- Elliptical trainer (no arms)
Advanced Strengthening & Preparation
4 ½ Months +
- Full pain free AROM
- Continue to improve muscular strength, stability and endurance with emphasis on external rotation strength
- Functional activities of daily living above shoulder height
- Advances strengthening program
- It is unacceptable to experience pain with activities/exercise. This indicates the load/stresses placed on the arm are too much.
Muscle Strength & Endurance
It is important to start with a weight that you can do 30 reps x 3 3 sets, then GRADUALLY increase the weight with the final aim of 12 x reps x 3 sets
- Chest press
- Shoulder press (military press)
- Reverse fly
- Be guided by Physio
- Be guided by Physio
- Train specific to demand of sport (aerobic, anaerobic)
Return to Sport
- Return to competitive sport once all goals achieved
- Physio and Surgeon have declared you fit to do so
Patients will often have a nerve block under sedation when having a shoulder arthroscopy and decompression/rotator cuff repair. Once the block is placed (which takes about 10 minutes), more medication will be given resulting in general anaesthesia. You will be asleep for the surgery.