About Physical Therapy After Rotator Cuff Surgery

The rotator cuff is made up of muscles and tendons which form a layer around the upper arm bone, or the humerus. The rotator cuff is what keeps the humerus in place and allows the arm to lift and rotate. The most common type of injury to the rotator cuff is a tear to one of the muscles, which usually occurs because the muscles and tendons are used frequently over a period of years. Those who are most likely to have problems with their rotator cuff and need surgery are those who lift their arms over their heads repeatedly, such as athletes involved in baseball, tennis, rowing and weight lifting.

Surgery

• Surgery for rotator cuffs is performed if other nonsurgical methods do not work. These include taking anti-inflammatory medication, putting the arm in a sling, steroid injections and exercises. If a patient requires surgery, there are a number of procedures, which depend on the severity of the tear in the tendon. A debridement procedure, which involves trimming and smoothing of the tendon, is done if there is a partial tear. For a complete tear, two parts of the tendon are sutured back together. After the surgery, the arm is often immobilized, and physical therapy is needed to allow the arm to regain its normal motion and strength.

Physical Therapy

• Physical therapy often begins soon after surgery. Physicians will ensure that your shoulder is put in motion right after surgery, because if it is not, scar tissue and stiffness can develop. A continuous passive motion machine will move your shoulder while you are in recovery immediately after surgery and for the next couple of days. While you are in the hospital, you will work with physical therapists to learn the exercises that you will need to practice at home to help you recover fully. Usually these exercises involve stretching the shoulders forward and to the side.

Stretching Exercises

• An important method of relieving pain is through stretching exercises. You can start these at home usually 6 to 12 weeks after surgery, depending on the type of surgery that was done, Taking a hot shower before exercising can help you relax. The exercises work on the flexibility and range of motion in the shoulders. Two exercises that you can practice early after the surgery are forward and external elevation. To practice forward elevation, lie on your back, raise your injured arm, hold your elbow and bend your arm upward from the shoulder. To practice external elevation, lie down on your back holding a rubber band, or another device that stretches, with both hands and stretch it outward with your hands fisted around it.

Strengthening Exercises

• About three months after the surgery, you can begin strengthening exercises. They usually involve moving the arm in different directions, often with the aid of weights. Many of these exercises involve lifting weights. For one of the exercises, the inclined press, lie back on a surface, such as a bed, with your back elevated, and lift weights first toward your chest and then upward. For an exercise called the sitting press, sit down and move your arms first inward and then upward with a weight in your hand. For an exercise called the supine press, do a similar exercise to the sitting press but while lying down.

Cryotherapy

• Another type of therapy that is used by patients recovering from rotator cuff surgery is cryotherapy, which can provide pain relief. When there are tears in the tendon, there are also tears in collagen, the protein that makes up muscles, tendons and ligaments. When the collagen is torn, blood vessels and cells also tear, releasing fluid that is contained among muscle fibers. In order to keep the fluid from going into tissues and to keep inflammation and pain from occurring, cold compresses such as ice packs and ice massages can be applied to the area. Ice massages are made by putting tap water into a foam cup, freezing it and massaging the ice in the cup into the painful area.

Devices

• One type of machine, the DonJoy Iceman, can make cryotherapy much easier. Some of the disadvantages to using ice packs and massages is that it is difficult to keep ice from melting, the ice is only applied to certain parts of joints and the procedures can only be done for about 10 to 20 minutes at a time. The DonJoy Iceman can apply a cold temperature to a joint by recirculating ice water through a pad which is placed on top of the painful area. Another machine, the Polarcare Cub, is similar to the DonJoy Iceman, but it does not require electricity to work.