Rotator cuff repair is a surgical procedure where the large tendon that makes up the rotator cuff is re-attached to the head of the humerus bone of the upper arm from which it has separated. Because this large tendon is responsible for activating various motions of the shoulder, healing time from a repair procedure can last up to 12 weeks. Exercises differ depending upon what point in the healing time they are performed. The recovery can be looked at in terms of two recovery phases: the first 6 weeks and the second 6 weeks. The first 6 weeks of rehabilitation are built around the healing of the rotator cuff back to the bone from which it detached, while the second 6 weeks are devoted to gradual strengthening of the upper extremity.
Elbow Range of Motion
For the first few weeks of recovery fro a rotator cuff repair, the arm is typically placed into an arm sling or shoulder immobilizer that is worn for the express purpose of rendering the shoulder motionless with minimal stress to the repair site. The forearm and elbow are also immobilized by necessity and design.
In general, the elbow is notorious for getting stiff after only a short period of immobility. It is, therefore, necessary to exercise the elbow, even before it is permissible to move any other part of the arm and shoulder. Elbow range of motion exercises are begun almost immediately after surgery to avoid unnecessary and unwanted stiffness.
Codman ("Pendulum") Exercises
These exercises are specifically designed to allow for motion of the shoulder but without any active muscle stimulation by the patient, Pendulum exercises are typically performed with the torso bent slightly forward, allowing the arm to hang away from the body. Movement of the upper body causes the arm to gently swing, much the same as a clock pendulum. The motions are usually circular, beginning with very small diameter rotations and gradually enlarging them.
Pendulum exercises help maintain joint lubrication and to lessen the risks for post-operative adhesion formation.
Passive Range of Motion
Passive range of motion, or PROM, exercises are performed without any active muscle involvement on the part of the patient. They are usually performed by a physical therapist or trained exercise partner. Passive range of motion exercises are better than pendulum exercises because they involve another person as the initiator of the motions, who can then gently add more range to the motions in a gentle and gradual fashion with better outcomes than the patient-generated movements. Fear and apprehension by the patient are reduced with the help of a second person.
Active-Assistive Range of Motion
In this stage of rehabilitation, the patient is allowed to participate in moving the upper extremity on a partial basis, using only minimal muscle exertion. This method helps the patient to begin re-educating muscle fibers but not to a point of exerting too much stress on the surgical repair site. The therapist still maintains control over the exercise regimen, but the patient becomes increasingly involved in her rehabilitation.
This type of exercise is a confidence-builder for patients as is a critical step toward full, active motion.
Once appropriate healing has taken place and permission is given from the surgeon, the active strengthening phase can be implemented. This level of exercise now begins to use the patient's own muscle groups to mobilize the upper extremity. Weights and repetitions are increased in small increments, but the work is done entirely by the patient.
Active strengthening is essentially the final stage of exercise and rehabilitation before returning to normal activities and can last 6 weeks or more, depending upon the progress of the patient and the amount of strength return the exercise is providing.