The rotator cuff consists of four muscles that function to hold the head of the humerus in place and rotate the arm in different planes of motion. Massive rotator cuff tears are lesions greater than 5 cm, and affect more than one tendon. The primary intervention for such tears includes surgical repair and rehabilitation. If you suffer from a rotator cuff tear, consult your physician or physical therapist for a rehabilitation program that's appropriate for you.
Range of Motion Exercises
After surgical repair, the arm is typically placed in a sling for a certain period of time to allow for healing and to prevent injury to the repaired components. Exercises are initiated and progressed in phases based on patient tolerance and rate of healing. According to the American Academy of Orthopaedic Surgeons, range of motion exercises are initiated after immobilization. These exercises are meant to gradually improve the available motion at the shoulder and prevent muscle contractures. Initially, a physical therapist begins with passive range of motion exercises performed in the plane of the scapula. One passive range of motion exercise involves using an overhead shoulder pulley to help facilitate shoulder flexion. As the patient progresses, exercises are advanced to active range of motion performed in many planes of motion.
Strengthening Exercises
Strengthening exercises are paramount after massive rotator cuff repair in order to restore function and facilitate the return to normal activities of daily living. The purpose of strengthening exercises is to restore normal strength to the four rotator cuff muscles and the scapular stabilizers. A physical therapist may begin with strengthening exercises for the surrounding musculature until the surgical repair is able to handle resistance. This may include gripping exercises using a ball or resistance putty. Rotator cuff strengthening is incorporated into the treatment progression once the surgical repair is deemed safe to tolerate resistance. Isometric exercises for the rotator cuff and scapular stabilizers are initially prescribed to protect the surgical repair. As the patient progresses, these are advanced to isotonic and isokinetic exercises. Commonly prescribed rotator cuff exercises are internal and external rotations that involve using therapy bands for graded resistance.
Functional Activities
Functional activities are initiated when the surgical repair nears full healing and the patient progresses towards normal range of motion and strength. These activities are geared at returning the patient to his previous recreational, occupational or leisure activities. Individuals are typically trained using functional activities that are conducive towards their specific needs. For throwing athletes, for example, a physical therapist may incorporate throwing activities that mimic the athletes' particular sport. Baseball players are commonly prescribed throwing exercises against a rebounder using progressively heavier balls to increase function and strength. These activities are typically advanced from shoulder level to full overhead drills as tolerated by the patient.
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