I am dealing with a tricky case at the moment. A gentleman who has a large supraspinatus repair 5 months ago by an old school surgeon who kept him under his care for several months before the patient sought a second opinion. Post-operatively this chap was kept immobilised in a sling for close to four months! This is crazy even for massive cuff tears and a very old school approach to recovery. Unfortunately, this gentleman has developed a rather nasty case of frozen shoulder unsurprisingly. I have referred him for an additional opinion from a local orthopaedic surgeon who I know keeps up to date with the latest evidence for repairs. Without saying too much about this chaps surgery, I’d like to talk through the latest protocols for even the largest cuff tears from the Royal Berks shoulder unit who focus on a research and evidence based approach
just like myself.
For a massive cuff tear of over 5cm:
Day 1-6 weeks
- Master sling with abduction and external rotation wedge
- Begin shoulder girdle, elbow and wrist mobility
-Manage analgesia, wound advice and educate about healing times
6 weeks- ensure patient does not force or stretch the repair!
-Begin to wean out of the sling
-Begin gentle pendulum exercises and passive flexion, extension, abduction, internal and external rotation
-Gradually progress to assisted, then active flexion extension, abduction, external rotation, Internal rotation
-Gentle isometric cuff exercises
- consider hydrotherapy
8 weeks
-Begin very gentle stretching into limited movements
-Begin close chain isotonic exercises
-Begin anterior deltoid work within range
-Begin core stability and proprioceptive work
-Encourage functional movements
Progression should be tailored to the individual patient. Attempt to maintain range in the first stage and gradually building to strength.