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Shoulder Rotator Cuff Repair

When a rotator cuff repair is the best course of action

There are several factors that can influence your decision to opt for rotator cuff repair surgery. You may have suffered a full thickness tear, your levels of shoulder mobility have significantly declined and no amount of conservative physiotherapy treatment has improved your levels of pain or mobility.

For many people, the main reason for a rotator cuff repair surgery is that the pain and reduction in range of movement is no longer manageable and is affecting their day-to-day life.

Shoulder Pain

Shoulder Rotator cuff repair – the mechanics

The glenohumeral joint (shoulder joint), unlike the hip joint (also a ball and socket joint), is an inherently unstable joint because it has a far shallower socket. To help maintain stability when static, it relies heavily on soft tissue structures such as ligaments. To assist with movement, it relies on the joint capsule and muscles.

The “rotator cuff” refers to four muscles (subscapularis, supraspinatus, infraspinatus and teres minor). These muscles help to retain joint stability when we use our shoulders. They work as a unit in functional activities of the shoulder, preventing the ball of the humerus (upper arm) from crashing upwards.

A fall on an outstretched arm or sudden pulling of the arm can result in complete rupture of the tendons. Age is a contributing factor to potential tears. The younger population, those in physical jobs or athletes involved in contact sports such as rugby or boxing regularly suffer this type of injury. The effects of this kind of injury include weakness, pain and reduction in range of motion.

The sooner a repair is performed on a newly injured tendon, the better the outcome for the patient. A rotator cuff repair can be performed arthroscopically or using the open method, or in combination which is referred to as a mini repair. A repair to the tendons involves stitching the torn tendon back to its attachment points. The indication for this surgery is that a complete tear will simply not heal on its own. If your goal is to optimally use you shoulder again, then this might be the best course of action.

Shoulder cuff repair – what the evidence says

Following an arthroscopic rotator cuff repair, the majority of patients report significantly lower levels of pain and improved shoulder strength and range of motion. Most surgical techniques are thought to have similar outcomes with regards to the levels of pain improvement in strength and functionality.

It is important to be aware of factors that could negatively impact recovery. Some examples include: poor compliance with rehabilitation programs, restrictions placed on the joint after surgery and tissue quality, which can be influenced by age or smoking.

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Shoulder rotator cuff physiotherapy: Before surgery

Prior to surgery, the physiotherapist’s job is to help you gain an understanding of your injury and how to avoid any further complications. You would need to avoid any excessive overhead activities, and certainly avoid pushing through pain.

The physio can also work with you, to help prepare you for your shoulder surgery. This pre-op work can greatly help your post-op recovery.

It is also helpful if the physio talks with you in detail about what to expect from your surgery and what the effects are, including average healing times and restrictions. You will need patience and a commitment to the rehabilitation process, but the physio can guide and encourage you throughout your recovery: in other words, partner you at every step of the way.

Shoulder rotator cuff physiotherapy: After surgery

It is vitally important that your rotator cuff physiotherapy treatment program is individualised specifically to you. So the physio should design your treatment program to take into account any restrictions that your surgeon has placed on your recovery. This normally involves “safe zones”: ranges of movement that are safe for you to move in, beyond which you might risk the integrity of the rotator cuff repair.

Specific hands-on treatment should be provided, to relieve restrictions in the surrounding musculature. The physio should carefully monitor your progress and support you to achieve optimal strength, range of movement and scar tissue breakdown to help maximise the benefits of your surgical repair.

You may have questions and queries that your physiotherapist can answer or else sign post you to other appropriate areas of expertise where you can get the answers you’re looking for, regarding your recovery.

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Shoulder cuff repair: the emotional challenge

Good Physiotherapy is sometimes a lot more than simply “physical therapy”, because emotional well-being helps physical recovery.

On occasions, patients feel emotionally challenged by the whole process of surgery and rehabilitation. It is natural to experience highs and lows during recovery. When it feels like things aren’t progressing as well as expected, the physiotherapist’s role is to provide friendly, reassuring support and encouragement.

Sometimes, it can be a matter of simply answering patients’ questions. Sometimes it is dealing with specific issues or anxieties relating to their rehab.

The point is that everyone is different, and a good physiotherapist recognises these differences and responds to the specific needs of each and every patient.

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If you choose Full Motion Physio

I have been trained at the renowned centre of orthopaedic excellence: Wrightington Hospital. I have the expertise and experience to guide you through the process: both before and after your surgery. I will help you back to your previous levels of activity, or as close to this as possible.

I have links with several top surgeons specialising in this field, or if you have already selected a consultant, I will aim to work closely with them in order to tailor your treatment program.

And of course, I am here to address not only the physical but mental challenges that come with recovery after surgery.

My approach is described in the Full Motion Method page. Extensive research has identified four essential elements for the best physiotherapy. The Full Motion Method covers each of these elements. 

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