Rotatorcuff Injury: Phases Of Rehabilitation

The rotator cuff is a group of muscles and tendons around the shoulder joint. A rotator cuff injury can cause a pain in the shoulder, which often worsens when you try to sleep on the affected side. The risk of damage to the rotator cuff increases with age.

Symptoms of rotator cuff injury

Overall, pain associated with a rotator cuff injury can manifest itself in various ways such as:

• Boring pain in the shoulder.
• Pain that interferes with sleep, especially if you sleep on the affected shoulder.
• Pain that makes it difficult for the affected person to save their hair or touch their back.
• Weakness in the arm.

Overall, the most common way to repair a rotator cuff injury is with surgery. After this, the patient must undergo rehabilitation. In the following section, we will look at what that entails.

Treatment phases for rotator cuff injury

Postoperative rehabilitation after surgical repair of the rotator cuff should begin with close communication between the orthopedic surgeon and the rehabilitation physician. Overall, the ideal rotator cuff injury rehabilitation program will allow the tendon bone to heal and prevent shoulder stiffness.

However, each patient and rotator cuff injury is different. Therefore, any rehabilitation plan must take these differences into account in order to achieve good results.

Also read: How to relieve shoulder pain with natural medicine

Individualized rehabilitation

In general, the rehabilitation phases must be individualized for each patient depending on:

• Type and extent of damage.
• The surgical technique used.
• Tissue quality.
• Safe repair.
• The patient’s age.
• Their activity level.
• The patient’s personal goals.

Patients with acute injuries are more likely to be injured again. Therefore, they need to follow a slower rehabilitation protocol to protect the surgical repair. In contrast, patients with risk factors for developing postoperative shoulder stiffness require early mobilization to prevent this complication.

In general, the rehabilitation phases are based on periodic assessments of the patient. This should also include a home exercise program in each phase of the rehabilitation treatment.

Rotatorcuff injury rehabilitation programs

In general, there are two types of programs:

1. Conservative

First of all, the conservative program consists of a delay of 2-4 weeks to minimize tissue strain and facilitate healing. In principle, patients over 50 with acute injuries require more than one tendon injury and / or with poor tissue quality a conservative treatment program.

2. Accelerated

On the other hand, this protocol accelerates rehabilitation for 2-4 weeks without the risk of damaging the repaired structures or incurring an early onset. Patients under the age of 50 with minor injuries, a single rotator cuff injury, and good tissue quality should follow a standard or accelerated treatment program.

Rehabilitation phases for rotator cuff injury

In general, there are four rehabilitation phases:

Phase 1. Immediate postoperative period

Here, maintenance and protection of the repair in the immediate 0-4 weeks postoperative period includes the following guidelines:

• Arm sling.
• Sleep with the sling, in an armchair and with a pillow under your arm.
• Only remove the immobilization during care and training.
• Cryotherapy.
• Pendulum exercises.
• Active elbow / wrist / hand – movement exercises.
• Extension of the spine.

Also read: Stretching exercises: Exercises to train the whole body

Phase 2. Protection and active movement

Next, this consists of gradually restoring the passive range of motion. This typically happens from week 4 to 10.

• In week 4, there should be an actively assisted range of motion (AAROM) in the spine.
• After 6 weeks, there should be a fully passive range of motion and initiate active assisted motion.
• In week 8, there should be scapulothoracic and submaximal isometric exercise in the closed kinetic chain and proprioceptive exercises in an open kinetic chain.

Phase 3. Early strengthening

Next, muscle strength is started from week 10 to 14. Overall, the following goals must be achieved:

• First, a fully active range of motion.
• Then strength and muscle endurance are restored.
• Also proprioceptive and neuromuscular control.
• Next, periscapular strengthening muscles.
• As the last a gradual return to daily activities.

Phase 4. Advanced strengthening

Finally, the patient is ready to return to previous levels of functionality. The timeline for this ranges from week 14 to 22. Milestones are:

• First, a complete and painless active range of motion.
• Then a return to sports activities.
• Also the presence of normal muscle strength and endurance.
• As the last one a return to all activities.