Surgical Considerations for the UE - Rotator Cuff Tear

Question 1

Which RTC muscle is most commonly torn?

Answer 1

Supraspinatus

Question 2

What are the different types of procedures for RTC?

Answer 2

• Traditional Open
• Mini-open (arthroscopically assisted)
• Arthroscopic
  -Most common approach

Question 3

What are the Primary, Secondary and Tertiary structures affected by surgery?

Answer 3

• Primary: Muscle/Tendon
• Secondary: Bone
• Tertiary: Periarticular tissues, deltoid muscles

Question 4

Physical Examination

What must be checked before and after each treatment session?

Answer 4

The integumentary of the shoulder

Question 5

Physical Examination

What is common to see with Shoulder PROM and Palpation in patients after RTC surgery?

Answer 5

Shoulder PROM
- All directions will be limited

Palpation
- Tender to Palpate (TTP) of shoulder and neck musculature

Question 6

What are some Prognostic Factors with RCT repair?

Answer 6

• Natural Hx
• Primary Tissue healing times
• Return to activity/sport timeline
• Social determinants of health (SDOH)

Question 7

How long does the 1st Phase of Rehab last for a RTC repair?

Answer 7

Phase 1A: Maximum Protection
- 0-4 weeks

Phase 1B: PROM
- 2-8 weeks

Question 8

How long does the 2nd Phase of Rehab last for a RTC repair?

Answer 8

Phase 2: Active-Assisting ROM
- 4-16 weeks

Question 9

How long does the 3rd Phase of Rehab last for a RTC repair?

Answer 9

Phase 3: Early Strengthening
- 10-22 weeks

Question 10

How long does the 4th Phase of Rehab last for a RTC repair?

Answer 10

Phase 4: Advanced Strengthening and Dynamic Stability
- 16-22 weeks

Question 11

What are the precautions for Phase 1 of RTC repair?

Answer 11

This is the Maximum Protection Phase/PROM
- Wear sling with abduction pillow at all times (Time frame will vary based on size of tear and surgeon)
- No AROM
- No lifting, pulling, or pushing with affected arm
- Focus on pain control

Question 12

What are the Interventions for the 1st Phase of Rehab for RTC repair?

Answer 12

Manual Therapy
- Manual PROM
- Gentle soft tissue massage

Home Exercise
- Codman Pendulums
- Table Slides

Education on pain management and post-op restrictions

Question 13

What are the Precautions with Phase 2 of RTC repair?

Answer 13

This is the A/AROM and Muscle
- Wear sling with abduction pillow at all times (time frame will vary based on size of tear)
- No AROM
- No lifting, pulling or pushing with affected arm
- Focus on proper posture

Question 14

What are the Interventions of Phase 2 of RTC repair?

Answer 14

Manual Therapy
- STM on cervical/shoulder musculature
- Grade 1-3 GH joint mobilizations

Continue to progress PROM

Introduce Active Assist ROM

Introduce isometric strengthen of shoulder musculature
- (Flexion, extension, abduction, ER, IR, Scapular retraction)

Education on activity modification to avoid provoking or aggravating symptoms

Question 15

What are the Precautions for Phase 3 of RTC repair?

Answer 15

This is the Early Strengthening Phase
- No lifting, pushing, or pushing >5lbs with affected arm or as directed by surgeon

Question 16

What are the interventions for Phase 3 of RTC repair?

Answer 16

Manual Therapy
- Continue manual PROM as needed
- Graded 1-4 GH joint mobilizations

Introduce UE and periscapular strengthening exercise

Introduce functional activities as tolerated

Education on activity modification to avoid provoking or aggravating symptoms

Question 17

What are the Precautions for Phase 4 of RTC repair?

Answer 17

This is the Advanced strengthening and Dynamic Stability phase
- Progress neck strengthening exercise
- Improve movement patterns and muscle endurance
- Create a long-term HEP
- Return to all functional activities

Question 18

What are the Interventions for Phase 4 of RTC repair?

Answer 18

• Manual Therapy (if needed)
• Progressive UE, periscapular and core strengthening exercises
• Increase conditioning to match activity and participation requirements
• Exercises that mimic their activities and demands
• Education in long-term management