I’ve heard the muscles of the shoulder called many things including “rotary cup or rotor cup,” but the correct term is actually rotator cuff, and it is a very commonly treated area of the body. Whether torn or sprained, pre or post-surgery, the diagnosis of rotator cuff injury comes across my desk frequently as a physical therapist.
What a rotator cuff is and what can make it hurt:
The rotator cuff is a group of four muscles that work to stabilize the shoulder joint when you move your arm. In other words, they hold the ball in the socket. Probably their most important job is to keep the ball of the joint from being raised up too high, causing the rotator cuff to be pinched or impinged by the top of the shoulder joint. This joint is also known as the acromion (or that bony point on the top of your shoulder).
So what happens when your rotator cuff isn’t doing its job? Rotator cuff tears can occur. They are a result of repetitive micro-tears from overuse of a weak rotator cuff, using poor body mechanics or from trauma such as a fall. In many cases a tear can be the result of a combination of overuse and trauma. The signs of a rotator cuff tear are pain in the shoulder possibly radiating down the arm, difficulty with reaching motions such as overhead and behind the back, and pain that increases at night.
A sprained rotator cuff will have many of the symptoms listed above but typically improves with time (especially with the help of a physical therapist) without surgical intervention. A torn or frayed rotator cuff may or may not require surgery depending on the severity. Physical therapy can be crucial in the decision to undergo shoulder surgery and should always be the first resort.
Pre-surgical physical therapy can do one of several things:
- Completely resolve the symptoms
- Lessen the symptoms and improve body mechanics preventing further injury
- Improve range of motion prior to surgery to allow the fastest, most successful recovery
- Or worst case scenario, give you peace of mind that you tried everything before going under the knife!
One thing PT will never do (or should never do) is make your shoulder pain worse.
What surgical options might look like:
Let’s say you are already planning on surgery. Here are the common procedures.
Arthroscopic repair will generally involve three small incisions. Two are for portals that allow the surgeon’s tools to enter the joint space, and one is for the small camera that allows the surgeon to see what he/she is repairing. Torn or loose edges of the tendon(s) are shaved down and the torn area of the tendon is sutured. In many cases the cuff is then anchored down to an area of bone known as a tuberosity. In some cases decompression (or shaving of additional bone) in the area may be necessary.
Decompression surgery or “clean-up” is arthroscopic surgery performed without the repair if the rotator cuff tear is not significant enough to warrant it.
Open rotator cuff repair is when the shoulder is opened up via a large surgical incision allowing the surgeon to repair the torn cuff.
What to expect in post-surgical physical therapy:
Most of my patients initially regret their decision to undergo surgery due to some pretty significant pain, but once that is under control (2-7 days) we start a post-surgical protocol that is specific to each surgeon. Some will have their patients start PT immediately, some will wait up to 4 weeks. It is always best to follow what your surgeon recommends.
There is going to be a sling involved. A bulky, uncomfortable, hot, smelly (depending on if you can get someone to help you with your deodorant) sling. It will be a must for anywhere from 3-6 weeks after a rotator cuff repair. The sling is important because it is holding your arm in the optimal healing position. It also prevents you from moving your arm which could cause your anchors to come loose and your surgeon’s head to pop off (LOL, just kidding, but I promise he/she will not be pleased).
In physical therapy we will remove the sling and I will perform what is called passive range of motion. This is me moving the arm, not you and it prevents contractures or scar tissue from forming which would not allow a full recovery. We would then gradually progress activity per your surgeon’s protocol until you are back to the level you would like to be.
Typically PT after an arthroscopic rotator cuff repair lasts 8-12 weeks, and after an open repair 12-15 weeks, but could be more or less for you depending on a great number of factors. A physical therapy student of mine came up with these tips for a successful recovery, and I love them, so I will leave you with this helpful information. Wishing everyone a healthy shoulder! – Kelly
Tips for Success:
- Throughout the rehabilitation process you may have certain “shoulder precautions” or activities that you are not supposed to do. It is important to follow these precautions to avoid injuring your repaired shoulder.
- Take your rehabilitation seriously! Be prepared to work hard while you are at physical therapy.
- Remember that everyone is different, and you may heal much faster or slower than normal.
- Do your homework! It is important to keep up with your home exercise program when you are not at physical therapy.
- Ask questions! Don’t be afraid to ask questions along the way. This can be a scary process, and it is your right to be informed as a patient.
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