SHOULDER
The most common concern after a rotator cuff repair – stiffness – might be a thing of the past!
Shoulder specialists are currently performing about 500,000 rotator cuff repairs per year in the US. As Baby Boomers age, that number will dramatically increase. A successful repair not only improves current symptoms, but also helps with long-term preservation of the shoulder joint. Ignoring full thickness tears often leads to irreversible joint damage.
Traditionally, shoulder surgeons have protected a repair in a sling for up to 6 weeks after surgery. Although passive range of motion with Physical Therapy is started early to minimize stiffness, these overly cautious protocols for small and medium-sized stable repairs can lead to loss of motion and stiffness. That makes for a difficult catch-up to break up painful adhesions and restore balanced mechanics of the ball-and-socket (glenohumeral) joint.
This is largely due to the inaccurate belief that small and medium-sized stable repairs are fragile and won’t heal if we move the shoulder too soon. For this reason, patients and therapists often interpret pain as harmful. Discomfort is expected and not usually harmful; after a stable repair, it’s good tough love to gradually force your shoulder to do something it doesn’t want to do. It can be unpleasant, but taken in increments, doable.
New data confirm what we have suspected for years. We are overprotecting small and medium-sized repairs which have a stable repair construct. Rotator cuff repairs with a “double row” construct provide a strong repair and a large footprint of healing chemistry. This combination of strong repair and good chemical healing not only can withstand early motion, but also provides a healthy healing interface to maximize solid tendon-to-bone healing.
The videos below demonstrate a typical rotator cuff tear before (vid1) and after (vid2) a repair. The key features of these videos are that the repair takes advantage of the native bone’s ability to provide growth factors and other blood-borne, glue-like properties to firmly cement the repair in place. In addition, the repair construct has strong fixation medially, which establishes the anatomy of the repair which is strengthened by lateral anchors which drape the sutures over the repair - like bungie cords on a roof rack. This produces a strong repair, with a large surface area for robust healing and early motion.
With a solid repair, your hard work, perseverance and time, we can eliminate stiffness. We’re in this together. You can’t do what we do, and we can’t do what you need to do.
You can see from the before and after videos, we can move a solid repair immediately (Warning: These educational videos contain surgical footage of the interior of a shoulder):
1. Video 1: Rotator cuff tear, before repair, prepared with healthy bone bed and ready for repair.
2. Video 2 Supraspinatus tendon double-row repair – stable and ready for immediate movement.
Tirefort et al (1), demonstrated that removing the protective sling after just two weeks lead to better range of motion and better outcomes for small and medium-sized stable repairs. With early removal of the sling, we can allow the glenohumeral joint to gain normal mechanics early, leading to better outcomes and more rapid return of function.
Remember, motion is lotion. You’ll get out of this what you put into it. Move.
Not every rotator cuff repair can be mobilized with a rapid protocol. It will be up to your surgeon’s recommendation, based on the specific aspects of the repair. Revisions, massive tears, and challenging bone and soft tissue characteristics often require a slower, more traditional protocol.
1. Tirefort J, Schwitzguebel AJ, Collin P, Nowak A, Plomb-Holmes C, Lädermann A. Postoperative Mobilization After Superior Rotator Cuff Repair: Sling Versus No Sling: A Randomized Prospective Study. J Bone Joint Surg Am. 2019 Mar 20;101(6):494-503. doi: 10.2106/JBJS.18.00773. PMID: 30893230.
