Do you have a Large or Massive Rotator Cuff Tear?
Dr. Goradia repairs most large and massive rotator cuff tears with a completely arthroscopic technique. The arthroscope (a small fiberoptic camera) actually allows Dr. Goradia to see more inside of a shoulder than if performing the operation with a large incision. These large tears require the surgeon to have excellent technical skills and experience. No two tears are alike so the surgeon has to indivdualize the treatment for each patient depending on their exact pattern of tearing.
As important as the surgery is the rehabilitation and aftercare. The physical therapist and surgeon must communicate on the patients’ progress and set backs. A cookbook approach to rehab does not work for these repairs. The following is a very general guideline. Dr. Goradia will however send specific instructions to the therapist based on each pateints’ rotator cuff.
In many cases the massive tears have been present for a long time and may have severe retraction, scaring and atrophy. The outcomes of these repairs inferior to repairs of smaller tears. The ultimate goal is to reduce pain and improve function but there shoulde will never be completely normal. No “bridges are burned” with the arthroscopic surgery so that if it fails the patient is still has other options.
Phase I: Early Post-operative Phase for Large & Massive tears
Immobilization
- External rotation or abduction immobilizer for 6 weeks
- May not remove at home
Rotator Cuff Rehabilitation Exercises
- Begin scapular shrugs
- Begin hand/wrist/elbow motion and grip strengthening to reduce stiffness/swelling and to encourage circulation.
- If Prescribed by Dr. Goradia: Limited Supine PROM for flexion and external rotation within painfree zone
- Ice or heat for comfort
- If Prescribed: begin submaximal isometrics at 4 weeks
- Use e-stim to reduce pain and swelling particularly around scapula
- Neck/trapezius, peri-scapular massage
Clinical Follow-Up
Patient will:
- Return to see Dr. Goradia 1 week, 3 weeks and 6 weeks
- Follow up with physical therapist as needed during this phase to check progress (usually 2-3 x/week)
Phase II: Large & Massive Tears 6 weeks – 3 months
Clinical Goals
- Passive ROM at 12 weeks equal to 75% of noninvolved side for:
- Flexion
- External rotation
- Internal rotation
- Begin strengthening
Testing
- Bilateral ROM
Rotator Cuff Exercises
- PROM exercises
- Supine FF, ER, IR
- Submaximal isometrics
- Shoulder shrugs, protraction, retraction
- Light therabands at 8-10 weeks
Emphasis must be made on scapular stabilization and control.
Clinical Follow-Up
Patient will follow-up 3x/week with therapist
At 8 weeks begin home AAROM with wand for FF, ER, IR and submaximal isometrics
Phase III: Large & Massive Tears 3 to 6 months
Clinical Goals
- 80-90% ROM
- Improve strength and function
Testing
- Bilateral ROM
- Strength evaluation
Rotator Cuff Rehabilitation Exercises
- Begin a more aggressive shoulder stretching program as indicated. This may include selfstretching or partner stretching.
- Inferior mobilization
- Theraband exercises; grade of tubing and exercise disposition (concentric or eccentric) will vary according to the patient’s strength and tolerance. Startwith internal/external rotation with the elbow tucked at the patient’s side then progress to flexion/abduction to 90 degrees, extension and adduction.
- Dumbbell exercises for the rotator cuff are implemented after satisfactory strength with therabands is observed
Clinical Follow-Up
- The patient will follow-up weekly with therapist to supervise their home program
- The patient will return at 6 months postop to see the physician and the therapist for measurement of strength and ROM
Phase IV: Return to Activities for Large & Massive Tears
- Patients will continue a home exercise program
- Focus on deficits in strength and function
**As always progression through the Phases is individualized for each patient