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Disorders and injuries of the rotator cuff
Postoperative management of RC reconstruction

Phase 1
Whenever the RC has to be sutured or reinserted, patients must follow their doctor's instructions to the letter during the first phase of rehabilitation, the healing phase. Of course, this also applies to difficult reconstructions of the RC, e.g. deltoid flap reconstruction. The reconstructed tissue must first be left to heal without being loaded for at least 6 weeks. Only a well-healed scar is subsequently capable of withstanding loads. Only passive movements - swinging the arms with the upper body bent forward and frequent passive arm movements on an Arthromot exercise splint - are allowed during this initial phase.

An Arthromot exercise splint is a motorised splint. It is usually brought to your room while you are still in hospital and you can commence passive exercise therapy on the first day after your operation. Since the splint moves the arm that has undergone surgery in all predetermined directions, the unchanging movements relax the muscles, which the patient experiences as a beneficial sensation. The exercises have to be carried out meticulously and conscientiously between 6 and 10 times a day for 6 weeks.

Each session lasts between 20 and 30 minutes. Failure to take the necessary precautions, e.g. unauthorised or premature removal of the cushioned abduction splint, actively raising the arm or moving the arm toward the body can threaten the reconstructed tendon cuff and jeopardise a good post-operative outcome. Between the passive movement exercises, the shoulder must always remain immobilised on the cushioned abduction splint. However, the elbow, wrist and fingers may be exercised as much as possible.

Phase 2
The programme changes after six weeks. The Arthromot splint can be returned and the cushioned splint gradually removed. Active intensive physiotherapy is also started at this time, both independently by the patient at home and also with the help of a physiotherapist experienced in shoulder problems (three sesssions a week).

During this programme, which is designed to increase mobility and strength, you will need a great deal of discipline, energy and motivation in order to restore good shoulder function. During the physiotherapy sessions you will not only relearn how to perform all the movements, you will also receive regular check-ups from your physiotherapist. You will also need to come and see me for regular check-ups. At first, you will be asked to try and hold your arm in a controlled manner in various directions (isometric exercises), initially with a shortened lever arm, i.e. with the arm flexed at the elbow.

You will then start to actively raise and lower your arm with increasing regularity and perform rotational movements of the shoulder. Some of these exercises are illustrated in the physiotherapy section at the end of this booklet. Increasing the mobility and strength of your shoulder should be a source of pleasure, not pain. Physiotherapy of the reconstructed RC should only continue until it starts to hurt and no further. In the course of time you will be given exercise apparatus for use at home. Such devices include the Poulimed, a system of ropes and pulleys that can be hung from any door and that allows you to train all the RC muscles under gradually increasing loads.

Another option for a later stage are the familiar Thera-Band exercise bands. Passive stretching exercises after an RC reconstruction should be undertaken very carefully under the supervision of a fully competent specialist.

This phase lasts approx. 2-4 months until full rehabilitation is achieved, depending on the type and difficulty of the reconstruction.