Arthroscopic Rotator Cuff Repair

 |  Medical Procedures  | 

Post Operative Instructions

Arthroscopic rotator cuff repair is done using minimally invasive techniques. Prior to surgery, you have worked extensively with your therapist to strengthen the rotator cuff muscles and regain your shoulder motion. After surgery, you will be concentrating on regaining your preoperative motion and eventually strengthening the muscles again. This page will describe the therapy and your postoperative course.

Here are some links that describe the anatomy, the treatment, and the surgery that you have just had:

http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=531&topcategory=Shoulder

http://orthoinfo.org/indepth/thr_report.cfm?Thread_ID=2&topcategory=Shoulder

During surgery I will take pictures of the inside of your shoulder. These will be given to you before you leave the hospital. Please bring them to your first clinic appointment so that we may review your surgery together. These are the only copies, so be sure to hold on to them for future reference.

At the end of your surgery, a catheter will be placed under the shoulder's acromial process (the bony bump on the top of your shoulder and at the top of your arm) and above the rotator cuff repair. It contains pain medication (usually marcaine, a local anesthetic) which will be carefully delivered by a computerized pump into your shoulder to reduce the pain of the operation. Between this pain pump and the addition of an interscalene block, you should be quite comfortable. The interscalene block is the set of shots the anesthesiologist placed in your neck prior to the surgery. This block usually last 12 to16 hrs. Pain medication by mouth will be prescribed to help with any further discomfort you may experience. Take this medication as directed. The pain pump will last for 72 hours or so, and the catheter should be pulled out of the shoulder at the end of that period. The catheter for the pain pump looks like heavy fishing line, is very thin and durable, and should not hurt when it is pulled out. Just throw the pump in the trash and change your dressings at that time.

A sling will also be placed on the operative arm at the end of the operation. This is for comfort and also should be worn at night for sleep for the first three to five days after the surgery. It is a good idea to sleep in a recliner for these first few days. This just keeps you from rolling over on the shoulder and causing pain. It is unlikely that you will do any damage to your shoulder should you roll over in bed. The recliner may be more comfortable for you during this time. Patients who don't have a recliner should prop themselves up in bed with many pillows for the same result.

Showers can be taken on post op day three after the pain pump has been removed. Please do not take a bath or swim until sutures are removed or you are seen in the office. Swelling and discoloration are common. Redness outside of the suture line and drainage occurring longer than three days post operatively should be brought to my attention immediately. Please call the office if you have questions or concerns.

Physical therapy begins at home when pain permits. This should start by day two or three. Carefully remove the sling and allow your hand to point to the floor straightening the arm at the elbow. Lean over and begin gentle swinging motions, circular motions, and figure of eight motions. This set of exercises is described as pendulum or Codman exercises. These can be done as frequently as tolerated and are great to get the shoulder moving.

Passive exercises such as Codman exercises are always encouraged immediately postoperatively. Most rotator cuff repairs may begin active motion exercises as soon as pain permits.

If the tear of the rotator cuff is large, or the repair difficult, I may restrict your motion in the early postoperative period to just the Codman exercises. All others may proceed to active assisted exercises such as pulley and broomstick motions as soon as pain permits. Resistance exercises do not start until the end of the sixth week after surgery. This allows the repair to fully heal prior to putting any stress on it. Be sure not to do the isometric or rotational exercises until instructed by me or by your therapist.

Please refer to the following link for explanations of the therapy after a rotator cuff repair below:

http://orthoinfo.aaos.org/booklet/view_report.cfm?Thread_ID=19&topcategory=Shoulder

Your first postoperative visit happens about 7 to 10 days after the surgery. Wounds will be checked and the pictures will be reviewed. I will also discuss the upcoming therapy and answer any questions you may have.

Your second postoperative visit will occur at the 5 to 6-week mark. I will assess your range of motion, and we will begin strengthening in therapy at this time. Hopefully you will be back to full strength at the 10 to 12-week mark. All restrictions will be lifted at this time, and your strengthening exercises will continue at home with the therabands.

By this time, you are well on your way to a successful recovery after a rotator cuff repair.

Notes

Some patients will have had a small incision to repair the tendon if it is impossible to repair through the scope. I do not perform formal open repairs of the rotator cuff; I prefer to do this with minimally invasive techniques either entirely through the scope, or with a mini- open technique.