Prior to Surgery

• Shoulder immobiliser to be fitted by physiotherapist

• Patient informed of early postoperative expectations:

  • May shower in collar and cuff sling and do pendulum exercises - 30 seconds twice daily from the day following surgery

  • One week post-op: see physiotherapist and start supine passive external rotation to neutral and supine passive forward elevation towards 90 degrees

  • Two weeks post op: see physiotherapist to check exercises and remove abduction bolster component of sling

  • Note: in some cases the sling must be worn full time in the first week and showering and pendulum exercises commence one week post surgery

Procedure

• General anaesthetic with local anaesthetic

• One night in hospital, sometimes two

• Surgery through arthroscopic (keyhole) approach or small incision, depending on tear pattern

• Commonly have decompression (acromioplasty) to increase the subacromial space

• Long head of biceps examined and may have tenotomy or tenodesis if indicated.

• Torn tendons sutured, commonly attached to bone using suture anchors

• Sling applied

Rehabilitation

• Sling use and passive movement protocol for first 6 weeks

• Wean off sling 6 weeks from surgery over a 3 day period

• From 6 – 12 weeks, light use of arm in comfort range (not lifting heavier than 2 kg)

• Physiotherapy guided rehabilitation to work on posture, scapula control and range of motion

• Strengthening exercises 3 months from surgery, gradually building up use accordingly. Initially Thera-Band strengthening, sometimes gym-based strengthening depending on the requirements

• The first 3 months is the ‘hard work’ period, but improvement continues for more than 12 months

Goals

• Little or no pain

• Improved strength and function

• Should never attempt very heavy lifting, especially overhead or with a wide arm span. Should never attempt to throw hard

• Many patients rate their shoulder as ‘90% normal’ or better

Risks

The risks include, but are not limited to:

• General risks of surgery

  • Anaesthetic risks

  • Medical risks

  • Infection

  • Nerve injury

  • Pain, including dystrophic pain problems

• General risks of tendon surgery

  • Inability to achieve full repair

  • Incomplete healing

  • Re-tearing

  • Problematic stiffness

Return to Work Guidelines

• Often the initial return to work is part time hours and modified duties, gradually building up.

• Sedentary work in sling: 10 – 14 days

• Light two-handed desk height duties: 6 – 7 weeks

• At 6-7 weeks may drive automatic, power steering car for short periods after being out of sling for a few days

• Medium lifting below eye level: 3 months

• Heavy work: may be 4 – 5 months (depending on progress)

Expectations

There is a wide range of expectations dependent on a number of factors, such as the severity of the tear and the general condition of the patient. This outline describes common progress if full repair can be achieved in a healthy patient.

• 3 months post surgery

  • Comfortable at rest

  • ‘70+ %’ return of range of motion. Often still difficult getting hand behind back

  • Commonly some aching felt throughout the muscles around the shoulder and the arm, especially at the end of a busy day

  • Momentary sharp pain with rapid or unexpected movement

  • Often still uncomfortable at night but improving

  • The shoulder still feels weak

  • Overall patients may rate the shoulder ’60 – 70% normal’

• 6 months post surgery

  • Still improving in comfort, movement, strength and function

  • Overall patients may rate their shoulder as approximately ’80 – 85% normal’

• 12 months post surgery

  • Patients may rate the shoulder as ‘90+ %’ normal