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1st May


Factors that Predict Good Rotator Cuff Repair Results

Rotator cuff tears often require surgical repair, if the tears are full thickness (versus partial tears) and cause pain and loss of normal function. However, long term results following surgery vary among people, for a variety of reasons.

Recently published research has looked at factors which can predict who will do the best after the surgery, and who may have more challenges or residual limitations later on. This information can also be used to prepare and modify the rehabilitation in the best possible way following the surgery and even before the operation.

It is not a surprise that younger people in general tend to do better after surgery. For people age 60 and beyond, optimal preparation before the surgery and disciplined rehabilitation and continued home exercise for a full year after the surgery, is therefore of particular importance. The same must be said for people with diabetes or who are obese, who have shown less favorable outcome after surgery.

People with osteoporosis (loss of bone strength and formation) have a greater chance of the rotator cuff repair failing, as the tendon fixation in the bone may not heal as readily or even pull out. The ways to counteract such potential problems are as much the responsibility of the physical therapist as the patient, as the exercise progressions may need to be slower and modified for these people.

People who are active with exercise or in sports generally do better after surgery than people who are more sedentary. In our experience, those who don’t exercise regularly tend not to follow through with their rehabilitation exercises as well either. Therefore, this correlation between exercise and proven better outcome must be clearly explained to these people. They may also need to have a less demanding and lengthy rehabilitation program, in order to improve the likelihood of them sticking to the exercises.

People who had restricted shoulder mobility, or even mild frozen shoulder before the surgery, had worse long term results after surgery in these research studies. This is more likely to occur if there is significant pain in the shoulder before the surgery, if the arm has been kept relatively immobile for some time, and if there is a prior history of frozen shoulder. Typically these people would also develop frozen shoulder following the surgery, and require more lengthy physical therapy rehabilitation. It is important that they start treatment within a week after surgery, with a physical therapist with extensive orthopedic manual therapy training, to address scar tissue that has formed in the joint. Ideally, this should even be started before the surgery. Anybody with significant pain in the shoulder after the surgery or with a history of frozen shoulder should be seen in physical therapy soon after the surgery, as they have a greater potential for building such scar tissue.

The timing of the operation is also important. People who have large tears, which have retracted much, and which have degenerated with ingrowth of much fatty tissue, all have shown worse healing of these repairs. This is likely to occur if a person waits for a long time after the injury before having surgery. Therefore, anybody with sudden onset of significant pain or difficulty reaching or lifting with the arm, should see a shoulder specialist without delay after the onset of symptoms, especially if this occurred from a trauma such as a fall, lifting or overhead sports. In rehabilitation, the exercise progressions may again have to be planned more cautiously, since the tissue quality may not be as good, and rehabilitation exercises for at least a year will be important to sufficiently regenerate and strengthen the repair.

It takes considerable time for the repair to heal and get solid. If this person has little pain and good motion after the surgery, quick exercise progressions over the first 4-6 months after the surgery could put the patient at great risk of re-tearing the repair, which may not be strong enough to handle such physical stress regardless of symptoms. The treating physical therapist must understand this, and thoroughly educate the patient, since the results almost never are as good if a second rotator cuff repair has to be made.

You may know someone who could be interested in this information, so feel free to pass this letter on. If you don’t know this already, we post our newsletters on our website, going back several years.

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