Degenerative ruptures are the natural evolution of a chronic tendinopathy of the cuff and of an external subacromial conflict.
Traumatic ruptures are related to young patients, “overhead” sportspeople while performing an athletic activity, or are the consequence of falls on the shoulder in case of accidents, being usually associated with anterior dislocations of fractures of the humerus.
The treatment is usually conservative when dealing with partial ruptures, with continuous check-ups that allow the autonomy of the patient in the everyday life.
Complete lesions, instead, have a worse prognosis and surgery is in the most of the cases the only solution, as well as for the partial lesions that seem not to respond to the conservative therapy after a few months.
The surgical repair of lesions can be performed both in open-pit or arthroscopy. In this case, the damage from which the periarticular tissues might suffer is limited and rehabilitation is less difficult.
The aim of the surgeon is to re-establish the so-called “footprint”, that is the correct anatomy of the insertion of tendons on the humerus. When the injury is inveterate, the retraction of the tendinous stumps and the degeneration of fibres can impede the surgeon from performing an anatomic re-insertion. In this occurrence, the specialists will aim at rejoining the edges of the lesion. A long term positive outcome of surgery depends on the integrity of the suture. The technique of the double row of suture is gaining ground, since it seems to implement the percentage of good long term outcomes.
It is extremely important in the management of the rehabilitation programme the collaboration with the surgeon who will have to supply us with information about the features of the tissue, the degree of tension of the applied sutures and the objects shared with the patient before surgery.
The rehabilitation programme needs to be accurately structured and monitored, keeping in mind two exigencies: paying respect to the biologic recovery of the suture and providing precocious stimulus in the sphere of the range of movement recovery.
Rehabilitation treatment after rotator cuff injury is very different depending on the reconstruction and the surgery that has been performed, so we’ll just provide some basic principles. Arthroscopic access, when possible, has more advantages in the duration and quality of the recovery intervention rather than open air surgery.
The rehabilitative period therefore depends on the type of surgery, the type of guardian and limitation of its use.
After removing the guardian you can start the recovery of range of motion in the pool with movements in flexion-extension and avoiding external rotation. And most of all, in this delicate phase, should be avoided sudden movements and forcing. This phase ends with the consultation of the surgeon only upon completion of the ROM.
Next you need to strengthen the muscles of the shoulder girdle, the deltoid, biceps/triceps, dorsal and pectoral and then the intra-rotators and external rotators of the shoulder through isometric exercises at first and then isotonic with increasing intensity elastic.
After the isokinetic testing to confirm that you have objectively recovered the strength, you must complete the therapeutic procedure with the resumption of preoperative sports activities with fluidity, resistance to movement exercises and education and prevention.