Discharge Instructions & Physical Therapy Instructions Arthroscopic Rotator Cuff Repair and Mini Open Rotator Cuff Repair

Initial recovery after shoulder surgery entails healing, controlling swelling and discomfort and regaining some shoulder motion. The following instructions are intended as a guide to help you achieve these goals until your 1 st postoperative visit.

Comfort

Although surgery uses only a few small incisions around the shoulder joint, swelling and discomfort can be present. To minimize discomfort, please do the following

• Ice - Ice controls swelling and discomfort by slowing down the circulation in your shoulder. Place crushed ice in plastic bag over your shoulder for no more than 20 minutes, 3 times a day
• Pain Medication - Take medications as prescribed, but only as often as necessary. Avoid alcohol and driving if you are taking pain medication
• Antibiotic Medication - If an antibiotic has been prescribed, start taking the day of your surgery. The first dose should be around dinnertime. Continue taking until the prescription is finished
• Sling - A sling has been provided for your comfort and to stabilize your shoulder for proper healing. Continue wearing the sling for a period of approximately six weeks or until Dr. Forsythe directs you to stop
• Driving - Driving is NOT permitted as long as the sling is necessary

Activities

• You are immobilized with a sling and abductor pillow, full time, for approximately the first 6 weeks. Your doctor can tell you when you can discontinue use of the sling at your 1 st postoperative visit. The sling may be removed for exercises
• Your sling may be removed for gentle PASSIVE range-of-motion (PROM) exercises. (SOMEONE ELSE MOVES YOUR SHOULDER). This should be done 3x a day /15 repetitions (ABDUCTION ONLY - away from your body)
• Active range-of motion (AROM - you move your shoulder) should be performed for shoulder internal/external rotation. Keep elbow positioned at the side and flexed at 90 ° so forearm is parallel to the floor. This should be done within a comfortable range until you feel slight pain (3x a day for 15 repetitions). You can shrug your shoulders
• While your sling is off you should flex and extend your elbow and wrist - (3x a day for 15 repetitions) to avoid elbow stiffness
• Ball squeezes should be done in the sling (3x a day for 15 squeezes)
• You may NOT move your shoulder by yourself in certain directions. NO active flexion (lifting arm up) or abduction (lifting arm away from body) until Dr. Forsythe or your therapist gives permission. These exercises must be done by someone else (Passive Range of Motion)
• Physical therapy will begin approximately 3 - 4 weeks after surgery. Make an appointment with a therapist of your choice for this period of time. You have been given a prescription and instructions for therapy. Please take these with you to your first therapy visit
• Athletic activities such as throwing, lifting, swimming, bicycling, jogging, running, and stop-and-go sports should be avoided until cleared by Dr. Forsythe

Wound Care

• Keep the dressing on, clean and dry for the first 3 days after surgery
• Remove the dressing 3 days after surgery. The steri-strips (small white tape that is directly on the incision areas) should be left on until the first office visit. You may apply band-aids to the small incisions around your shoulder
• You may shower 5 days after surgery with band-aids on. Apply new band-aids after showering
• Tub bathing, swimming, and soaking should be avoided for two weeks after your surgery

Eating

• Your first few meals after surgery should include light, easily digestible foods and plenty of liquids, as some people experience slight nausea as a temporary reaction to anesthesia

Call your physician if

• Pain persists or worsens in the first few days after surgery
• Excessive redness or drainage of cloudy or bloody material from the wounds. (Clear red tinted fluid and some mild drainage should be expected). Drainage of any kind 5 days after surgery should be reported to the doctor
• Temperature elevation greater than 101°
• Pain, swelling, or redness in your arm or hand
• Numbness or weakness in your arm or hand

Return to the office

• Your first return to the office should be within the first 1 - 2 weeks after your surgery. Call Dr. Forsythe's office to make your first postoperative appointment

Physical Therapy Instructions Arthroscopic Rotator Cuff Repair and Mini Open Rotator Cuff Repair

2 TO 5 WEEKS POST-SURGERY

• Patient to continue sling using abductor pillow only at night
• Use of modalities as needed (heat, ice, electrotherapy)
• Continue passive range-of-motion exercises - active-assistive (wall climbs, wand) and active ROM exercises may be added
• Add joint mobilization as needed
• Isometric exercises - internal/external rotation, abduction, flexion, extension
• Active internal/external rotation exercises with rubber/surgical tubing (as tolerated)
• Active shoulder extension lying prone or standing (bending at the waist) - avoid the shoulder extended position by preventing arm movement beyond the plane of the body
• Active horizontal adduction (supine) as tolerated

6 TO 8 WEEKS POST-SURGERY

• Discontinue use of sling
• Continue shoulder ROM exercises (passive, active-assistive and active) as needed
• Continue active internal/external rotation exercises with rubber tubing - as strength improves, progress to free weights

External Rotation: is performed lying prone with arm abducted to 90° or side-lying with the arm at the side - perform movement through available range

Internal Rotation: is performed supine with the arm at the side and elbow flexed at 90°

• Active shoulder abduction from 0° - 90°
• Add supraspinatus strengthening exercise, if adequate ROM is available (0° - 90°) - the movement should be pain free and performed in the scapular plane (approximately 20° - 30° forward of the coronal plane)
• Active shoulder flexion through available range-of-motion (as tolerated)

2 TO 3 MONTHS POST-SURGERY

• Continue shoulder ROM exercises (as needed) - patient should have full passive and active ROM
• Continue isotonic exercises with emphasis on eccentric strengthening of the rotator cuff
• Add push-ups - movement should be pain free - begin with wall push-ups - as strength improves, progress to floor push-ups (modified - hands and knees, or military - hands and feet) as tolerated

2 TO 3 MONTHS CONTINUED

• Add shoulder bar hang exercise to increase ROM in shoulder flexion and abduction (as needed)
• Active horizontal abduction (prone)
• Add strengthening exercises to the elbow and wrist joint (as necessary)
• Upper extremity PNF patterns may be added - shoulder flexion/abduction/external rotation and extension/adduction/internal rotation diagonals are emphasized
• Add upper body ergometer for endurance training
• Add gentle Plyometrics

4 MONTHS POST-SURGERY

• Add advanced capsule stretches, as necessary
• Continue to progress isotonic exercises
• Add military press exercise
• Add progressive Plyometrics including stair-stepper and tilt board
• Add pitch-back beginning with a light ball
• Add total body conditioning program

5 MONTHS POST-SURGERY

• Continue strengthening program - emphasis may be placed on exercising the shoulder in positions specific to the sport
• Continue total body conditioning program with emphasis on the shoulder (rotator cuff)
• Skill mastery - begin practicing skills specific to the activity (work, recreational activity, sports, etc.) - for example, throwing athletes (e.g., pitchers) may proceed to throwing program
• May add progressive shoulder throwing program - advance through the throwing sequence, as needed