Are There Any Benefits of Early Motion After Arthroscopic Rotator Cuff Repair?Here's the drill after arthroscopic rotator cuff repair: you are in an abduction brace for four to five weeks. During that time, you may be given a series of passive exercises to complete. Passive exercise indicates that someone else (family member, physical therapist) is moving the arm for you. The idea is to avoid active muscle contraction that might pull on the healing tissue and disrupt the sutures holding the torn rotator cuff.
As you start to wean off the brace, active-assisted exercise is prescribed. Active-assisted usually means you use your nonsurgical hand to help guide the operative side through the motions. It can also mean someone helps guide your arm but you are actively using your muscles as well.
What is the purpose of these exercises? The goal is to prevent postoperative stiffness, muscle atrophy (wasting), and loss of motion. At the same time, movement is designed to restore function. The question arises: is early passive motion exercise really needed after arthroscopic rotator cuff repair?
With arthroscopic repair, there is much less cutting of the muscles. Healing may (or may not) be disrupted by early motion. Studies with animals actually show a better tendon healing response when the limb is immobilized longer and exercise is delayed. Is it possible the same principle is true for humans?
A study was done in Korea to verify whether early passive motion exercise is beneficial after arthroscopic shoulder repair. They divided a group of patients who had similar characteristics (age, hand dominance, other medical or health problems) into two groups. All rotator cuff tears were small-to-medium in size.
Group one started passive shoulder exercises right from day one after the surgery. Group two was not allowed to move the arm until the brace came off four or five weeks later. Patients with small tears were able to remove the brace after four weeks. Anyone with a medium-sized tear wore the brace an extra week. Everyone did active-assisted movements after the brace came off.
The question then is: did the group who started early passive exercise have a better (or worse) result when compared with the group who waited until the brace was off to begin moving the arm? Using pain, function, and healing (as seen on MRIs and ultrasound studies), they found no difference between the groups.
On the one hand early passive motion didn't assist healing. On the other hand, this approach didn't cause harm by disrupting the healing tissue. The authors propose the idea that early passive motion isn't required after arthroscopic rotator cuff repair. They point out that their patients all had small-to-medium sized tears.
The results of this study are consistent with animal studies and a few other similar studies on humans. More study is needed to confirm the idea that early passive motion may not be needed after arthroscopic repair surgery for small-to-medium rotator cuff tears. At the same time, it would be helpful if researchers could verify that a longer period of immobilization could actually improve the rate of healing.
Yang-Soo Kim, MD, PhD, et al. Is Early Passive Motion Exercise Necessary After Arthroscopic Rotator Cuff Repair? In The American Journal of Sports Medicine. April 2012. Vol. 40. No. 4. Pp. 815-821.
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