Houston Methodist. Leading Medicine

Shoulder FAQ

Question:

My sister had a rotator cuff repair last week. The surgeon sent her to a specific physical therapist in town, but I want her to go to my therapist. Can she switch without telling the doctor?

Answer:

It may not be advised without consulting with the surgeon first. Some therapists have additional specialty training that makes them a better choice for something like rotator cuff surgery. Surgeons spend time communicating with one therapist (or even a group of therapists) the type of surgery they do and what's required in a rehabilitation program for the patient's best outcome. It's best to see someone who has an understanding of the required surgery-specific rotator cuff rehabilitation program. To put this a little different way, results of surgery depend on two things -- good surgical repair and a surgery-specific rotator cuff rehab program. That means more than ever, PTs and orthopedic surgeons communicate with one another about what kind of surgery was done, what the patient needs, and the best way to approach functional rehabilitation. For example, there three types of rotator cuff repair techniques. These include 1) open rotator cuff repair, 2) mini-open rotator cuff repair, and 3) all-arthroscopic rotator cuff repair. Each one has its own advantages and disadvantages. Therapists know that patients who have an open incision approach must be treated differently than an all-arthroscopic procedure. The difference lies in the fact that the deltoid muscle is cut in a traditional open rotator cuff repair. For example, the patient must avoid contracting the deltoid muscle for up to eight weeks. It takes a full month longer for patients with an open-incision to regain their previous level of activity compared with even the mini-open repair. The rehab program moves along at a pace that is directly linked with the size of the tear. Larger tears with more tissue damage and greater retraction of the tendon take longer to rehab. A more conservative approach is used. The surgeon must let the therapist know the condition of the tear at the time of the surgery. Where was it located? How large was the tear and in which direction? Was it L-shaped, U-shaped, or crescent-shaped? What fixation method did the surgeon use to repair the tear (single-row sutures, double-row sutures, suture bridge)? In a surgery-specific rehabilitation program, the rehab timeline can then be matched to small, medium, and large tears. Your sister may want to ask her surgeon if it's okay to switch therapists. But be aware that most surgeons want consistency in a program. Having one therapist see the patient from beginning to end is usually preferred. Having to communicate necessary information to another therapist takes extra time for everyone. Neil S. Ghodadra, MD, et al. Open, Mini-open, and All-Arthroscopic Rotator Cuff Repair Surgery: Indications and Implications for Rehabilitation. In Journal of Orthopaedic & Sports Physical Therapy. February 2009. Vol. 39. No. 1. Pp. 81-89; A1-A6.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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