After a rupture of the rotator cuff, i.e. the muscles surrounding the shoulder are ruptured, the function and stability of the rotator cuff is considerably reduced. The shoulder joint is extremely mobile, thanks to a low bony guidance. Stability is provided by the surrounding muscles, tendons and ligaments, which fix the humerus in the socket. An injury, a tear/rupture, causes the arm to be disabled. The following is a brief guide to the recovery of the rotator cuff after surgery.
Aftercare
A physiotherapeutic intervention and thus also the post-treatment of a rotator cuff rupture always depends on the so-called wound healing phases – our body’s own repair mechanism. The three main phases (inflammatory phase, proliferation phase and consolidation phase) are characterized by progressive processes in the healing chain. A picture of these processes, what is important in the respective phases, what may and should be done and also what is better to avoid, is presented in the following in a short and understandable way.
Wound healing is initiated with the inflammatory phase, day 0 to about day 5. Contents: Tissue has been destroyed (by the rupture itself and also by the surgical intervention), vessels are damaged, blood flows in, the classic signs of inflammation such as swelling, pain, overheating, reddening of the skin and functional impairment occur. Helper cells set to work to close the wound with a quickly created temporary tissue.
Here, gentle treatment is the first step. Raise your arm up to counteract the swelling, cool down a little to reduce the pain. In physiotherapy, a daily lymph drainage is performed to remove the swelling and cell debris.
Gradually, you will start with a slight passive mobilization of the shoulder joint and also adjacent joints, which you will automatically immobilize. In the second phase, around day 5-21, the focus is on new tissue formation. Here it is crucial to convey to the new fibers what they are needed for.
Because if they are only kept still in a gentle position, they adapt to this situation and become sticky and intertwined. In order to avoid this, the shoulder must be regularly moved passively and actively in its physiological sense, and stimuli must be given in the direction of the tensile stress (controlled stretching). Muscles can already be strengthened isometrically to the appropriate degree.
In this way, the fibers of the new tissue are optimally aligned for their later function. Nevertheless, it is important to proceed with caution and not to put too much strain on the tissue yet, which in turn would disturb the healing process. The codeword for this phase is: movement without too much strain.
The final phase in wound healing for complete healing of the rupture can last up to 360 days. The tissue becomes more resilient, more stable. Here the motto is – become active.
The goal is to return to the old function, strength and mobility. MTT (Medical Training Therapy) is suitable for this. Under the supervision of qualified personnel such as therapists and doctors, the affected muscles are trained with targeted exercises.
As mentioned at the beginning, the rotator cuff aims to center the shoulder in its joint. Associated and responsible muscles are: M. teres minor, M. subscapularis, M. supraspinatus and M. infraspinatus. Through individually guided training in MTT, the strength is rebuilt using special equipment, among other things, and thus the joint is restored to its original stability and functionality.
