Another Controversy for Physical Therapists: Rotator Cuff Repair

Every year forums and discussion boards have a topic revolving around the use of guidelines or protocols for postoperative rotator cuff repair.  What interventions are provided to the patient and at what point postoperatively?  I will assume the largest factor motivating the conversation is the simple fact that rotator cuff repairs can and do fail.  Mike Reinold, PT is the first person I think of when it comes to passion highly focused on the shoulder (and part of that is because he has taken advantage of blogging and tweeting).  Interestingly, his current blog topic deals with exactly what I planned on discussing today:  how do physical therapists determine how they treat someone with a rotator cuff repair?

First of all, how soon after the repair should physical therapy services be initiated?  Does the surgical procedure matter?  How much consistency is there between surgeons in how they decide to repair a torn rotator cuff?  Does the size or location of the tear matter?  Do any of those factors really matter?  What are the outcomes between the various guidelines?  (In other words, is there a clinically detectable difference in outcomes between guidelines?  Is common sense a better guide?  If you toss out guidelines or protocols, is there any definite, for sure, "don't do X" advice because the "don't do X" will have a high probability of contributing to repair failure?

Personally, I agree there is controversy with this topic.  From what I have read over the years with how physical therapists treat this particular postoperative condition, there isn't consistency.  Now, it isn't all on the shoulders no pun intended of physical therapists.  Reality is more often than not orthopaedic surgeons refer postoperative patients to physical therapists.  So... the lack of consistency might be more related to the lack of knowledge or lack of evidence on behalf of the surgeons.  I honestly don't know, just sayin'.

On February 19 from 1-4 pm during the American Physical Therapy Association Combined Sections Meeting a session titled, "Controversies in Rehabilitation Progression Following Rotator Cuff Repair: An Evidence-based Consensus Guideline by American Society of Shoulder and Elbow Therapists" will be led by Brian Leggin, PT, Charles Thigpen, PT, Reg Wilcox III, PT and Gerald Williams, Jr., MD.

photo by Grace via Flickr

~Selena