Imagine you just had shoulder surgery for a rotator cuff tear and your doctor gave you a packet full of strict instructions that you’re now supposed to follow for months and months. Early on these restrictions are extremely limiting. He can’t be serious, can he? I mean, does it really matter if you don’t wear your sling all the time or lift your coffee mug before you’re supposed to?
Sample instructions for weeks 0 – 6 after surgery from Massachusetts General Hospital:
1. Sling – Use your sling most of the time. Remove the sling 4 or 5 times a day to do pendulum exercises.
2. Use of the affected arm – You may use your hand on the affected arm in front of your body but DO NOT raise your arm or elbow away from your body. It is all right for you to flex your arm at the elbow.
*No Lifting of Objects
*No Excessive Shoulder Extension
*No Excessive Stretching or Sudden Movements
*No Supporting of Body Weight by Hands
A 2015 article in the Journal of Elbow and Shoulder Surgery reported results of a study researching this very issue: does patient compliance influence re-tear rates after surgery? They found the answer is YES.
Out of 127 cases, 29% had a re-tear within 26 weeks (~ 6 months) after surgery. Patient non-compliance was highest (17.3%) during weeks 6 – 12, which is typically when patients begin to wean off their sling. Most of the re-tears happened during this time-frame: the first 12 weeks when the repairs were new and instructions were most strict.
Several contributing factors were reported, such as having a large tear to begin with, a poor quality tendon with a lot of retraction, or a high-tension repair with poor footprint coverage. However, the authors state that, “only the postoperative compliance was significantly associated with the cuff failure as an independent prognostic factor at all the assessment periods.” Patient non-compliance stood out as a major risk factor for re-tearing!
What does this mean for you as a patient?
Do whatever you can to follow the rules. You may not know if you have other factors against you, putting you at risk for re-tearing. Take control where you can and be careful!
What does this mean for me as your physical therapist?
In addition to helping restore your shoulder range of motion, strength, and function, my job is to provide you with encouragement and accountability to adhere to your protocol, especially early on. You’ve been through a lot and you will be so glad you stuck it out when you finish strong with a healthy shoulder!
Shahrulazua A, Haber M, Bokor DJ. The influence of intraoperative factors and postoperative rehabilitation compliance on the integrity of the rotator cuff after arthroscopic repair. J Shoulder Elbow Surg 2015; 24: 229-235. http://dx.doi.org/10.1016/j.jse.2014.06.050