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=Rehabilitation of Rotator Cuff Injury=

Treatment
After experiencing a rotator cuff tear, minimally invasive surgery is needed in order to repair the torn tendon. After surgery, the rehabilitation of the rotator cuff is necessary in order to regain maximum strength and range of motion within the shoulder joint. Physical therapy progresses through four stages, increasing movement throughout each phase. The tempo and intensity of the stages are solely reliant on the extent of the injury and the patient’s activity necessities. The first stage requires immobilization of the shoulder joint. The shoulder that is injured is placed in a sling and shoulder flexion or abduction of the arm is avoided for 4 to 6 weeks after surgery (Brewster, 1993). Avoiding movement of the shoulder joint allows the torn tendon to fully heal. Once the tendon is entirely recovered, passive exercises can be implemented. Passive exercises of the shoulder are movements in which a physical therapist maintains the arm in a particular position, manipulating the rotator cuff without any effort by the patient. These exercises are used to increase stability, strength and range of motion of the Subscapularis, Supraspinatus, Infraspinatus, and Teres minor muscles within the rotator cuff. Passive exercises include internal and external rotation of the shoulder joint, as well as flexion and extension of the shoulder. As progression increases after 4-6 weeks,active exercises are now implemented into the rehabilitation process. Active exercises allow an increase in strength and further range of motion by permitting the movement of the shoulder joint without the support of a physical therapist. Active exercises include the Pendulum exercise (as shown in Image 2), which is used to strengthen the Supraspinatus, Infraspinatus, and Subscapularis. External rotation of the shoulder with the arm at a 90-degree angle is an additional exercise done to increase control and range of motion of the Infraspinatus and Teres minor muscles (Andrews, 2009). Various active exercises are done for an additional 3-6 weeks as progress is based on an individual case by case basis. At 8-12 weeks, strength training intensity will increase as free-weights and resistance bands will be implemented within the exercise prescription.



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