Shoulder Surgery has progressed, has the Rehabilitation?

Authors: Lennard Funk

References: Published in International Musculoskeletal Medicine, 2012


The published clinical literature has shown the following:

  1. Strict immobilization results in functional instability with rotator cuff inhibition, muscular atrophy, and poor neuromuscular control.
  2. Moderate stresses should be placed on the suture line before the end of three weeks to influence the scar tissue outcome.
  3. Increased stress within a certain limit enhances ligament healing and improves joint function.
  4. Closed chain exercises are an integral part of accelerated rehab programmes. They should be started early and used throughout the rehab process.
  5. Accelerated rehabilitation promotes functional recovery and reduces post-operative pain which allows patient early return to desired activities.
What we know is that early safe mobilization is good for strength, tendon healing, improved kinetic chains, and proprioception. We also know that there is no difference with regard to stiffness. However we do not currently know the effect of immobilization or mobilization on tendon re-tear rates. Post-operative rehabilitation, however, needs many other considerations. These include reducing the pain, range of movement, muscle power, muscle flexibility as well as timing. These are all required to return a patient to his normal daily activities or sports.

In summary, we have shown that both arthroscopic shoulder surgery and rehabilitation have progressed significantly. The rehabilitation has progressed thanks to advances in tendon healing, mechanical adaptation studies, the advances in kinetic chain rehabilitation, our understandings of proprioception, and early mobilization. Unfortunately this work has not been universally applied in clinical practice, possibly due to tradition, fear, and ignorance. With continued clinical research and outcomes further advances in rehabilitation of the shoulder should improve outcomes for our patients.

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