Reduced ROM following surgery for severe rotator cuff injury

[Buttersj]

Hi all,

I have an 84 year old male patient who is 6 months post-surgery for a very severe Rot Cuff traumatic injury. Repair of all Rot Cuff tendons, capsulotomy, AC jt excision and non-repaired rupture of LHB. His humeral head is anteriorly placed approx. 1.5 cm > opposite. I saw this patient 5 months post-op and he had a lot of scar tissue and adhesions, hiking of the shoulder in all movements, an altered scapulohumeral rythmn, muscle atrophy and weakness; AROM: ABD=30 Flex=25 HZ ADD 10% ER=45 IR=35 PROM: ABD=70 FLEX=40. The patient is compensating with overactive traps. His scapula is abducted with some dynamic winging.
So far I have used Passive ROM EXS, Periph & Accessory GH Jt Mobs, AAROM EXS in supine, pulley, UL ergometer, Scap setting and resistive band work for Rot Cuff. However, despite some improvement (his PROM in ABD = 90, Flex 50 improved scaphum rythmn) his AROM is progressing so slowly!

Any advice or thoughts would be much appreciated.

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[karen.hankey]

What is restricting his AROM. Is it pain, or is there an end-feel there?

[rockin ronnie]

my feeling is, good luck with that one. If he has better activation in supine then you could work his anterior/lateral deltiod with short/long lever arm raises against resistance. You need to make sure he is doing exercises to fatigue. otherwise if his shoulder is painful then TSJR might be the way to go. If he isn;t to painful then he may just be stuck with what he's got.

[Buttersj]

Thanks for the replies,

I should have said that he has no pain, just some discomfort at end of available range (if I try to push past this). I cannot reduce the position of the hum head with mobilisations, I therefore feel advice from his surgeon is necessary (possibly with a view to a MUA). Just wondered if being more forceful would help, I recently read an article that stated that an aggressive programme is necessary for stiff shoulders, but I am concerned about damaging his remodelling tissues.

Any comments will be much appreciated.

[linbin]

hi
if you feel upper trapezious is getting activated more,try resisted shoulder depresssion exercises.also please try to strengthen serratous anterior as it forms the main force couple with trapezious,try scapular adductor,posterior deltoid.then try movements of g-h joint in scaption plane.check how's the movement of g-h joint while stabilizing and restricting scapular motion.

[Yarok]

Hi

if want improve ROM try MuscleEtechniques or sport stretchings instead passive stretches
thanks

[Judith Mollet]

If the LHB = long head of biceps hasn't been repaired I recken we won't be seeing the anterior position of humeral head improve/reduce much, maybe low grade work with subscapularis could help.
If you've already been thro the low grade tonic /proprioceptive bits of stabilising done in "kinetic control" then good luck to you both!
How is his compliance ?
Regards