Thread: Second time Rotator Cuff

Just got the phone call from my bro that he tore up his shoulder again. Last time it was Labrum, Rotator Cuff, and Biceps tendon. This time, I haven't had a chance to get all the details, but I'm guessing its at least labrum and rotator cuff again since he mentioned 6 weeks in a sling and 6 months recovery. Anyone do this twice? His ROM was extremely shitty after the first one, and his strength suffered as well. Last night at the gym he managed to crank out 55 pullups (10-9-8-7-6-5-4-3-2-1), but he can't lift things overhead.

Will his Strength and ROM decrease after this one? Is that dependent on the surgery and PT? Not sure if he's scheduled anything yet or if he's gonna try to wait until later in the summer so that he can do his recovery during "shoulder season."

Fuck, totally bumming right now as we were signed up to be teammates in an Ultimate league this summer and I'm rebuilding his mountain bike right now, so I was looking forward to hanging out with him this summer, and now he'll probably be cooped up in the house.

What can I expect to see as far as his PT goes? I'm actually starting PT school in a few weeks, but the first semester is all Anatomy and Phys again, no Musculoskeletal diagnoses and treatment for a few semesters (at least according to the schedule).

Sorry to hear about your brother. Rotator cuff surgery is a tough recovery once, let alone twice. The surgery is technically more difficult the second time around, and his surgeon will have a very specific recovery path in mind, so I would adhere to that carefully. The outcome is generally dependent on 1) repair healing, and 2) avoiding stiffness in the shoulder. Obviously, those two things are somewhat at odds with each other - hence, it's a balance between immobilizing the shoulder long enough to heal to the point that some motion is doable without ruining the repair, but not so long that it's entirely healed but then the shoulder's too stiff to move. Therefore, initially there is usually no real PT for range of motion, and after a period of time (dictated by your surgeon) there is a subsequent focus on passive range of motion. Active range of motion comes last so that the rotator cuff doesn't actually fire (and therefore stress the repair) until the repair is healed enough to withstand it.

Best of luck to your brother...

Update:

It is just the rotator cuff. It is apparently a portion near the top of the shoulder that is most affected, so any hard strike to the underside of his arm causing hyperextension is basically the end of it. He's going out to frisbee tonight to see how it goes. He's going armed with KTape and a brace, so we'll see what happens. He's not a huge skier, so I think he's going to try to live up the summer biking and playing disc and then get the repair done in August, as long as he can't cause any irreparable damage in the meantime (still waiting to hear back from the surgeon on that).

Will they hook him up with a CPM this time? They didn't last time, but I've heard good things about them. I think he has to be immobilized for a few weeks following the repair, but not sure on that.

Tell him not to lay out, and he should be fine. I tweaked mine on both shoulders skiing and snowboarding. Never had it fixed, but the ability to lift stuff overhead returned. At the time of injury, I couldn't hold my arm out sideways, more than about 6 inches off my body.

Originally Posted by warthog

Tell him not to lay out, and he should be fine. I tweaked mine on both shoulders skiing and snowboarding. Never had it fixed, but the ability to lift stuff overhead returned. At the time of injury, I couldn't hold my arm out sideways, more than about 6 inches off my body.

Would have a conversation with the surgeon. The problem with rotator cuff tears is that they tend to get bigger with time, but hard to predict which ones will become symptomatic. In turn, when they do become symptomatic, the muscle involved in the tear can by that time become atrophied/scarred enough to make it irreparable. For this reason many surgeons err towards fixing them in a young person like your brother (thankfully, they are rare in young people except in some traumatic situations). The hardest part is deciding what to do with someone like you, Warthog, where there was presumptively a full-thickness tear but the patient became asymptomatic - you can always make a person with painless and full range of motion worse. That's why developing a relationship with a surgeon and having a honest discussion about risks and benefits is key (there's no automatically right answer).