Rotator cuff (RC) disease is a frequent cause of shoulder pain and can result in weakness, alterations in glenohumeral kinematics, and shoulder instability in some circumstances. Symptomatic rotator cuff tears are thought to affect between 4% and 32% of the population and appear to be more prevalent with increasing age. Although patient age, activity level and tear size influence surgical decision-making, non-surgical management is frequently the preferred method of initial treatment after a rotator cuff tear. When non-surgical management of a symptomatic rotator cuff tear is not successful, operative repair is frequently necessary. Both open and arthroscopic repair of full or high-grade partial thickness rotator cuff tears have historically provided satisfactory pain relief and improvement in functional outcome scores.
While successful arthroscopic rotator cuff repair requires meticulous surgical technique, it is also apparent that an individualized rehabilitation protocol supervised by skilled therapists is equally important. Rehabilitation protocols have traditionally varied considerably among providers with respect to timing of progression and appropriate therapeutic exercise.10 To this end, rehabilitation protocols are frequently based on clinical experience and expert opinion rather than scientific rationale.
The purpose of this clinical commentary, therefore, is to provide an update on current treatment strategies used in rotator cuff repair rehabilitation. The scientific rationale behind current treatment strategies is discussed where available.