After rotator cuff tear surgery, would it really hurt anything to give a tiny bit of movement?

Q: I had surgery for a rotator cuff tear two weeks ago. I'm wearing the abduction sling but I truly hate it.  I've been given instructions by the surgeon but told not to do anything more than dangle and do circles with the arm while dangling. Would it really hurt anything to give it a tiny bit of movement?

A: The nonhealing rate after rotator cuff repair is fairly high (20 to 90 per cent). This is the case despite all the improvements in the surgical technique and the less invasive aspect of arthroscopic surgery. The reasons for such a high rate of tendon failure-to-heal remain unknown. Size of tear, age, and compliance with post-operative recommendations have been suggested as three of the top possibilities.

As a patient, you can't do anything about the size of the tear or your age, but you can follow the surgeon's recommendations carefully to reduce the risk of a retear or failure to heal. Having said all that, we can tell you there are some surgeons studying the effect of early motion after arthroscopic rotator cuff repair for small-to-medium sized tears.

Animal studies seem to suggest that a longer period of immobilization may actually enhance tendon healing. Early motion is thought to help reduce stiffness and pain but might be counterproductive. The results of a recent study from Korea provide us with some additional information.

They divided a group of patients who had similar characteristics (age, hand dominance, other medical or health problems) into two groups. All rotator cuff tears were small-to-medium in size.

Group one started passive shoulder exercises right from day one after the surgery. Group two was not allowed to move the arm until the brace came off four or five weeks later. Patients with small tears were able to remove the brace after four weeks. Anyone with a medium-sized tear wore the brace an extra week. Everyone did active-assisted movements after the brace came off.

The question then is: did the group who started early passive exercise have a better (or worse) result when compared with the group who waited until the brace was off to begin moving the arm? Using pain, function, and healing (as seen on MRIs and ultrasound studies), they found no difference between the groups.

On the one hand early passive motion didn't assist healing. On the other hand, this approach didn't cause harm by disrupting the healing tissue. The authors propose the idea that early passive motion isn't required after arthroscopic rotator cuff repair. They point out that their patients all had small-to-medium sized tears.

It is highly recommended that you follow your surgeon's instructions. But you can certainly make a follow-up appointment to discuss your proposed changes in the protocol. There may be specific reasons why the surgeon has made the recommendations you have been given. Knowing what those are might help ease your "itch."

Reference: Yang-Soo Kim, MD, PhD, et al. Is Early Passive Motion Exercise Necessary After Arthroscopic Rotator Cuff Repair? In The American Journal of Sports Medicine. April 2012. Vol. 40. No. 4. Pp. 815-821.