This post is bought to you by the letter 'P'

Hello again. Today is Wednesday 26th April 2017, three weeks since my rotator cuff repair with GraftJacket. I'm tending to post weekly at the moment as each week I'm permitted to add something else to my list of rehab movements, so that gives me something to write about.

I'm still wearing the sling most of the time, removing it to shower and dress and of course, do my limited exercises. Last week I started doing pendulums, a couple of days ago I added the pulley to my routine, plus I am now able to do some passive movements - so I guess this post is bought to you by the letter 'P'.

P is for:

- Pendulums - I spoke about these in my last post. They are sometimes referred to as Codman exercises, after the surgeon Ernest  Codman who was the first surgeon to perform a repair of the rotator cuff and one of the pioneers of modern methods of outcome monitoring using data gathered from real patients. You can read all about the man and his work here.

 

- Pulley - I cannot recommend an exercise pulley enough for helping to regain range of motion in the early stages. A simple exercise pulley costs little and provides and almost completely passive way to raise and lower the arm through it's main arc of movement. It's not really effective for rotational range, but for abduction (out to the side) and flexion (out to the front), it is highly effective.

- Passive - I am using passive movement to gently push my external and to a lesser extent, my internal rotation. I lie on my back with my elbow at 90degs, rested on a cushion near to my side. I grasp my wrist (or you can use a stick as in the picture) and gently rock it to invoke internal and external rotation of the shoulder. As this is only 3 weeks since surgery, little or no force is used and we stop at pain. Doing this 4 or 5 times a day, I'm seeing small improvements in range each time.

So that's all good stuff. I'm not getting any clicking or unduely painful sensations, although there is still some residual pain from the surgery and it doesn't feel strong nor normal - it's early. However, there are some things we should avoid:

Cross-body movements - stretching the arm accross the body (e.g. scratching the opposite shoulder) is out until at least 6 weeks. This is becasue the supraspinatus (and infraspinatus) is stretched to it's limit by cross-body movement.

Full rotation - whilst I'm getting some rotation back, forcing full external or internal rotation is ill advised as it stretches the deltoid and rotator cuff. Internal rotation is particularly risky early on and I'm waiting until 6 weeks before exploring this to any extent.

A word on progress:
For some people reading this, the progress I'm making may seem fast, to some it may seem slow. If you have had a similar procedure and you are worried about your progress, please do not compare yourself with what you read here as we are all different. I would say the GraftJacket implant allows for a robust-enough repair to begin gentle penulums and to start increasing ROM at 2-3 weeks. Some surgeons still allow this with conventional repairs, especially where a double-row fixation like a speed-bridge has been used, but this is not always the case. It is true that the earlier movement can begin, the less stiffness is likely to persist and the quicker full movement will return. However, you may be kept immobilised by your surgeon for longer and for good reason. Listen to them and follow your protocol, as I am doing.