(barring over retraction and iatrogenic deltoid
detachment); however, large tears are difficult to
address with this approach.
3.Arthroscopic rotator cuff repair: Further develop-
ment of arthroscopic suture management, arthro-
scopic knot tying, and use of arthroscopically
delivered suture anchors has led to the ability to
perform rotator cuff repairs arthroscopically. The
ability to preserve cortical bone enhances the
strength of fixation while maintaining the ability
of the tendon to heal to bone (St Pierre et al, 1995).
These techniques require a significant amount of
practice and skill at arthroscopic techniques.
Newer techniques and instruments are being
developed and this procedure now can be done as
effectively as open repair (Ellman, Kay, and
Wirth, 1993; Gartsman, Khan, and Hammerman,
1998; Murray, Jr, et al, 2002; Tauro, 1998; Wilson,
Hinov, and Adams, 2002).- Postoperative rehabilitation
•Following surgery, a good rehabilitation program
should be instituted to ensure optimal recovery
(Wilk and Arrigo, 1993).- The rehabilitation is tailored to the operative treat-
ment. Following arthroscopic subacromial decom-
pression, a sling is used for a few days for comfort,
and active motion may be resumed immediately.
Once motion is achieved, strengthening exercises
are started. - Strengthening should focus on lower rotator cuff
strength and scapular stabilization. - Pool therapy is often very effective for shoulder
rehabilitation for regaining proper motion and
allowing protected use of the shoulder muscles in
the recovery period.
•Following rotator cuff repair, the recovery is slower
to allow the cuff to heal to the tuberosities. - The surgeon will direct postoperative range of
motion based on the size of the tear and the stability
of the repair at the time of surgery.
•Passive internal and external rotation can be started
early, with active motion being delayed if the corre-
sponding tendon was repaired.
•Forward elevation may be delayed if the motion will
cause stress on the repair. - More aggressive range-of-motion exercises are
instituted after 4–6 weeks. - Return to sports is recommended when full painless
motion is recovered following surgery. This will
differ for each patient; however, 6–8 weeks is usually
sufficient for decompression alone, and 4–6 months
for rotator cuff repair.
- The rehabilitation is tailored to the operative treat-
- Rotator cuff pathology is a frequent cause of pain in
active patients in all stages of life. From younger
patients participating in throwing sports, to the weekend
athlete developing overuse injuries, to the elderly patient
throwing a baseball with his grandson, the proper diag-
nosis and treatment of this condition can lead to resolu-
tion of symptoms and return the patient to a more
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Surg78A:1015–1023, 1996.272 SECTION 4 • MUSCULOSKELETAL PROBLEMS IN THE ATHLETE