Comparison of Rehabilitation Protocols After Rotator Cuff Repair Surgery: Case Study

Abstract

Background: Rotator cuff repair surgery is commonly performed to restore shoulder strength, reduce pain, and improve functional use of the upper limb after symptomatic tendon tear. Postoperative rehabilitation is essential because the repaired tendon must be protected while stiffness, muscle inhibition, scapular dyskinesis, and fear of movement are gradually addressed. Two widely used rehabilitation strategies are an early controlled motion protocol and a delayed protective motion protocol. Early controlled motion emphasizes protected passive range, scapular control, pain-free mobility, and timely progression to active assisted exercise. Delayed protective motion prioritizes tendon healing, sling compliance, inflammation control, and slower progression before active loading. Clinical comparison at the case level is useful because the balance between mobility and protection varies with tear size, tissue quality, pain irritability, patient confidence, and surgical precautions.

Presentation of Cases: This comparative case study presents two adults following arthroscopic rotator cuff repair for symptomatic full-thickness supraspinatus-dominant tears. Case A followed an early controlled motion protocol, whereas Case B followed a delayed protective motion protocol. Both patients were medically stable, had surgeon clearance for physiotherapy, and participated in a twelve-week supervised rehabilitation schedule with comparable therapist contact and home instruction. Baseline assessment included pain, active and passive shoulder range of motion, scapular posture, sling tolerance, sleep disturbance, fear of movement, hand-to-mouth ability, overhead activity readiness, and functional use during grooming, dressing, household work, and occupational tasks.

Intervention: The early controlled motion case received education, sling use outside exercise periods, pendulum activity, passive flexion and external rotation within repair limits, scapular setting, thoracic mobility, distal joint mobility, gradual active assisted elevation, low-load isometrics, closed-chain proprioceptive drills, and later progressive strengthening. The delayed protective motion case received prolonged sling protection, pain and swelling control, supported positioning, elbow-wrist-hand exercises, gentle scapular retraction, breathing and posture work, delayed passive mobility, cautious active assisted motion, and slower strengthening progression. Progression criteria were based on pain response, range tolerance, repair precautions, movement quality, and ability to complete home exercises safely.

Outcome Measures: Recovery was documented using the Numeric Pain Rating Scale, Shoulder Pain and Disability Index, American Shoulder and Elbow Surgeons score, Quick Disabilities of the Arm, Shoulder and Hand score, goniometric range of motion, manual muscle testing, handheld dynamometer screening, scapular observation, sleep tolerance, and a functional activity log developed for this case comparison.

Results: Both protocols improved shoulder pain, mobility, strength, and daily function. The early controlled motion case demonstrated faster gains in passive and active range, earlier confidence during grooming and table-level tasks, and quicker reduction in stiffness. The delayed protective motion case demonstrated better early comfort, fewer flare-ups, stronger adherence to tendonprotection precautions, and gradual but steady gains after the immobilization phase. At twelve weeks, both patients improved on impairment and activity-level outcomes. Early controlled motion produced slightly greater improvement in range-dependent activities, while delayed protective rehabilitation produced a steadier pain profile and greater movement security during the early healing period.

Conclusion: The comparative findings suggest that early controlled motion may be useful when pain is controlled and stiffness risk is high, whereas delayed protective rehabilitation may be preferable when tissue protection, pain irritability, or apprehension are dominant concerns. Individualized progression is essential after rotator cuff repair. Keywords: Rotator cuff repair, shoulder rehabilitation, early controlled motion, delayed protective protocol, arthroscopic repair, physiotherapy, shoulder function, tendon healing.