A. Causes

• Pathology: Full or partial-thickness tear of one or more rotator cuff tendons (Supra/Infraspinatus)
• Mechanism: Chronic impingement (wear and tear) or acute trauma (e.g., fall onto an outstretched hand).
• Indication: Surgery is performed to re-attach the torn tendon to the bone.
• Healing Time: Tendon-to-bone healing requires a minimum of 6-12 weeks.

B. Symptoms

• Pre-Op: Pain, weakness, and difficulty with overhead reaching or lying on the shoulder.
• Post-Op Pain: Surgical pain that necessitates controlled movement during early rehab.
• Stiffness: High risk of developing post-surgical stiffness (Adhesive Capsulitis).
• Weakness: Inability to actively lift or rotate the arm due to the repaired tendon.

C. Diagnosis

• Pre-Op: Confirmed by MRI/Ultrasound showing the location and size of the tear.
• Post-Op Monitoring: Strict adherence to the surgeon’s sling and ROM protocol is paramount.
• Assessment Metric: Differentiation between Passive ROM (PROM) and Active ROM (AROM).
• Sling Use: Typically non-negotiable for 4-6 weeks to protect the tendon attachment.

D. Physiotherapy Treatment Plan

• Immediate Phase: PROM (Passive ROM) only, initiated by the therapist/opposite arm; no active contraction of the cuff.
• Immobilization: Strict, continuous use of the sling as prescribed by the surgeon.
• Scapular Stabilization: Gentle isometric exercises for the muscles surrounding the shoulder blade (Rhomboids, Trapezius).
• AROM Progression: Active ROM initiated cautiously (usually 6-8 weeks) once cleared by the surgeon.
• Strengthening: Started with very low-resistance isometrics and gentle elastic band exercises (high reps, low weight).
• contraindication: Avoiding any overhead lifting, pushing, or pulling for several months.
• Functional Goal: Gradual progression to activities of daily living and work tasks that require endurance.
• Patient Education: Highlighting the critical risk of re-tear if protocol is not strictly followed.