A 55-year-old male is referred to physical therapy following arthroscopic rotator cuff repair performed 2 weeks prior. The patient's injury occurred 3 months ago when he hit a series of repetitive serves during a tennis match while experiencing gradually progressive shoulder pain. The pain did not subside after the match. The pain escalated to the point where it was present at rest, during sleep, and with all activities of daily living. The patient consulted the referring orthopaedic surgeon who evaluated his shoulder and found significant weakness in the right (dominant) shoulder in external rotation and elevation and pain along the anterior and lateral margins of the acromion. An MRI scan with contrast enhancement showed a 2-cm full-thickness tear in the supraspinatus tendon extending posteriorly into the infraspinatus without a concomitant labral tear. The patient was found to have a type II acromion. The patient successfully underwent an arthroscopic rotator cuff repair using suture anchors and a modest acromioplasty to address the type II acromion. He was given immediate postoperative instructions including: Codman pendulum exercises, shoulder shrugs and scapular retractions, grip-strengthening exercises, and instructions to use a sling to protect the shoulder. Two weeks after the surgery, the patient had his incisions inspected, external sutures removed, and he was referred with the order of "evaluate and treat" to physical therapy. The patient presents with the right shoulder immobilized in a sling with a pillow that places the shoulder in approximately 20° of abduction in the scapular plane. He has no complaints of radiation of symptoms into the distal right upper extremity and he rates his pain on the visual analog scale as 2/10 at rest and 5/10 with movement of the right shoulder. The patient's medical history is otherwise unremarkable.
Based on the patient's diagnosis and surgery, what do you anticipate may be the contributors to his activity limitations?
What are the most appropriate physical therapy interventions?
What is his rehabilitation prognosis?
ACROMIOPLASTY: Surgical procedure whereby the surgeon removes the anterior-inferior portion of a type II acromion to more closely resemble a flat type I acromion
ROTATOR CUFF TEAR: Tearing and failure of the tendon of the supraspinatus and infraspinatus rotator cuff muscles; tears can be full thickness (involving entire thickness of the rotator cuff) or partial thickness. Partial-thickness tears can involve the superior (bursal) surface or inferior (articular) side of the tendon. Superior partial rotator cuff tears result from abrasion and impingement of the rotator cuff tendon against the coracoacromial arch, whereas articular side partial-thickness rotator cuff tears most often result from tensile overload of the muscle tendon unit.
TYPE II ACROMION: Acromion with a curved shape from an anterior to posterior (sagittal plane) orientation. A type I acromion is flat, allowing for maximal room in the subacromial space.
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