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Early mobilisation following rotator cuff repair

Completed Research

Early mobilisation following rotator cuff repair


Patients diagnosed with a tear of the supraspinatus tendon were invited to participate in a study to evaluate the effectiveness of rehabilitation programs following rotator cuff repair.

Traditionally, patients have been advised by surgeons to follow a program which includes wearing a sling for 4 to 6 weeks which is known as “immobilization” or “immobilizing” the arm. This timeframe has been chosen based on experience rather than on scientific evidence.

Many patients report that spending 4 to 6 weeks in a sling is one of the most challenging parts of rehabilitation. There are also concerns that immobilizing the arm for that long increases the risk of stiffness, discomfort and time it takes patients to return to normal activities of daily living.

Research following surgeries to other joints such as the ankle suggests that decreasing immobilization time does not increase the risk of complications however there have been few such studies on the rotator cuff.


The primary objective of the Study was to demonstrate that the clinical outcome of the healing rate of the tendons is the same between the 2 rehabilitation protocols i.e. the traditional protocol with 6 weeks immobilization and our early mobilization protocol with 2 weeks immobilization.

Integrity of repair on MRI at 6 months was the primary means of measuring outcome. Secondary measurement was via standardized assessments of the shoulder and general quality-of-life assessments at baseline and 6 months.


This was a pilot prospective cohort study that enrolled 20 patients over a one year period.

Study Procedure

Patients had their shoulders immobilized in a standard abduction immobilization sling for 2 weeks. No mobilization and no physiotherapy of the shoulder was authorized during this time. Self-directed mobilization of the elbow, wrist, and hand was performed. The sling was removed at the beginning of the third week post-surgery and gentle activities of daily living (e.g. reading, eating, showering, typing etc.) permitted. The patients were specifically advised against lifting more than 1kg, attempted use of the arm at shoulder height or above, pushing, reaching or climbing. At week 6 post-surgery, a passive and active assisted range of motion protocol was introduced and supervised by a physiotherapist. A strengthening program was introduced at 3 months following surgery. Return to full unrestricted activities was anticipated at 6 months. Standard, functional parameters, patient outcome measures (Constant-Murley Shoulder Score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) and Veterans Rand 36 General Health Survey) and MRI scans were assessed pre-operatively, and post-operatively at 6 months. MRI scans were analysed by a single radiologist for the whole Study group.

Inclusion Criteria

Patient considerations:

  • Age ≤ 70 years old
  • Non smoker
  • No history of inflammatory disease
  • Patients who understand the conditions of the Study and are willing to participate for the length of the prescribed term of follow-up and rehabilitation
  • Patients who are capable of, and have given informed consent to their participation in the Study.

Anatomical considerations:

  • Biceps: Any
  • Isolated tear of the rotator cuff involving the supraspinatus tendon only
  • No marked tendinous retraction
  • Fatty infiltration no more than stage 2 (Goutallier) for any rotator cuff muscle
  • Normal infraspinatus and subscapularis
  • Degenerative or traumatic tear
  • Acromio-Clavicular joint: Any
  • No gleno humeral Osteoarthritis

Surgical procedures:

  • Repair using modern transosseous equivalent double row suture anchor technique
  • Standard immobilization sling
  • Systematic acromioplasty under arthroscopy
  • Full arthroscopic procedure or mini open procedure accepted


  • Post-operative imaging study using the same MRI machine
  • Review of imaging by trained musculoskeletal radiologist

Exclusion Criteria

Patient considerations:

  • Patient aged >70 yrs
  • Smoker or who have been heavy smokers within the last 6 months (i.e. more than 20 cigarettes per day)
  • Diabetic disease
  • Systemic inflammatory disease
  • Genetic collagen disease
  • Previous history of shoulder surgery for any reason
  • Recent treatment with oral steroids within the last 2 months or injectable within the last 4 weeks
  • Patients with an inability to complete post-surgery physical therapy or return for follow-up visits
  • Severely overweight patient, BMI > 35

Anatomical considerations:

  • Muscle fatty infiltration staged more than 2
  • Coronal retraction more than stage 2 (top of the humeral head)
  • Preoperative stiffness in forward elevation (<150°)
  • Shoulder instability or osteoarthritis

Surgical considerations:

  • Another surgical procedure than the ones described

Ethics and Governance

Approved by North Shore Private Hospital Human Research Ethics Committee to be undertaken at North Shore Private Hospital. HREC reference NSPHEC 2013-002.


Baseline Characteristics

Of the 20 patients who were enrolled in the study all 20 completed follow-up including evaluation and MRI. Eight patients were female. The patients’ average age at the time of surgery was 50.9 ± 7.7 year (range 37-67 years). Pre-operative forward elevation was 129±39 degrees (range 60-180 degrees). All patients underwent a subacromial decompression at the time of surgery. Seventeen patients had a biceps tenodesis performed concurrently and two patients had a distal clavicle excision performed concurrently. The length of follow up averaged 6.2 ± 0.5 months (range 6-8 months).

Functional Outcomes

As expected following rotator cuff repair, patient-rated outcome measures improved (table I). ASES scores increased an average of 32.2 points (p<.001) and ranged from an 8 to 73 point increase. Normalized constant scores increased on average 31.5 points (p<.001) and ranged from 3 to 68 point increase. VR 36 physical scores improved on average 11.8 points (p<.001) and ranged from 1.3 to 25.7 point increase. There was no difference in VR 36 mental scores (p =.60).

Physical exam findings improved following rotator cuff repair. Forward elevation improved from 129±39 degrees to 167±23 degrees (p<.001). Abduction did not demonstrate significant change (p=0.24). Post-operative abduction strength measured by dynamometer was 5.4±2.7 kg.

Repair Integrity

Post-operative MRI results demonstrated clinical healing (Sugaya score of 1-3) in 19 patients and a failed repair in one patient with a Sugaya score of 5 (see table II). This represents a healing rate of 95%. No patients had development or progression fatty degeneration of any of the rotator cuff muscles on follow-up MRI. Figure 1 demonstrates an intact rotator cuff repair as seen on post-operative MRI.

With these results, we have concluded that early sling discontinuation following double row rotator cuff repair may be an acceptable option for small non-retracted rotator cuff tears in properly selected patients with a high likelihood of healing.


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Lead Investigator:

Dr Allan Young


September 2013


September 2015


Kruse LM, Falconer TM, Dimmick SJ, Balestro JC, Cunningham G, Cass B and Young AA (2016). Early Sling Discontinuation Following Rotator Cuff Repair. Techniques in Shoulder and Elbow Surgery September 2018 – Volume 19 – Issue 3 – p 106–110


Shoulder and Elbow Society of Australia bi-ennial closed conference Darwin, August 2016

Royal North Shore Hospital Shoulder Symposium, November 2016


Completed Research

{Updated August 2018}

The VAULT Study (Reliability of Glenoid Version Measurement on 3D-corrected axial CT scan)
In Research - Completed

Humeral Head to Greater Tuberosity Angle Study

In Research - Completed

Retrospective Review of the use of the Rota-Lok system for massive rotator cuff repairs

In Research - Completed

Early mobilisation following rotator cuff repair

Propionibacterium acnes
In Research - Completed

Propionibacterium acnes contamination in shoulder surgery

In Research - Completed

Modified Biceps Repair

In Research - Completed

Improving medial footprint coverage in double row cuff repair using FiberTape

In Research - Completed

Rate of P Acnes in arthritic shoulders undergoing primary total shoulder replacement surgery using a strict specimen collection technique

In Research - Completed

Comparative study of physician applied and patient reported Constant Scores utilising bathroom scales to derive force measurements

The VAULT Study - Glenoid Version Measurement
In Research - Completed

The VAULT Study – Glenoid Version Measurement

The FUSE Study (Fitness band Used in Shoulder Evaluation)
In Research - Completed

The FUSE Study – Fitness band Used in Shoulder Evaluation

In Research - Completed

Precision and Accuracy of Pumps used in Shoulder Arthroplasty

TXA Study (Systemic Tranexamic Acid in Shoulder Arthroplasty
In Research - Completed

The TXA Study (Systemic Tranexamic Acid in Shoulder Arthroplasty)

In Research - Completed

The TXA 2 Study (Systemic Tranexamic Acid in Shoulder Arthroscopy and Rotator Cuff Repair)