Physiotherapy in Toronto for Shoulder

Q: I had shoulder surgery about six months ago. They repaired a torn rotator cuff and a torn labrum. The joint just seems so stiff some days. Is this normal?

A: According to surgeon observation and reported studies, stiffness after shoulder surgery is more common in older adults (40 years old or older). This is especially true when concomitant (combined) procedures such as a rotator cuff repair and a SLAP repair are done at the same time.

SLAP refers to the labral tear you have. It stands for superior labral anterior-posterior. The structure that is torn is the labrum, a fibrous rim of cartilage around the shoulder socket. It is designed to help hold the round head of the humerus (upper arm bone) in the joint thus increasing the joint stability. Superior anterior-posterior tells us the location of the damage: top of the shoulder socket from front to back.

The reason for the stiffness isn't entirely clear. It may be due to age-related changes as collagen tissue dries out and loses its pliability (flexibility). But there's some evidence that it might be related to the type of rehab program used after surgery.

A recent study from Harvard University compared patients having isolated rotator cuff repairs with those who had the combined rotator cuff repair with SLAP repair. The patients in both groups were over age 40. In fact, the average age was 58 years old, which is older than most other studies of this type.

The patients in both groups followed a very intensive rehab program right from the start. Early range of motion was part of the protocol. This type of rehab isn't always used for fear of re-tears in the healing tissue. But they found no stiffness in the patients. Normally, patients are told not to stretch the arm overhead for the first six weeks to avoid damaging the repair.

There may be some other explanation for your postoperative stiffness. The best thing to do is make a follow-up appointment with your surgeon and let him or her examine your shoulder. It's possible the problem could be cleared up easily with some additional therapy.

Reference: Brian Forsythe, MD, et al. Concomitant Arthroscopic SLAP and Rotator Cuff Repair. In The Journal of Bone & Joint Surgery. June 2010. Vol. 92-A. No. 6. Pp. 1362-1369.