For patients with a massive, irreparable rotator cuff tear
When the rotator cuff tendons wear out and tear over time, the shoulder loses its normal ability to lift the arm above 90 degrees. The rotator cuff muscles that would usually do this job are no longer working properly.
The deltoid, a strong muscle covering the outside of the shoulder, can be trained to take over much of this lifting work instead. The exercises below are designed to teach the deltoid to do this.
Do these exercises three to five times a day. Done consistently, they should ease your pain and gradually improve how far you can move your arm and how well it functions. Keep at it for at least 12 weeks, and always start each session lying down. Dr Jang’s team will teach you the exercises in person and check your progress at the 6 and 12 week marks.
Exercises
- Standing, lean forward and let your arm hang loosely, then swing it gently in small circles for about 5 minutes. This pendulum motion eases pain and loosens the muscles around the shoulder before you begin.
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Lie flat on your back with a pillow under your head.
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Lift your weak arm up to vertical (90 degrees), using your good arm to help if you need to. Keep the elbow straight and lined up with your ear.
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Hold the arm there under its own strength.
- Keeping your fingers, wrist and elbow straight, slowly swing the arm forwards and back, in line with the outside of your leg, as shown in the diagram. Move smoothly and continuously for 5 minutes, or until the muscle tires.
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As your control improves, widen the arc gradually until the arm travels all the way from your thigh to overhead, touching the bed behind you, and back again.
Keep this smooth and continuous for 5 minutes, or until the muscle tires.
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Once you feel steadier, add a light weight (a tin of beans or a small paperweight works well) into the affected hand.
Repeat steps 5 and 6 with the weight.
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As your confidence grows, progress from lying down to sitting, and eventually to standing.
To bridge the gap, try reclining, either by raising the head of the bed or propping yourself up on pillows.
From this reclined position, repeat the same exercise, now working a little against gravity.
Start again by simply holding the arm upright under its own strength, then repeat steps 5, 6 and 7.
Begin without any weight, then reintroduce the same light weight you used lying down.
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This last exercise targets a different way of activating the deltoid.
How to do it:
Make a fist with your affected hand. Place the flat palm of your other hand against it, and push the fist up against that resistance. As you push, you should find your arm rises fully overhead almost on its own.
Repeating this teaches the deltoid to produce that same lift by itself over time, without needing your other arm to push against.
Aim for 10 repetitions per session, 3 to 5 sessions a day.
- Stop straight away if your pain increases or you start to feel unwell.