Post operatively, I am normally concerned with two presentations in patients. Patient’s with significant post operative range of motion and those with minimal to no pain have the highest risk of tearing their repaired tissues due to the lack of protection from either stiffness or post operative pain. Patients may incorrectly assume the absence of significant pain indicates they may accelerate their post operative Physical Therapy protocol and skip the important barriers of range of motion, strengthening, and weight bearing. In the rotator cuff repair literature we find significant re tear rates especially among older patients. These re tears may or may not coincide with an increase in shoulder pain or lost function. Previous authors have found lower re tear rates in the short term among patients with higher amounts of post operative stiffness. A recent study highlights the long term value of this post operative stiffness on future re tears of the rotator cuff.

Millican and colleagues followed over 130 patients up to 10 years after undergoing arthroscopic rotator cuff repair (J Shoulder Elbow Surgery. 2020). Patients were divided into two close to equal groups based on their degree of post operative shoulder stiffness. Patients who were categorized as stiff at 6 weeks were significantly less likely to re tear (3% vs. 19%) at 6 months compared to their more mobile peers. Authors reported the post operative stiffness was resolved by 5 year follow up for all motions except shoulder external rotation. Importantly, authors noted the protective effect of post operative stiffness was still seen at 9 years post op between the groups. The early levels of post operative stiffness may have a protective effect on the repair site and prevent patients from entering into restricted ranges of motion such as hand behind their back in the early phases of recovery.

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