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This is a consensus statement on rehabilitation developed by the American Society of Shoulder and Elbow Therapists. The purpose of this statement is to aid clinical decision making during the rehabilitation of patients after arthroscopic rotator cuff repair. The overarching philosophy of rehabilitation is centered on the principle of the gradual application of controlled stresses to the healing rotator cuff repair with consideration of rotator cuff tear size, tissue quality, and patient variables. This statement describes a rehabilitation framework that includes a 2-week period of strict immobilization and a staged introduction of protected, passive range of motion during weeks 2-6 postoperatively, followed by restoration of active range of motion, and then progressive strengthening beginning at postoperative week 12. When appropriate, rehabilitation continues with a functional progression for return to athletic or demanding work activities. This document represents the first consensus rehabilitation statement developed by a multidisciplinary society of international rehabilitation professionals specifically for the postoperative care of patients after arthroscopic rotator cuff repair.

Rotator cuff disease of the shoulder, a common condition, is often incapacitating. Whether nonsurgical or surgical, successful management of rotator cuff disease is dependent on appropriate rehabilitation. Numerous rehabilitation protocols for the management of rotator cuff disease are based primarily on anecdotal clinical observation. The available literature on shoulder rehabilitation, in conjunction with clinical observation that takes into consideration the underlying tissue quality and structural integrity of the rotator cuff, can be compiled into a set of rehabilitation guidelines. The four phases of rehabilitation begin with maintaining and protecting the repair in the immediate postoperative period, followed by progression from early passive range of motion through return to preoperative levels of function.

Heterotopic ossification (HO), a well-known sequela of trauma, burns, head injury, and certain congenital or acquired metabolic conditions, has a predilection for the hip and the elbow. This disease has uncommonly been found after elective open shoulder surgery but extremely seldom after minimally invasive surgery. In our search of the peer-reviewed literature, we found no reports of HO after arthroscopic rotator cuff repair. The clinical importance of heterotopic bone after shoulder surgery remains unclear because of inconsistent definitions, varying correlations of symptom severity and radiographic findings, and lack of treatment efficacy data. Here we report a case of severely symptomatic HO after arthroscopic rotator cuff repair - successfully treated with excision of the heterotopic bone, interval release, and manipulation.

Total shoulder arthroplasty (TSA) is a standard operative treatment for a variety of disorders of the glenohumeral joint. Patients, who have continued shoulder pain and loss of function in the presence of advanced joint pathology, despite conservative management, are often managed by undergoing a TSA. The overall outcomes that are reported after surgical intervention are quite good and appear to be primarily determined by the underlying pathology and the tissue quality of the rotator cuff. The current Neer protocol for postoperative TSA rehabilitation is widely used and based on tradition and the basic science of soft tissue and bone healing. The purpose of this paper is to review the indications for TSA, focusing on the underlying pathologies, and to describe the variables that impact the rehabilitation program of individuals who have had a TSA. A postoperative TSA rehabilitation protocol and algorithm, founded on basic science principles and tailored toward the specific clinical condition, are presented.

Imaging plays an increasing role in physical therapy (PT) practice. We sought to determine if picture archiving and communication system (PACS) deployment would increase the proportion of imaging studies viewed by physical therapists (PTs) at the point of care and to assess PTs' perception of the value of access to imaging information. The study was performed in a 720-bed urban teaching hospital where an average of 2,000 rehabilitation visits per month are performed by 12 PTs. We compared the proportion of imaging studies viewed by PTs before and after PACS implementation. We surveyed PTs to assess their perception on the value of access to imaging studies. Film library records pre-PACS and web server audit trail post-PACS implementation were reviewed to measure access. Chi-square was used to compare proportions and trends. During the 3-month period before PACS usage, PTs viewed 1% (6/505) of imaging studies, citing time as the primary barrier. Post-PACS, the proportion of imaging studies viewed rose from 28% (95/344, second month) to 84% (163/192, fifth month) (p < 0.0001, chi-square). Most PTs believed that access to imaging studies has high value and has a positive impact on clinical practice. Physical therapists rarely viewed imaging studies before PACS due to time barriers. They viewed more imaging studies (84%) post-PACS and felt that access to imaging studies has a positive impact on clinical practice. Further studies are needed to assess whether PACS enhances PTs' clinical decision making and improves patient outcomes.

Case report.Patients with hyperflexion/hyperabduction injury to the glenohumeral joint are at risk for isolated greater tuberosity fractures, which are often undiagnosed or misdiagnosed. In this case report, we describe the clinical decision-making process that led to the diagnosis of an isolated greater tuberosity fracture and subsequent rotator cuff tear.The patient was a 45-year-old male who sustained a shoulder injury as the result of a fall while skiing. After the initiation of physical therapy, he was diagnosed with an isolated greater tuberosity fracture. Little is known regarding the optimal management and overall prognosis of this type of fracture. Conservative nonoperative management and postoperative physical therapy management are discussed.With conservative nonoperative management, the patient was unable to regain high-level functional shoulder use. Suspicion of continued pathology of the greater tuberosity dictated further diagnostic imaging, which led to surgical intervention. Upon completion of postoperative rehabilitation, he was able to resume full recreational activities.It is recommended that sound clinical decision-making dictate the management and ongoing evaluation of traumatic shoulder injuries, especially when managing a patient with an injury for which optimal treatment and prognosis is not well established.

The patient was a 39-year-old woman with a 3-month history of worsening right distal humerus pain that was insidious in onset. At the time of the initial physical therapy visit, the patient complained of weakness and numbness throughout the entire right upper extremity, with an inability to perform daily activities. Magnetic resonance imaging revealed extensive bone marrow signal abnormalities extending from the proximal humeral epiphysis to the distal humeral diaphysis. Further evaluation with radiographs and computed tomography revealed multiple lytic lesions through the humerus. Tissue biopsy confirmed a diagnosis of cystic fibrous dysplasia.