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Shoulder subscapularis tendon repair, +/- biceps tenodesis

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You have just undergone an arthroscopic (key-hole) subscapularis tendon repair in your shoulder with Kemble. This means you had a partial or complete tear of the subscapularis tendon. At the same time, most patients would have also undergone a tenodesis (take-down and re-attachment in a new location) of the biceps tendon at the shoulder. This is because the biceps tendon often becomes unstable following a subscapularis tendon tear. 

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The following is a schematic diagram of the location of the tendon and its tear in relation to your shoulder, as well as a picture of a repair with sutures and anchors.

subscapularis%20tendon%20tear_edited.jpg
subscapularis tendon repair.png

Postoperatively your arm will be in a sling. You can start coming out of the sling under supervision of  the physiotherapist and for prescribed exercises. However, you should remain in the sling for the majority of the time for the first 6 weeks. 

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Dressing: your shoulder will have several arthroscopic key-hole portal wounds. this will have sutures holding it closed. on top of that there will be a water-proof dressing. On top of that again there will be some bulky temporary padding held with tape to decrease swelling for the first day or so. This bulky temporary padding should be removed before you are discharged from hospital. 

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It is normal to have some tingling or numbness or weakness following your procedure. This is often due to a nerve block performed preoperatively to help with your pain. This will wear off in the first day or two.

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The following is your physiotherapy prescription:

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For biceps tendon: 

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  • No restricted elbow flexion for 6 weeks (cup of tea weight or less is ok), then allow all elbow motion thereafter

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For subscapularis tendon: 

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Weeks 0-6: Phase 1

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  • This is the "healing phase", where your tendon is starting to heal back to bone. 

  • The goal here is to protect the repair whilst maintaining as much motion as possible for the rest of the shoulder joint. 

 

  • No active contraction of subscapularis (no active internal rotation). 

  • No active OR passive ER past neutral (0 deg).

  • Allow active abduction/elevation to 90 deg

  • Pendulars ok

  • Sling except while doing exercises or bathing. 

 

Weeks 6-12: Phase 2

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  • This is the "regaining range of motion" phase, where your tendon is now 30% of the strength of before. 

  • The goal of this phase of recovery is to protect the tendon repair while gently gaining motion and preventing formation of adhesions (scar tissue) which might limit motion. Another goal during this phase is to reduce inflammation and pain.

  • Gradually build up ER aiming for 2/3rds of other side

  • Allow active internal rotation but not against resistance

  • Allow full active elevation and abduction

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Weeks 12+: Phase 3

 

  • This is the "strengthening phase", where your tendon is now around 60% of the strength of before. 

  • The goal of this phase is to start building up on strength, and to regain full range of motion similar to the other side. 

  • Allow active internal rotation against resistance but build up gradually.

  • Allow full ER range

  • Things to avoid

    • No supporting of body weight by hands and arms

    • No excessive behind the back movements

    • No sudden jerking motions

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