PHYSICAL THERAPY AFTER SUPRASPINATUS TENDON REPAIR IN ACTIVE-DUTY MILITARY PERSONNEL

Abstract

Rotator cuff injuries, particularly tears of the supraspinatus tendon, are among the leading causes of upper limb dysfunction in working-age individuals and military personnel. Despite continuous advancements in arthroscopic repair techniques and fixation materials, postoperative functional outcomes remain variable.

The aim of this study was to provide scientific justification for and to develop a staged physical therapy program following arthroscopic supraspinatus tendon repair in the early post-immobilization period.

Initial assessment revealed significant impairment of shoulder joint mobility (ICF code b710), decreased muscle strength and activation efficiency of the rotator cuff (b730), protective neuromuscular inhibition (b735), and moderate pain (b280). Activity limitations included difficulties with reaching, lifting, and performing self-care tasks (d445, d430, d540), accompanied by compensatory trunk movements and altered scapulohumeral rhythm (d410). Participation restrictions were observed in occupational activities and physically demanding leisure activities (d850, d920). The rehabilitation program was developed according to a hierarchical ICF-based model, with gradual progression from correction of body function impairments to restoration of activity and participation. Interventions were implemented across three phases (0–4 weeks, 5–8 weeks, 9–16 weeks), taking into account the biological phases of tendon healing.

During the first stage, emphasis was placed on controlled restoration of mobility without compromising the integrity of the surgical repair. By week 4, active shoulder abduction improved from 30° to 65°, flexion from 40° to 75°, and external rotation from 5° to 20°, with pain reduced to ≤3 points on the NRS. The second stage focused on developing active motor control and reducing compensatory strategies; by week 8, active abduction reached 95°, flexion 105°, and external rotation 35°, accompanied by substantial normalization of scapular coordination. In the final stage, functional restoration was prioritized. By week 16, active abduction increased to 120°, flexion to 130°, and external rotation to 45°, while pain decreased to 1–2 points. The patient regained independence in overhead activities and gradually returned to occupational and physically demanding tasks.