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Dad had shoulder surgery for a rotator cuff tear last week and I'm here taking care of him for a few days. He's supposed to be doing some shoulder exercises that won't stress the surgical site. I saw the therapist show him how to do these at the hospital. Now that he's home, I notice he is making big giant circles. I don't remember that part. Can you tell me if that's safe with this kind of surgery?

Any time the rotator cuff is torn and surgery is required to repair or reconstruct the damage, patients are placed in a sling postoperatively to protect the healing tissue. Patients are then given a standard set of shoulder exercises called Codman's or pendulum exercises to keep the shoulder joint from getting stiff or freezing up. When performed right, these exercises are done by using the trunk to generate motion of the arm. The patient is standing holding on to a supportive surface with the uninvolved hand while leaning forward and allowing the involved arm to dangle. The trunk and hips are rocked forward and back, side-to-side or in a circular motion. Overflow of motion from the trunk moves the arm forward and back, side-to-side, and in circles clockwise and counterclockwise. The motions can be large or small depending on how much swing the person puts into the hips and trunk. When done incorrectly, the shoulder generates the motion. This makes the exercises active (using the rotator cuff muscles) instead of passive (protecting the muscles). In the past, there has been some concern that these exercises could put too much tension on the repair. A recent study from the University of Michigan supports the notion that these exercises may not be as passive as we once thought. And it's the use of large circles that seems most likely to fire up the supraspinatus (rotator cuff) muscle injured most often. If it's been two weeks, it may be a good idea to make a follow-up appointment with the therapist to recheck the exercises. That gets you off the hook trying to correct Dad when you're not sure yourself what to expect and the therapist can answer any other questions or concerns you (or your father) may have.

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