Comprehensive Rehabilitation Following Arthroscopic Rotator Cuff Repair in an Elderly Patient: A Case Study

Background: Rotator cuff tears are a common cause of shoulder pain and functional limitation, particularly in elderly individuals. Arthroscopic double-row rotator cuff repair is considered an effective surgical technique for restoring tendon integrity and improving shoulder biomechanics. However, postoperative challenges such as persistent weakness, limited range of motion, and scapular dyskinesis may delay functional recovery. Targeted physiotherapy focusing on scapular stabilization and progressive strengthening is therefore essential to optimize outcomes. Case Presentation: A 64-year-old female presented for physiotherapy at 12 weeks following arthroscopic double-row repair of a complete supraspinatus tear with partial infraspinatus involvement of the right (dominant) shoulder. She reported difficulty performing overhead activities, weakness during reaching tasks, and discomfort during abduction and external rotation. Clinical examination revealed reduced active range of motion with mild end-range pain, decreased strength of the right external rotators (3/5), and impaired scapular control. Passive movements were nearly full. Pain intensity improved from 5/10 to 2/10 on the Visual Analog Scale during rehabilitation. Functional assessment using the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire showed improvement from 75/100 at baseline to 50/100 at follow-up, indicating a clinically meaningful reduction in upper limb disability. Intervention: A structured rehabilitation program was implemented, including wall crawl exercises for range of motion, scapular stabilization exercises (wide-grip resistance band rows and side-lying external rotation), rotator cuff strengthening with resistance bands, proprioceptive neuromuscular facilitation (D2 flexion pattern), scapular clock exercises, and whole-body vibration therapy. Resistance was progressively increased using color-coded TheraBands based on pain tolerance and movement quality. Outcome and Conclusion: Following intervention, the patient demonstrated improved shoulder mobility, enhanced scapular control, reduced pain, and better performance in daily activities. This case highlights the importance of integrating scapular-focused rehabilitation and progressive strengthening to restore scapulohumeral rhythm and optimize functional recovery after arthroscopic rotator cuff repair in elderly patients.