When the Sheik walked into his first post-operative rehabilitation session, it was clear this wasn’t just any shoulder injury. A leader in his community and an active participant in a variety of sports, the Sheiks shoulder had endured years of wear and tear before finally requiring surgical intervention. Following a combined SLAP Type II Lesion, supraspinatus and infraspinatus tears, and subacromial impingement, he underwent a complex procedure to restore function. This case study recounts the Sheiks four-month journey from immobility to reclaiming his strength and mobility.

The Injury and Surgery

The Sheiks diagnosis was multifaceted, involving:

1. A SLAP Type II lesion with pulley lesion (Grade 2) in the left shoulder.

2. A full-thickness tear of the supraspinatus tendon and a partial tear (50%) of the infraspinatus tendon.

3. Subacromial impingement caused by a bone spur.

The surgery addressed these issues through:

• Arthroscopic tenodesis of the long head of the biceps tendon.

• Double-row refixation of the supraspinatus and infraspinatus tendons using advanced anchors.

• Subacromial decompression to remove the impinging spur.

The procedure was a success, but the path to recovery would require discipline and a carefully structured rehabilitation plan.

Phase 1: Protecting the Repair (Weeks 1-6)

Focus: Pain management, protection, and early mobility.

For the first three weeks, the Sheiks arm was immobilised in an orthosis, ensuring the surgical repair could heal without stress. Passive mobilisation was limited to:

• Flexion: Progressed cautiously to 90°.

• External rotation (ER): Capped at 10–15° in the scapular plane.

• Internal rotation (IR): Restricted to 45–60°.

During this phase, pain management was critical. Cryotherapy and swelling control measures were employed, alongside gentle isometric activation of scapular stabilizers to prevent muscle atrophy. The Sheik was diligent, adhering strictly to the guidelines and avoiding any unnecessary strain.

Phase 2: Regaining Range of Motion (Weeks 7-12)

Focus: Controlled mobility and neuromuscular activation.

The second phase marked the transition from passive to active-assisted range of motion (AAROM) exercises. The Sheik began gentle shoulder movements:

• Flexion: Gradually increased to 120°.

• ER: Advanced to 45°.

• IR: Improved to 60° in the scapular plane.

Strength training also began, with a focus on the scapular and rotator cuff musculature. Using light resistance bands and dumbbells, he worked on rows, serratus punches, and rhythmic stabilization drills. Proprioception exercises, such as ball stabilization against a wall, were introduced to rebuild his dynamic shoulder control.

Despite some initial frustration with the slow pace, the Sheik remained committed, trusting the process. His efforts paid off, as his range of motion improved steadily, and his confidence grew.

Phase 3: Strength and Functionality (Weeks 13-16)

Focus: Strength building and functional integration.

By the third phase, the Sheik was ready to build strength and endurance. Isotonic exercises became a staple of his routine:

• Prone T, Y, and W exercises targeted his rotator cuff.

• Push-up progressions (starting on the wall) were introduced to improve functional strength.

• Medicine ball drills began to prepare his shoulder for sport-specific demands.

Cardiovascular fitness also became a focus, with swimming added to his regimen for light endurance training. He worked tirelessly, driven by the goal of returning to his active lifestyle. His trainers monitored him closely, ensuring his progression did not risk overuse or instability.

The Outcome

By the end of the fourth month, the Sheik had achieved remarkable results:

• Full pain-free range of motion (ROM): He could now flex, extend, and rotate his shoulder without limitations.

• Strength Restoration: The affected arm reached 85% of the strength of his unaffected arm, an impressive milestone.

• Functional Recovery: He returned to independent daily activities and even began light golf swings and tennis serves.

His rehabilitation was a testament to the power of perseverance and expert guidance. The Sheik’s journey serves as a reminder that even the most complex injuries can be overcome with the right combination of patience, discipline, and professional support.

Reflection

For the Sheik, this experience was not only a physical challenge but a mental one. Rehabilitation taught me patience, he shared. Each phase felt like a victory, and I now have a greater appreciation for my body and what it’s capable of.

Today, the Sheik continues to train under the watchful eye of his rehabilitation team, ensuring his shoulder remains strong and functional. His story is a powerful example of how a structured, phase-based rehabilitation plan can transform lives, restoring not only movement but also confidence and independence.