From Research to Practice: Subscapularis Tendon Repair

“Doc, when can I serve again?”

That was the very first thing Aakash asked me. Not about pain, not about sling time, not even about whether his repair had held up. He just wanted to know when he could toss the ball, coil his body, and unleash that powerful serve again.

Aakash is a 40-year-old software consultant from Bangalore, a weekend warrior whose true love is tennis. His friends know him as the guy who never misses his Sunday doubles game. But months of shoulder pain finally led him to surgery – an isolated subscapularis tendon repair. He came to me post-op, eager (maybe too eager!) to fast-track his return.

And that’s where our journey began.

Subjective assessment: Listening beyond the shoulder

Aakash’s main complaints were the expected ones: stiffness, weakness, and discomfort when moving his arm away from his body. But the bigger story was in his head – he was restless, worried about “losing his game,” and suspicious that the surgeon’s advice to “take it slow” would cost him months on court.

He had no systemic red flags, but I had to address some psychological yellow flags: impatience, performance anxiety, and a touch of denial about the seriousness of his repair. He needed reassurance that this wasn’t just about healing tissue – it was about setting up the next decade of pain-free tennis.

Objective assessment: What we saw

• Range of motion (ROM): Expected restrictions in external rotation and forward elevation, particularly in the early post-op phase.
• Strength: Weakness in internal rotation and functional positions like the serve set-up.
• Palpation/observation: Post-surgical stiffness and protective guarding.
• Function: He couldn’t tuck in his shirt without wincing, let alone swing a racket.
• Differentials like adhesive capsulitis or cervical referral were considered but quickly ruled out given the mechanism and surgical details.

How research guided the plan

Below, I’ve listed the Physio Network Research Reviews that helped me with Aakash’s rehabilitation:

1. Rehabilitation following subscapularis tendon repair

This Physio Network Review by Robin Kerr was a goldmine. It emphasised the delicate balance between protecting the repair and restoring early mobility. Subscapularis repairs, compared to supraspinatus or infraspinatus, demand stricter precautions because of the tendon’s key role in internal rotation and anterior stability.

For Aakash, that meant no aggressive external rotation stretching early on. Instead, we used a staged progression: gentle assisted elevation, isometrics in neutral, and gradual integration of closed-chain stability drills as the weeks rolled on.

2. Return to sport after subscapularis repair

This Physio Network Review by Andrew Cuff highlighted structured return-to-sport timelines and functional criteria for athletes. Instead of promising Aakash a specific date, I reframed the conversation: “We’re not working toward weeks – we’re working toward checkpoints.”

We built those checkpoints around pain-free ADLs, restoration of functional ROM, progressive strength milestones, and ultimately, sport-specific drills. This not only kept him motivated but also anchored his recovery in evidence rather than arbitrary deadlines.

3. Quality of life with rotator cuff tears

This Review by Dr Teddy Willsey reminded me that outcomes after cuff surgery aren’t just about tendon integrity – they’re about quality of life. Patients who don’t get back to valued activities often report dissatisfaction even if their repair is intact.

So, every stage of Aakash’s program included a translation to tennis. Early theraband work mimicked the toss position. Mid-stage cable exercises simulated follow-through control. Even core and lower-limb work were justified by linking them to serve power and court agility.

4. Prognosis and recovery timelines

Here’s where expectation management came in. Evidence shows that while tissue healing follows a fairly predictable biological timeline, functional recovery can vary widely. By week 12, patients may feel “ready,” but true return-to-play readiness often takes closer to 6-9 months.

For Aakash, this meant honest but hopeful messaging: “Yes, you’ll be back. No, it won’t be by next month. But if you respect the process, you’ll step on the court stronger and smarter than before.”

This Review by Dr Teddy Willsey gives a good outline for returning to play after an upper limb injury.

• Weeks 0-4: Sling use, pendulums, passive-assisted ROM. Education focused on protection, patience, and setting expectations.
• Weeks 4-8: Gradual AAROM to AROM, isometrics into gentle bands. We celebrated milestones like reaching his back pocket or pouring water.
• Weeks 8-12: Strengthening progression, overhead stability, functional patterns. Here, we began tennis-specific drills with low resistance.
• Months 3-6: Plyometric and power-based work- medicine ball throws, resisted serves, reactive stability training.
• Months 6-9: On-court return-to-play program: shadow swings, progressive hitting, doubles before singles, then full unrestricted play.

Wrapping up

Working with Aakash reinforced that rehab is equal parts tissue healing and identity rebuilding. For him, tennis wasn’t just recreation – it was community, pride, and stress relief.

The Research Reviews didn’t just give me exercises; they gave me language, confidence, and a roadmap. They reminded me to protect the repair, respect the timelines, and never lose sight of what “success” actually meant for the patient.

If you’re managing a subscapularis repair, or any cuff case, remember: the patient isn’t chasing full ROM or your ‘5/5’ strength. They’re chasing the life that injury stole from them. For Aakash, it was the tennis court. For someone else, it might be playing with their kids or sleeping through the night without pain.

That’s why staying up-to-date with research matters. It sharpens your tools and humanises your care. Want to stay sharp, current, and clinically confident? Subscribe to Physio Network’s Research Reviews and turn the latest evidence into better results for your patients.