STANDARD ROTATOR CUFF REPAIR PROTOCOL

This rehabilitation protocol has been developed for the patient following a rotator cuff surgical procedure. This protocol will vary in length and aggressiveness depending on factors such as:

 Size and location of tear
 Degree of shoulder instability/laxity prior to surgery  Acute versus chronic condition
 Length of time immobilized
 Strength/pain/swelling/range of motion status
 Rehabilitation goals and expectations

Early passive range of motion is highly beneficial to enhance circulation within the joint to promote healing. The protocol is divided into phases. The overall goals of the surgical procedure and rehabilitation are to:

 Control pain, inflammation, and effusion
 Regain normal upper extremity strength and endurance
 Regain normal shoulder range of motion
 Achieve the level of function based on the orthopedic and patient

goals

The physical therapy should be initiated within the first week and one half to two full weeks post-op. The supervised rehabilitation program is to be supplemented by a home fitness program where the patient performs the given exercises at home or at a gym facility.

Important post-op signs to monitor:

 Swelling of the shoulder and surrounding soft tissue
 Abnormal pain response, hypersensitive-an increase in night pain  Severe range of motion limitations
 Weakness in the upper extremity musculature

Return to activity requires both time and clinical evaluation. Return to intense activities following a rotator cuff repair require both a strenuous strengthening and range of motion program along with a period of time to allow for tissue healing. Symptoms such as pain, swelling, or instability should be closely monitored by the patient.

Phase 1: Week 1-6 Rotator Cuff Repair

WEEK EXERCISE

1-6 ROM

Pendulum exercises Elbow (flex/ext) range of motion

Initiate STRENGTH

NO Active Shoulder flexion or abduction allowed in the first 6 weeks

Grip strengthening with putty or ball BRACE

Brace for 6 weeks
Brace removed to perform exercises above

MODALITIES
Ice 15-20 minutes

GOALS OF PHASE:

 Promote healing of repaired rotator cuff  Control pain and inflammation
 Gradual increase of ROM
 Delay muscle atrophy

GOAL

Gradual 

Phase 2: Week 6-12 Rotator Cuff Repair

WEEK EXERCISE

6-12 ROM

Continue all ROM 10-12 wk Posterior capsule stretching

GOAL

Full ROM

STRENGTH

MODALITIES

GOALS OF PHASE:

Manual rhythmic stabilization exercises at 90 flex Shoulder shrugs with resistance
Shoulder retraction with resistance
Supine punches with resistance

Prone shoulder extension
Prone rowing
Prone ER with abduction
Initiate forward flexion, scaption, empty can Sidelying ER

Bicep/Tricep work
Isokinetic ER/IR at neutral at week 10-12

Ice 15-20 minutes

Initiate Grade III-IV joint mobs as needed Rope/Pulley (flex, abd, scaption)
Towel stretching
Wand activities in all planes

 Minimize pain and swelling
 Reach full ROM
 Improve upper extremity strength and endurance  Enhance neuromuscular control

WEEK

12-24 ROM

STRENGTH

Phase 3: Week 12-24 Rotator Cuff Repair

EXERCISE

Continue with all ROM activities from previous phases Posterior capsule stretching
Towel stretching
Grade III-IV joint mobs as needed for full ROM

Progress strengthening program with increase in resistance and high speed repetition

Initiate IR/ER exercises at 90 abduction
Progress rhythmic stabilization activities to include

standing PNF patterns with tubing Initiate single arm plyotoss

Initiate military press, bench press, flys, lat pulldowns UBE for strength and endurance
Initiate sport specific drills and functional activities Initiate light upper body plyometric program week 16-20 Progress isokinetics to 90 abduction at high speeds

MODALITIES
Ice 15-20 minutes

GOALS OF PHASE:

 Full painless ROM
 Maximize upper extremity strength and endurance  Maximize neuromuscular control
 Initiate sports specific training/functional training