Rotator Cuff Repair Rehab Protocol

Precautions Overview:

  • Wear shoulder brace with Pillow for 6 weeks at all times
  • Sleep in shoulder brace for 6 weeks
  • No lifting, pushing, or pulling with operative arm for 6 weeks
  • No active motions away from body/overhead for 6 weeks

Phase I: Immediate postoperative (Weeks 1-6)

Goals:

  1. Maintain integrity of the repair
  2. Preserve ROM
  3. Diminish pain and inflammation
  4. Prevent muscle atrophy

Week 1:

  • Wear shoulder brace with pillow day and night
  • Perform pendulum exercises 4 times daily (arm hanging at side, slowly swing hand back and forth and in small circles)
  • Gentle active assisted range of motion to 90 degrees OK as long as pain free (gentle internal and external rotation of the shoulder with arm abducted 45 degrees in the plane of the scapula, passive forward flexion)
  • Elbow flexion/extension, forearm rotation, wrist flexion/extension, and finger motion 4 times daily
  • Ice for pain and inflammation (15-20 minutes every hour)
  • Sleep in shoulder brace

Days 7-21

  • Continue above protocol plus
  • Submaximal pain-free isometrics
    • Elbow flexed to 90 degrees (flex your bicep in your arm)
    • Hand grip (make a fist)
    • Wrist flexion/extension
    • Shrugs
    • Scapular Retractions
  • OK to clean wound with soap and water once sutures/staples have been removed (2 weeks)
  • Do not submerge incisions sites

Week 4-6

  • Continue above protocol plus
  • Begin table walks
  • Progress passive range of motion to 120 degrees flexion/abduction
  • Begin gentle resisted exercises of elbow, wrist, and hand
  • Remain non-weight bearing with shoulder

Phase II (Weeks 6-12)

Criteria to progression to phase II:

  1. Tolerate shoulder passive range of motion and isometrics

Activity Overview:

  1. Abduction pillow removed, sling worn when out of the house and at night
  2. Remain non-weight bearing on operative arm (no lifting, pushing, or pulling)
    1. No lifting anything heavier than a coffee cup
  3. Ice and over-the-counter medications for pain control
  4. You may not drive until off of all narcotic pain medications and you must be able to use your arm to grab and forcefully turn the wheel if necessary. Timing is variable among people undergoing this surgery but generally takes 10-12 weeks from surgery.

Goals:

  1. Progress passive range of motion
  2. Gradually restore active range of motion
  3. Pain and inflammation control
  4. Re-establish dynamic shoulder and scapular stability

Weeks 6-8

  • Continue passive range of motion and isometrics
  • Progress strengthening elbow, wrist, hand
  • Begin active assisted and active range of motion in the plane of the scapula
  • Begin gentle glenohumeral internal rotation and external rotation isometrics
  • Begin gentle scapulothoracic rhythmic stabilization and isometrics

Weeks 9-12

  • Continue above exercises/protocol
  • Begin periscapular and deltoid sub-maximal pain free isotonic strengthening exercises
  • Begin active range of motion in forward flexion, internal rotation, and external rotation with light resistance

Phase III: (week 12 onward)

Criteria for progression to phase III:

  1. Function and strength improving in shoulder
  2. Ability to isotonically activate all components of deltoid and periscapular musculature

Activity overview:

  1. Continue to avoid heavy lifting until gradual progression is made to achieve strength gains
  2. No sudden or jerking motions to shoulder/arm
  3. Ice as needed after therapy

Goals:

  1. Enhance functional use of arm
  2. Enhance shoulder mechanics, muscular strength, and endurance

Weeks 12+

  • Continue previous program as needed
  • Progress motion, strength, periscapular stabilization
  • Focus on employment/sport specific exercises/rehab