Rotator Cuff Repair Rehabilitation Protocol

Post Op

Exercises

0-1 Week

1.     Pendulum exercises 3x/day minimum

2.   Elbow and wrist AROM 3x/day minimum

3.   Cryocuff/ice:  days 1-2 as much as possible, then post activity or for pain

1-2 Weeks

ADL's (activities of daily living) within pain tolerance, avoiding impingement

1. Passive range of motion (PROM) and active-assisted range of motion (AAROM) (wand, pulley) within pain tolerance

2. Sub-maximal isometrics for shoulder musculature

3. Manual resistance for scapula motions

4. Postural awareness education

5. Therapist supervised UBE for motion, avoiding substitution or impingement

6. Gentle soft tissue mobilization

7. Modalities as indicated for pain or inflammation

2-6 Weeks

Progress PROM and AROM as tolerated

Joint mobilization for scapula and glenohumeral (posterior capsular stretching)

Strengthening exercises for scapula stabilizers and rotator cuff

May include PRE's theratube/band, PNF, UBE, and weight equipment

Emphasis of strengthening on high reps and low weight, with postural awareness

Goal: Involved shoulder AROM grossly within normal limits by 6 weeks without shoulder hiking

6-12 Weeks

Progress to independent strengthening program. 

Reinforce postural awareness, quality of exercise techniques, and proper progressive resistance exercise (PRE) progression

Post Op

Exercises

Sling/swathe at all times, except for exercises

PROM limits to: 90 pure abduction, 20 extension, 70 internal rotation (also not behind back)

1. Pendulum exercises 3x/day minimum

2. PROM within limits and pain tolerance

3. Elbow and wrist AROM 4x/day minimum

4. Cryocuff/ice: days 1-2 as much as possible, then post activity or for pain

Decrease use of sling during the day, except in uncontrolled situations and at night.
ROM limits continued.

1. PROM within limits and pain tolerance

2. Manual resistance for scapula motions

3. Postural awareness education

4. Gentle soft tissue mobilization and joint mobilization

5. Modalities as indicated for pain or inflammation

Discontinue sling at night.
No ROM limits.

1. Progress AAROM/AROM in all ranges, including wand and pulleys

2. Joint mobilization for scapula and glenohumeral mobility

3. Gentle strengthening exercises for scapula stabilizers and rotator cuff.

May include sub-max isometrics, theratube/band, PNF, and UBE.

Emphasis of strengthening on high reps and low weight, with postural awareness.

Goal: Involved shoulder AROM grossly within normal limits by 12 weeks

2.   Progress towards independent home program

Reinforce postural awareness, quality of exercise technique, and proper PRE progression

PROM limits to:  90 pure abduction, 20 extension, 70 internal rotation (not behind back)

1.   Pendulum exercises 3x/day minimum

2.   PROM within limits and pain tolerance

3.   Elbow and wrist AROM 4x/day minimum

4.   Cryocuff/ice:  days 1-2 as much as possible, then post activity or for pain

ROM limits continued

1.   PROM within limits and pain tolerance

2.   Manual resistance for scapula motions    

3.    Postural awareness education

4.    Gentle soft tissue mobilization and joint mobilization

5.    Modalities as indicated for pain or inflammation

No ROM limits

1.   Initiate AAROM (wand and pulleys), unless specified by physician to progress more slowly

2.   Joint mobilization for scapula and glenohumeral mobility

3.   Gentle exercises for scapula stabilizers and rotator cuff

May include sub-max isometrics, PNF, and supervised UBE

4.   Progress AROM, with education for quality of motion to avoid shoulder hiking

*Patient must be able to elevate without hiking shoulder to progress