Rotator Cuff Repair (Small to Medium Tear)

PHASE I: 1-2 WEEKS POST-OP

Range Of Motion

  • No PROM of shoulder for first 2 weeks
  • ROM as tolerated for elbow, wrist and hand
  • For Biceps Tenodesis:
    • No Active elbow flexion until 3 weeks (AAROM ok)

Sling

  • Immobilized in sling with abduction pillow at all times, may be removed for exercises and showering. Wear sling at night.

Therapeutic Exercise

  • NO Pendulums
  • Cervical ROM
  • Begin scapula musculature isometrics / sets
  • Elbow, wrist, hand ROM
  • Ball squeezes
  • For Biceps Tenodesis:
    • No Active elbow flexion until 3 weeks (AAROM ok)

PHASE II: 2-4 WEEKS POST-OP

Range Of Motion

  • Passive Forward Elevation (PFE): 60 degrees
  • Passive External Rotation (PER) at 20° of abduction: 0°
  • PER at 90° of abd: NA
  • Active Forward Elevation (AFE): NA

Sling

  • Immobilized in sling with abduction pillow at all times, may be removed for exercises and showering. Wear sling at night.

Therapeutic Exercise

  • Codman’s Pendulums
  • Therapist assisted Forward Elevation
  • Supine passive ER stretches with broom handle
  • Table slides
  • Continue scapula musculature isometrics / sets
  • Elbow, wrist, hand ROM
  • Ball squeezes
  • For Biceps Tenodesis:
    • No Active elbow flexion until 3 weeks (AAROM ok)

PHASE III: 4-6 WEEKS POST-OP

Range Of Motion

  • PFE: 90°
  • PER at 20° of abd: 20°
  • PER at 90° of abd: NA
  • AFE: NA

Sling

  • Continue use of sling until end of Week 5
  • Between Week 5 and 6 may wear sling for comfort only
  • Discontinue sling at end of Week 6

Therapeutic Exercise

  • Continue Phase I and II exercises
  • Supine AAROM
  • Pulley exercises
  • Light scapular strengthening (retraction/protraction) , shoulder shrugs, scapular setting
  • Gentle joint mobilization and soft tissue mobilization

PHASE IV: 6-12 WEEKS POST-OP

Range Of Motion

6 WEEKS

  • PFE: 90° - 120°
  • PER at 20° of abd: 20° - 30°
  • PER at 90° of abd: NA

AFE: NA

9 WEEKS

  • PFE: 130° - 155°
  • PER at 20° of abd: 30° - 45°
  • PER at 90° of abd: 45°-60°

AFE: 80°-120°

12 WEEKS

  • PFE: 140° - WNL
  • PER at 20° of abd: 30° - WNL
  • PER at 90° of abd: 75° - WNL

AFE: 120°-WNL

Sling

  • None

Therapeutic Exercise

  • Stretching, mobs, ROM exercises
  • NO ROTATOR CUFF RESISTANCE EXERCISES
  • Progress supine to seated to standing AAROM
  • Progress pool based AAROM if available
  • Begin unrestricted AROM against gravity at 9 weeks
  • Towel Slide or horizontal dusting
  • AAROM supine washcloth press-up
  • AROM supine press-up
  • Side-lying supported active elevation (on box or exercise ball)
  • AROM reclined wedge press-up
  • Supine elastic band Forward Elevation
  • Aquatic Forward Elevation at slow speed

PHASE V: 8-16 WEEKS POST-OP

Range Of Motion

  • Full ROM without discomfort

Sling

  • None

Therapeutic Exercise

  • Begin light theraband resistance exercises for the rotator cuff
  • AROM or Resisted Pully Forward Elevation
  • Incline Dusting
  • Ball roll on wall
  • FE with upright T-bar
  • AAROM elevation
  • Upright T-bar AAROM FE, active lowering
  • Upright active FE with no weight
  • Upright active FE 1 lbs.
  • Aquatic FE fast speed
  • Side-lying dumbbell ER at 0°, resistance of 25% of MVIC
  • Elastic resistance ER, IR and forward punch
  • Begin strengthening for lats, biceps/triceps, pecs, rhomboids, deltoids
  • Progress with theraband exercises slowly to tolerance
  • Begin to add sport and job specific activities

PHASE VI: 12-20 WEEKS POST-OP

Range Of Motion

  • Full ROM without discomfort

Sling

  • None

Therapeutic Exercise

  • Endurance
  • High, middle and low scapular rows
  • Standing dumbbell ER at 0° abd, 10-rep max
  • Standing dumbbell ER in scapular plane, 10-rep max
  • Elastic resistance shoulder flexion
  • Elastic resistance throwing accelerate
  • Elastic IR at 90°

PHASE VII: 20+ WEEKS POST-OP

Range Of Motion

  • Full ROM without discomfort

Sling

  • None

Therapeutic Exercise

  • Strengthening
  • Upright FE 3-4 lb, 10 rep max
  • Side-lying dumbbell ER at 0°, 10-rep max
  • Prone horizontal abd, 10-rep max
  • Seated military press
  • Elastic resistance ER at 90°
  • Elastic resistance throwing decelerate
  • Standing dumbbell ER at 90° abd, 10-rep max
  • If cleared by Dr. Roth, may now be able to return to:
    • Weight Training
    • Skiing
    • Golf
    • Basketball
    • Manual Labor

PHASE VIII: 8+ MONTHS POST-OP

Range Of Motion

  • Full ROM without discomfort

Sling

  • None

Therapeutic Exercise

  • If cleared by Dr. Roth, may now be able to return to:
    • Throwing Sports
    • Tennis
    • Volleyball

Related Links