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