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Rotator-Cuff Repair

Phase I: Immediate post surgical phase (day 1-10)

Goals: Maintain integrity of the repair
Gradually increase Passive ROM
Diminish pain and inflammation
Prevent muscular inhibition

Day 1-6
• Sling/Abduction brace
• Passive Supine ROM (No Pendulums)
o Flexion to tolerance 0-140
o ER 0-40
0 with wand 5 times a day 20 repetitions
• Active Elbow/Wrist/Hand (E/W/H) gripping and ROM exercises
• Scapular depression and Retraction (Sitting)
• Neck/Upper quarter stretching
• Cryotherapy for pain and inflammation (ice 15-20 minutes every hour)
• Sleeping (in sling or brace)

Day 7 – 10

Continue use of sling
• Progress passive ROM to tolerance
o Flexion to at least 140
o ER in scapular plane to 35-45 deg.
o IR in scapular plane to 35-45 deg.
• Continue Active E/W/H ROM exercises
• Neuromuscular Re-education (to prevent Shldr/Scap hiking) use mirror
• Continue Submaximal isometrics
o Flexion with bent elbow
o Extension with bent elbow
o Abduction with bent elbow
o ER/IR with arm in scapular plane
• Continue use of ice for pain control (at least 6-7 times daily)
• Sleeping (in brace)
1. No lifting of objects
2. No excessive shoulder extension
3. No excessive stretching of sudden movements
4. No supporting of body weight by hands **w/transfer in/out of chair/bed
5. Keep incision clean and dry
Rotator Cuff Repair Rehabilitation Protocol (Post Arthroscopic Repair)

Phase II: Protection phase (day 11- week 6)

Goals: Allow healing of soft tissue
Do not overstress healing tissue
Gradually restore full passive ROM (week 4-5)
Reestablish dynamic shoulder stability
Decrease pain and inflammation

Day 11 – 14

• Continue use of sling
• Passive ROM to tolerance supine
o Flexion 0 – 170 deg.
o ER at least 45 deg. to normal for opposite side.
o IR in 45 deg. abduction to 45 deg.
• Dynamic stabilization drills; i.e., rhythmic Humeral head stabilization drills
o ER/IR in scapular plane
o Flexion/extension at 90 deg. flexion
• Continue all isometric contractions
• Overhead pulleys (Passive motion only)
• Continue use of cryotherapy as needed
• Continue all precautions

Week 3 – 4

• Patient should exhibit full passive ROM
• Continue scapular stabilization Ex and initiate scap. strengthening
o resistive retraction, rows (caution: Not if pt. had biceps tenodesis)
• Initiate Active ER supine in scapular plane using wand to stretch at terminal range
• Initiate isotonic elbow flexion
• Self capsular stretches
• Continue use of ice as needed
• May use heat prior to ROM exercises
• May use pool for light ROM exercises (passive only no resistive Ex)
• Continue sling

Week 5 – 6

• Discontinue use of sling and may use heat prior to exercise
• AAROM and stretching exercises
• AA Flex with Active Ext to neutral and AA Abduction with Active Adduction
• Initiate AROM exercises
o Shoulder flexion scapular plane
o shoulder abduction
• Active exercise program
o ER side-lying
o Side-lying IR
o Prone Rowing
o Prone horizontal abduction
o Biceps curls
o Start UBE (upper body ergometer) below 90 deg. elevation
1. No heavy lifting of objects
2. No excessive behind-the-back movements
3. No supporting of body weight by hands and arms
4. No sudden jerking motions
Rotator Cuff Repair Rehabilitation Protocol (Post Arthroscopic Repair)

Phase III: Intermediate phase (week 7-14)

Goals: Full active ROM (week 8 – 10)
Dynamic shoulder stability
Gradual restoration of shoulder strength and power
Gradual return of functional activities

Week 7

• Continue stretching and PROM (as needed to maintain full ROM)
• Continue dynamic stabilization drills
• Initiate isotonic strengthening program pain-free
o ER/IR supine
o Prone rowing
o Prone horizontal abduction
o Prone extension
o Elbow flexion
o Elbow extension
* Patient must be able to elevate arm without shoulder or scapular hiking before initiating isotonics; if unable,
continue humeral head/scapular stabilization Ex.

Week 8 – 13

• Continue all exercise listed above
• ER side-lying
• Lateral raises*
• Full can in scapular plane*
• If physician permits, may initiate light functional activities

Week 14

• Continue all exercise listed above
• Progress to fundamental shoulder exercises
Phase IV: Advanced strengthening phase (week 15-22)
Goals: Maintain full non-painful ROM
Enhance functional use of UE
Improve muscular strength and power
Gradual return to functional activities

Week 15

• Continue ROM and stretching to maintain full ROM
• Continue shoulder strengthening to fundamental shoulder exercises
• Initiate interval golf program (if appropriate)
• May initiate shoulder plyometrics

Week 20

• Continue all exercises listed above
• Progress golf program to playing golf (if appropriate)
• Initiate interval tennis program (if appropriate)
• May initiate swimming

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