Rehabilitation Protocol
Rotator Cuff Repair (Massive)
PHASE I: Protected ROM (8 weeks)
- May remove dressing and shower postop day #3
- Sutures are all underneath the skin and will dissolve on their own
- Ice or cold flow systems encouraged for the first week at a minimum: should be used 3- 4 times per day.
- Sling should be in place when not performing exercises
- Hold pendulum exercises until 4 weeks following surgery
- May start active scapular mobility exercises at 6 weeks – Must keep the shoulder musculature relaxed
- Avoid all active and active assistive exercises until cleared by the surgeon. This includes pulley exercises, wand and supine assisted exercises
- Initiate exercise program 3 times per day:
- Immediate elbow, forearm and hand range of motion out of sling
- Passive external rotation of the shoulder to tolerance - instruct family member (start at 6 weeks)
- PROM into scapular plane elevation to 120 degrees (start at 6 weeks)
PHASE II: Progressive ROM (8 to 12 weeks)
- May discontinue sling
- Lifting restriction should be reinforced with patient, nothing heavier than a coffee cup
- Start PROM – scapular plane forward elevation and external rotation of the shoulder to tolerance
- As PROM progresses, initiate AAROM – includes pulleys, wand and supine gravity assisted exercises. Emphasize all motions except IR behind the back until 3 months
- Avoid AROM, rotator cuff strengthening or resisted training
- Isolate and strengthen scapular stabilizers
- Progress terminal capsular stretching of the shoulder as needed
PHASE III: ( >12 weeks)
- Discontinue formal lifting
- Progress from AAROM to AROM with normalized mechanics without substitution patterns
- Start progressive rotator cuff and shoulder strengthening at 3 months – isometrics initially
- Initiate isotonic strengthening at 4 months (Theraband, dumbbells, Hughston’s exercises, etc). Include home cuff strengthening program. Continue to emphasize scapular stabilizers.
- Equate active and passive range of motion. Encourage scapulohumeral mechanics during active shoulder motion
- Simulate work/recreational activities as rotator cuff strength and endurance improve
