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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
  • American Academy of Orthopaedic Surgeons
American Shoulder and Elbow Surgeons
  • New England Shoulder and Elbow Society
  • Boston Sports & Shoulder Center
  • Tufts University