Rotator Cuff Repair

Post-Operative Physical Therapy Protocol

The outline below is meant for patients recovering from surgery for Rotator Cuff Repair. Details and steps can change depending on your situation.

Phase I – 0-6 Weeks Post-Op

GOALS:

  • No active ROM of the shoulder girdle
  • Remain in sling
  • **6 weeks is the crucial healing period**

Home Exercise Program:

  • Scapular elevation, depression, protraction, retraction (e.g. “scapular clocks”)
  • Pendulums with emphasis on “relaxed” shoulder and using trunk as prime moving force
  • Elbow, wirst, hand motion with elbow at side
  • Cryotherapy prn

 

Phase II – 7-12 Weeks Post-Op

GOALS:

  • Full ROM (Target to achieve full ROM by 12 weeks)
  • Begin dry land active ROM without weight in biomechanically correct ROM only
  • Discontinue sling

Physical Therapy Treatment

  • Glenohumeral and Scapulothoracic joint mobilizations
  • PROM (Target to achieve full ROM by 12 weeks)
  • Minimal manual resistance for isometric ER and IR and rhythmic stabilization (flexion, extension, Horizontal ab/adduction) at 45°-90°-120° elevation in the scapular plane as patient gains control of the upper extremity
  • AARROM progressing to minimal manual resistance for PNF patterns
  • Aquati Therapy – Increase speed of movement for increased resistance as tolerated, progress to using hands as a “paddle” and then to webbed gloves for increased resistance as tolerated. Also add periscapular strengthening (i.e. wall push-ups, supine scapular retraction while floating)
  • Begin dry land active ROM without weights. Must be in good biomechanical ROM. Add light resistance as patient gains control of movement with good biomechanics.
  • Include these exercises:
    • Elevation in the scapular plane (initially supine, progress to inclined, then upright)
    • Prone Rowing
    • Serratus “punches” supine
    • Sidelying ER
    • Progress to IR on light pulleys or Theraband (after 6 weeks post-op only)

Home Exercise Program:

  • As in Phase I, progress PROM as tolerated to full ROM
  • All AROM exercises and isometrics. Again, emphasize proper biomechanics.

 

Phase III – 13+ Weeks Post-Op

GOALS:

  • Return to functional activities
  • Begin a strengthening program

Physical Therapy Treatment:

  • G-H joint mobilizations and PROM when indicated
  • Progress exercises in Phase II with increased weight based on 3 sets of 12-15 reps
  • Gradually add the following exercises and progress weights:
    • Periscapular strengthening (wall push-ups, upright rowing, etc.)
    • ER, IR, and PNF patterns on pulleys
    • ER, IR, at 90° abduction
    • Begin functional progression for sports/activity-specific tasks
    • Begin isokenetics for ER, IR at 12 weeks post-op (Begin in modified abduction, progress to supine or sitting 90° abduction position)

Home Exercise Program:

  • Maintain PROM
  • Light Theraband exercise of ER, IR, Elevation, and “Full can” on non-PT days
  • Progress to independent strengthening program prior to discharge