Rotator Cuff Repair Post-Operative Protocol
Post-Op Rotator Cuff Repair
The outline below is meant for patients recovering from surgery for Rotator Cuff Repair. Details and steps can change depending on your situation.
First Post-Op Visit
You have undergone a rotator cuff repair on your shoulder. The purpose of this form is to emphasize what was discussed today during your post operative visit. I realize that the sling you are wearing is very uncomfortable and can make it very difficult to sleep. However, it is a “necessary evil” in order to give you the best chance of having a successful outcome. Rotator cuff tissue that has torn is typically not very strong and is the weak link in the healing process.
The way that rotator cuff repairs fail is typically by the tissue tearing through the stitches, and this is usually caused by lifting the arm or actively moving it before the healing process is complete. Therefore, it is very important to remain in the sling and only perform the simple passive range of motion (PROM) exercises that were discussed today.
The shoulder will get stiff during the immobilization process, but we will deal with that later. SLEEP can be difficult during this time period. Most people find it most comfortable to sleep in a recliner or simply propped up in bed with lots of pillows to support their arm and body. You should wear your sling while sleeping. Hang in there during this 6 weeks. It will be tough, but it will also be worth it when you are fully recovered.
PHASE I – 0-6 Weeks Post-Op
1. No active ROM of the shoulder girdle
2. Remain in sling
3. **6 weeks is the crucial healing period**
4. Scapular elevation, depression, protraction, retraction (e.g. “scapular clocks”)
5. Pendulums with emphasis on “relaxed” shoulder and using the trunk as prime moving force
6. Elbow, wrist, hand motion with the elbow at side
7. Cryotherapy prn
6 Weeks Instructions
Healing of rotator cuff tissue is a process. You have successfully made it through the early healing phase and now it is VERY important for you to proceed as directed and not to take yourself outside of the recommended activity levels as it will most certainly affect your final outcome and likely prevent the tear from healing properly. The next phase of the healing process involves strengthening of the scar tissue (rotator cuff healing interface to bone) to mature and become stronger. During the next 6 weeks I ask that you work on obtaining your shoulder range of motion without lifting any weight or doing any strengthening exercises. The first step is to work on ACTIVE-ASSISTED RANGE OF MOTION.
This means that you will be moving your shoulder/arm with assistance. This can be done with assistance from your other arm, walking up the wall with your fingers, using a wand/cane or a pulley system. The more that you work on this, the better you will feel and be able to progress to ACTIVE RANGE OF MOTION (AROM). AROM involves moving you shoulder/arm under its own power. Your goal is to obtain 70-80% of your range of motion during this 6 weeks. Some people do get significantly stiff after rotator cuff repair surgery and can take longer to get their range of motion back. The best way to improve your ROM and “stretch” the shoulder is to work on it frequently and use “body weight stretches”.
To do body weight stretches you will plant your hand on a stationary object (i.e. wall, cabinet, door frame etc.) and slowly use your weight to impart stretch in the directions that need to be improved. This usually includes rotation outwards and elevation forward. Internal rotation (reaching behind your back) is usually the last thing to return. You can work on this using a towel, belt or rope thrown over your opposite shoulder to help stretch with our other arm. This is a lot of information, and I realize that some of it may be confusing. This is why I will refer you to a physical therapist to help guide you for the next 6 weeks. Good Luck!!! See you in 6 weeks. Dr. Jones
PHASE 2 – 7-12 Weeks Post-Op
1. Full ROM (Target to achieve full ROM by 12 weeks)
2. Begin dry land active ROM without weight in biomechanically correct ROM only
3. Discontinue sling
4. Glenohumeral and Scapulothoracic joint mobilizations
5. PROM (Target to achieve full ROM by 12 weeks)
6. 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
7. AARON progressing to minimal manual resistance for PNF patterns
8. Aquatic 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)
9. Begin dry land active ROM without weights. Must be in good biomechanical ROM. Add light resistance as the patient gains control of the movement with good biomechanics.
10. 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)
11. As in Phase I, progress PROM as tolerated to full ROM
12. All AROM exercises and isometrics. Again, emphasize proper biomechanics.
PHASE 3 – 13+ Weeks Post-Op
1. Return to functional activities
2. Begin a strengthening program
3. G-H joint mobilizations and PROM when indicated
4. Progress exercises in Phase II with increased weight based on 3 sets of 12-15 reps
5. 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 isokinetic for ER, IR at 12 weeks post-op (Begin in modified abduction, progress to supine or sitting 90° abduction position)
6. Maintain PROM
7. Light Theraband exercise of ER, IR, Elevation, and “Full can” on non-PT days
8. Progress to independent strengthening program prior to discharge