Arthroscopic Rotator Cuff Repair Rehabilitation Protocol

Rotator Cuff Repair Rehabilitation Protocol (Post Arthroscopic Repair) require 20 weeks of treatment. This post will provide you with the schedule for Rotator Cuff Repair Rehabilitation Protocol (Post Arthroscopic Repair)

Note to Therapists: Please ask patients to bring arthroscopic photos with them
for your review and contact our office regarding Operative reports or any questions. This protocol may be adjusted for patients on an individual basis.

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)

oFlexion to tolerance 0-140

-ER 0-40

-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

oFlexion to at least 140

0supine

oER in scapular plane to 35-45 deg.

oIR 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

oFlexion with bent elbow

oExtension with bent elbow

oAbduction with bent elbow

oER/IR with arm in scapular plane

•Continue use of ice for pain control (at least 6-7 times daily)

•Sleeping (in brace)

Precautions:

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



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

oFlexion 0 - 170 deg.

oER at least 45 deg. to normal for opposite side.

oIR in 45 deg. abduction to 45 deg.

•Dynamic stabilization drills; i.e., rhythmic Humeral head stabilization
drills

oER/IR in scapular plane

oFlexion/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

oresistive 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

oShoulder flexion scapular plane

oshoulder abduction

•Active exercise program

oER side-lying

oSide-lying IR

oProne Rowing

oProne horizontal abduction

oBiceps curls

oStart UBE (upper body ergometer) below 90 deg. elevation

Precautions:

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



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

oER/IR supine

oProne rowing

oProne horizontal abduction

oProne extension

oElbow flexion

oElbow 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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