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 Small to Medium Rotator Cuff Repair Surgical Rehabilitation

Phase I (0 – 4 weeks)

Appointments

  • Home exercise program will begin after surgery

  • PT 1-3x/week.

Rehabilitation Goals

  • Progression of elevation in scapular plan and ER in 20-30 degrees of abduction

  • Correct postural dysfunctions

Precautions

  • Sling utilization will be determined by communication between physician and physical therapist. Typical sling use ranges from 4-8 weeks depending on surgical procedure, tissue quality, healing potential and stiffness

  • No active abduction ROM for 8 weeks to protect repair and no external resistance to abduction and supraspinatus for 12 weeks

Suggested Therapeutic Exercise

  • Progress forward elevation and passive ER using only exercise demonstrated to have less than 15% EMG activity level

  • Supported side lying shoulder flexion

  • Supine forward elevation with elastic band resistance form 90

    degrees

  • Small circle (20cm) pendulums

  • Scapular strengthening

  • Grade I and II joint mobilizations for pain relief as needed at all

    shoulder girdle joints, GH, SC, AC, ST

  • Elbow, wrist, finger AROM and light strengthening

  • Ensure normal cervical spine, thoracic spine and hip mobility

    to facilitate kinetic chain upper extremity ROM

Cardiovascular exercise

  • Walking and stationary bike

  • Avoid running, jumping, treadmill, elliptical and Stairmaster

Progression Criteria

  • At least 8 weeks post-operative

  • Passive forward elevation 90-120 degrees

  • Passive ER to 20-30 degrees at 20 degrees abduction

 

Phase II (weeks 8 – 3 months)

Appointments

• Rehabilitation appointments are 1-3 times per week

Rehabilitation Goals

ROM goals for approximately 9 weeks:

  • Passive forward elevation to 130-155 degrees

  • Passive ER at 20 degrees of abduction to 30-45 degrees.

  • Passive ER at 90 degrees of abduction to 45-60 degrees to full

  • Controlled progression of active assistive range of motion and AROM. AROM initiation based on PROM goals, delayed 9 weeks postoperative

  • Initiate light muscle performance activities

  • Correct postural dysfunctions- active elevation 80-120 degrees

    without compensation

Precautions

  • Wean out of sling slowly starting postoperative weeks 6-8 based on size of tear, integrity of tissue and repair, and surgeon preference

  • No active abduction ROM for 8 weeks to protect repair and no external resistance to abduction and supraspinatus for 12 weeks

Suggested Therapeutic Exercise

  • Appropriate progression of upper extremity use for light ADLs in pain free ROM starting with waist level activities, progression to shoulder level

  • AAROM for forward elevation and ER with exercises demonstrated to have less than 30% EMG activity level. Generally in gravity minimized positions and/or short lever arm: cane assisted forward elevation, wall ball roll, active assisted forward elevation with fingers interlaced, wall walks or slide, aquatic exercise: slow speed elevation in scapular plane

  • ROM exercises in other planes can be initiated in latter half of this phase if significant ROM limitations are present (caution with passive tension over the repair): ER at progressing angles of abduction, IR, functional IR behind the back, horizontal adduction

  • Progress AROM as demonstrated with good scapulothoracic mechanics and remaining pain free. Generally in upright position progressing from supported to unsupported elevation: pulley progression based on PROM and scapular control, passive progressing to active assisted elevation with active lowering, short lever arm forward elevation, ipsilateral step up shoulder flexion with a ball(both hands)k ipsilateral step up shoulder flexion with no ball

  • Active shoulder flexion

Cardiovascular Exercise

  • Walk and stationary bike

  • Avoid running and jumping, no treadmill, elliptical, or

    Stairmaster

Progression criteria

• Passive forward elevation to at least 140 degrees to full

  • Passive ER at 20 degrees of abduction to at least 30 degrees to full, passive ER at 90 degrees of abduction to at least 75 degrees to full

  • Active elevation to at least 120 degrees without compensation

 

Phase III (months 3 - 5)

Appointments

• Rehabilitation appointments 1-3xwk

Rehabilitation Goals

  • Full P/AROM

  • Gradually restore shoulder strength, power, and endurance

  • Return to ADLs, work, and recreational activities that do not

    require heavy lifting, powerful movements, or repetitive

    overhead activities

  • Advanced proprioceptive and dynamic neuromuscular control

    retaining

Precautions

  • Post-rehabilitation soreness should alleviate within 12 hours of the activities

  • No lifting of objects more than 15-20 pounds with short lever arm

  • Lifting only light resistance with long lever arm

  • No sudden lifting, jerking, or pushing movements

Suggested Therapeutic exercises

  • Progress ion of strengthening with exercises demonstrated to have 30-49% EMG activity level. Generally in upright position with progression of lever arm and resistance

  • Multi-plane shoulder AROM with a gradual increase in the velocity of movement while making sure to assess scapular rhythm

  • ER and IR art various angles of abduction

  • Prone series rowing horizontal abduction, extension

  • Dynamic stabilization

  • OCK proprioception awareness drills

  • CKC progression

  • Biceps curls, triceps extensions, lat pull downs, wrist and

    forearm strengthening

  • Exercises should be progressive in terms of shoulder elevation

    range

  • Rhythmic shoulder stabilizations, starting with proximal

    perturbations

  • Shoulder mobilizations as needed

  • Core and lower body strengthening

  • Grade II and IV joint mobilizations as indicated to address

    capsular restrictions at all shoulder girdle joints GH, SC, AC, ST

Cardiovascular exercise

  • Walking, stationary bike, and Stairmaster

  • No treadmill or swimming

• May begin light jogging and running if the patient has normal rotator cuff strength in neutral and functional shoulder AROM

Progression Criteria

  • Full shoulder AROM in all planes and multi-plane movements

  • Manual muscle testing 5/5

  • Pain free during strengthening exercises

  • Negative impingement signs

 

Phase IV (Months 6+)

Appointments

• Rehabilitation appointments 1-3xwk

Rehabilitation Goals

  • Normalize muscular strength, power and endurance

  • Return to high demand activities

  • Complete return to sport

  • Develop strength and control for movements required for

    sport/work

  • Develop work capacity cardiovascular endurance for

    sport/work

Precautions

  • Post-rehabilitation soreness should alleviate within 12 hours of the activity

  • Avoid activities that result in substitution patterns

  • Avoid exercises that generate a large increase in load

    compared to previous exercises

Suggested Therapeutic exercises

  • Continue shoulder mobilizations, stretching and PROM exercises as needed per impairments

  • Rotator cuff strengthening in 90 degrees of shoulder abduction as well as positions demanded by work/sport

  • Progressive return to weight lifting program starting with relatively lightweight and high repetitions. Increase weight while decreasing reps

  • Core and lower body strengthening

  • Throwing program, swimming program or overhead racquet

    program

  • Transition to upper extremity prevention/maintenance

    program

Cardiovascular exercise

• Replicate sport or work specific energy demands

Progression Criteria

• The patient may return to sport after receiving clearance from the orthopaedic surgeon and the sports rehabilitation provider.

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