Orthopaedic Surgeon
Small to Medium Rotator Cuff Repair Surgical Rehabilitation
Phase I (0 – 4 weeks)
Appointments
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Home exercise program will begin after surgery
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PT 1-3x/week.
Rehabilitation Goals
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Progression of elevation in scapular plan and ER in 20-30 degrees of abduction
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Correct postural dysfunctions
Precautions
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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
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No active abduction ROM for 8 weeks to protect repair and no external resistance to abduction and supraspinatus for 12 weeks
Suggested Therapeutic Exercise
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Progress forward elevation and passive ER using only exercise demonstrated to have less than 15% EMG activity level
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Supported side lying shoulder flexion
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Supine forward elevation with elastic band resistance form 90
degrees
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Small circle (20cm) pendulums
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Scapular strengthening
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Grade I and II joint mobilizations for pain relief as needed at all
shoulder girdle joints, GH, SC, AC, ST
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Elbow, wrist, finger AROM and light strengthening
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Ensure normal cervical spine, thoracic spine and hip mobility
to facilitate kinetic chain upper extremity ROM
Cardiovascular exercise
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Walking and stationary bike
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Avoid running, jumping, treadmill, elliptical and Stairmaster
Progression Criteria
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At least 8 weeks post-operative
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Passive forward elevation 90-120 degrees
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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:
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Passive forward elevation to 130-155 degrees
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Passive ER at 20 degrees of abduction to 30-45 degrees.
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Passive ER at 90 degrees of abduction to 45-60 degrees to full
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Controlled progression of active assistive range of motion and AROM. AROM initiation based on PROM goals, delayed 9 weeks postoperative
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Initiate light muscle performance activities
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Correct postural dysfunctions- active elevation 80-120 degrees
without compensation
Precautions
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Wean out of sling slowly starting postoperative weeks 6-8 based on size of tear, integrity of tissue and repair, and surgeon preference
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No active abduction ROM for 8 weeks to protect repair and no external resistance to abduction and supraspinatus for 12 weeks
Suggested Therapeutic Exercise
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Appropriate progression of upper extremity use for light ADLs in pain free ROM starting with waist level activities, progression to shoulder level
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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
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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
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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
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Active shoulder flexion
Cardiovascular Exercise
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Walk and stationary bike
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Avoid running and jumping, no treadmill, elliptical, or
Stairmaster
Progression criteria
• Passive forward elevation to at least 140 degrees to full
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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
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Active elevation to at least 120 degrees without compensation
Phase III (months 3 - 5)
Appointments
• Rehabilitation appointments 1-3xwk
Rehabilitation Goals
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Full P/AROM
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Gradually restore shoulder strength, power, and endurance
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Return to ADLs, work, and recreational activities that do not
require heavy lifting, powerful movements, or repetitive
overhead activities
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Advanced proprioceptive and dynamic neuromuscular control
retaining
Precautions
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Post-rehabilitation soreness should alleviate within 12 hours of the activities
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No lifting of objects more than 15-20 pounds with short lever arm
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Lifting only light resistance with long lever arm
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No sudden lifting, jerking, or pushing movements
Suggested Therapeutic exercises
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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
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Multi-plane shoulder AROM with a gradual increase in the velocity of movement while making sure to assess scapular rhythm
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ER and IR art various angles of abduction
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Prone series rowing horizontal abduction, extension
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Dynamic stabilization
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OCK proprioception awareness drills
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CKC progression
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Biceps curls, triceps extensions, lat pull downs, wrist and
forearm strengthening
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Exercises should be progressive in terms of shoulder elevation
range
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Rhythmic shoulder stabilizations, starting with proximal
perturbations
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Shoulder mobilizations as needed
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Core and lower body strengthening
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Grade II and IV joint mobilizations as indicated to address
capsular restrictions at all shoulder girdle joints GH, SC, AC, ST
Cardiovascular exercise
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Walking, stationary bike, and Stairmaster
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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
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Full shoulder AROM in all planes and multi-plane movements
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Manual muscle testing 5/5
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Pain free during strengthening exercises
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Negative impingement signs
Phase IV (Months 6+)
Appointments
• Rehabilitation appointments 1-3xwk
Rehabilitation Goals
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Normalize muscular strength, power and endurance
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Return to high demand activities
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Complete return to sport
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Develop strength and control for movements required for
sport/work
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Develop work capacity cardiovascular endurance for
sport/work
Precautions
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Post-rehabilitation soreness should alleviate within 12 hours of the activity
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Avoid activities that result in substitution patterns
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Avoid exercises that generate a large increase in load
compared to previous exercises
Suggested Therapeutic exercises
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Continue shoulder mobilizations, stretching and PROM exercises as needed per impairments
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Rotator cuff strengthening in 90 degrees of shoulder abduction as well as positions demanded by work/sport
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Progressive return to weight lifting program starting with relatively lightweight and high repetitions. Increase weight while decreasing reps
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Core and lower body strengthening
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Throwing program, swimming program or overhead racquet
program
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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.