Rotator Cuff Repair Protocol - Medium to Large

Rotator Cuff Repair Protocol - Medium to Large

Day 1 post-op to 2 weeks

• Change dressings day 1 post-op. Keep portal sites or incision clean and dry.  Remove sutures at 7-10 days post-op. Patient then allowed to get area wet.
• Stay in sling except for exercises
• Therapeutic exercise
  • Pendulums
  • Table slides into flexion, external rotation, and abduction (in scapular plane)
  • Supine opposite arm assist flexion
  • Supine wand for ER at 45 degrees abduction
  • Posterior shoulder rolls or scapular squeezes
  • Cervical active range of motion
  • Elbow active range of motion
  • Hand squeezes
• Manual
  • Passive range of motion (ROM) into all ranges to patient tolerance; be careful on internal rotation
  • Grade I-II joint mobs to glenohumeral joint with emphasis on posterior and inferior directions
  • Scapular manual resistive exercises (MRE)
    • In side-lying (contralateral side), resist scapular protraction and retraction with depression
  • Ice every 1 to 2 hours for first 72 hours, then 3-4 x/day
• Precautions
  • No active use of shoulder
  • No putting weight through shoulder
  • No reaching behind back

Weeks 2-3

• Goals
  • Protect the repair while gaining ROM
  • Maintain ROM and strength of distal and proximal joints
  • Reduce pain and inflammation 
• Stay in sling when up and moving around. Patient can take it off when just sitting and when doing exercises
• Therapeutic exercise
  • Continue exercises as above
  • Gentle submaximal isometrics at 2-3 weeks for flexion, external rotation, internal rotation, and extension with bent elbow
• Manual
  • Passive ROM in all directions to patient tolerance. Patient brought up to 90 degrees abduction for external rotation
  • Gentle submaximal isometrics at 2-3 weeks
  • Gentle rhythmic stabilization in balance point (100 degrees flexion, 10 degrees horizontal abduction) and neutral rotation with arm by side at 3-4 weeks
  • Continue scapular MRE's
• Precautions
  • Continue above precautions

Weeks 4-5

• Discharge sling at physician's discretion 
• Goals
  • Full passive ROM by end of week 4
  • Do not overstress healing tissue
  • Start to regain dynamic stability 
• Therapeutic exercise
  • Continue those above
  • Supine active assist wand flexion
  • Flexion wall crawl with opposite arm assist
  • Standing wand extension
  • Theraband internal rotation, external rotation, extension
  • Side-lying external rotation
  • Blackburns 1 (prone horizontal abduction in neutral) and 5 (prone extension with external rotation)
• Manual
  • Continue same as above.
  • Full passive ROM by 3-4 weeks post op
  • MRE for IR/ER and extension

Weeks 6-7

• Therapeutic exercise
  • Continue with those as above
  • Standing wand flexion (start with bent elbow) progressing to active ROM
  • Full active ROM by end of week 7
  • Flexion wall crawl without help from other arm
  • Horizontal adduction stretch at week 7
  • Towel internal rotation stretch at week 7
• Manual
  • Continue with those above

Weeks 8-14

• Therapeutic exercise
  • Blackburn 3 (prone horizontal abduction with external rotation)
  • Add weight to side-lying external rotation and Blackburn 5
  • Progress with band color, reps and sets
  • Theraband IR/ER at 90 degrees abduction at 9 weeks
  • Full can at 9 weeks
• Manual
  • Continue as above
  • Rhythmic stabilization performed in multiple body positions and ROM

Weeks 15 to 21

• Therapeutic exercise
  • Progress with all above exercises