Rotator Cuff Repair Protocol – Massive

Rotator Cuff Repair Protocol-Massive

Day 1 post-op to week 4

• Change dressings. 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
  • Supine wand for ER at 45 degrees abduction
  • Posterior shoulder rolls or scapular squeezes
  • Cervical active range of motion (ROM)
  • Elbow active ROM
  • Hand squeezes
• Manual
  • Passive ROM into all ranges to patient tolerance, careful on internal rotation.
  • 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 3-4

• Goals
  • Protect the repair while gaining range of motion
  • Maintain ROM and strength of distal and proximal joints
  • Reduce pain and inflammation 
  • Stay in sling
• Therapeutic exercise
  • Continue exercises as above
  • Supine opposite arm assist flexion
  • Table slide for abduction
• Manual
• Passive ROM in all directions to patient tolerance. Patient brought up to 90 degrees abduction for external rotation
• Continue scapular MRE’s
• Precautions
• Continue above precautions

Weeks 5-6

• Goals
  • Full passive ROM by end of week 6
  • 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
  • Gentle submaximal isometrics at week 6 for flexion, external rotation, internal rotation, and extension with bent elbow
• Manual
  • Continue same as above
  • Side lying external rotation at week 6
  • Blackburn 1 (prone horizontal abduction in neutral) at week 6

Weeks 7-8

• Discharge sling at physician’s discretion 
• Therapeutic exercise
  • Continue with those as above
  • Standing wand flexion (start with bent elbow) progressing to active ROM
  • Full Active ROM by week 8
  • Flexion wall crawl without help from other arm
  • Horizontal adduction stretch at week 8
  • Towel internal rotation stretch at week 8
  • Theraband IR/ER at week 8
• Manual
  • Continue with those above

Weeks 9-15

• Therapeutic exercise
  • Continue as above
  • Blackburn 3 (Prone horizontal abduction with external rotation)
  • Full can at 12 weeks
• Manual
  • Continue as above
  • Rhythmic stabilization performed in multiple body positions and ROMs

Weeks 16 to 22

• Therapeutic exercise
  • Progress with all above exercises
  • LOW RESISTANCE, HIGH REPETITIONS