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