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Rotator Cuff Repair Protocol - Massive

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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