Small/Medium Rotator Cuff Repair Protocol

Acute Protective Phase (0-2 weeks post-operative):

Goals:

• Pain under control with use of medication, ice, and sling.
• Maintain integrity of repair.
• Supple PROM as tolerated to attain flexion-90, ABD-90, IR-40, ER-45 (rotation at 0 ABD).
• Initiate sub-maximal isometrics for scapular retraction/depression.

Contraindications/Precautions:

• Avoid shoulder AROM or aggressive stretching.
• No lifting, sudden movements, or supporting of body weight with hand.
• Wear sling as recommended by physician. Remove for rehab or bathing.
• Keep incision clean/dry until physician follow-up and suture removal.

Rehab to include:

• Shoulder PROM in clinic and at home for flexion, ABD, IR, ER (rotation 0-45 ABD).
• Joint mobilization grade I-II glenohumeral and scapulothoracic .
• Pendulum exercise.
• AROM hand/wrist/elbow.
• RROM hand/wrist.
• Submaximal isometrics for scapular retraction/depression.
• Pain modalities.

Subacute Phase (2-6 weeks post-operative):

Goals:

• Minimize pain.
• Allow for soft tissue healing.
• Supple PROM as tolerated to attain flexion-120, ABD-120, IR-50, ER-70 (rotation at 45 ABD).
• Improved neuromuscular control and volitional activation of periscapular muscles.

Contraindications/Precautions:

• No shoulder AROM until 6 weeks, no RTC RROM until 8 weeks.
• No lifting, sudden movements or supporting of body weight with hand.
• Wear sling as recommended by physician. Remove for rehab or bathing.

Rehab to include:

• Shoulder PROM flexion, ABD, IR, ER (rotation 0-45 ABD).
• Joint mobilization grade I-III glenohumeral and scapulothoracic .
• AROM/RROM hand, wrist, elbow.
• AAROM shoulder flexion, ABD, IR, ER, to tolerance (rotation 0-45 ABD).
• Flexibility apley IR.
• Isometric scapular retraction/depression.

Intermediate Phase (6-8 weeks post-operative)

Discontinue sling at 6 week follow up with Dr. LaFrance.

Goals:

• Painless full supple PROM flexion-180, ABD-180, IR-90, ER-90 (rotation at 90 ABD).
• Painless full AAROM/AROM flexion-180, ABD-180, IR-70, ER-90 (rotation at 90 ABD) apley IR T10.

Contraindications/precautions:

• No shoulder RROM until 8 weeks.
• No lifting objects.

Rehab to include:

• RROM hand, wrist.
• Continue with persiscapular isometrics.
• Initiation of sub-maximal shoulder isometric IR/ER/ABD/Flex/Ext in GH neutral.
• Initiate shoulder AROM in all planes, starting in gravity lessened positions and progressing against gravity as tolerated without pain.

Initial Strengthening Phase (8-12 weeks):

Goals:

• Maintain full AROM.
• 4+/5 RC, scap stabilizers.

Contraindications/Precautions:

• No heavy lifting, especially above shoulder level.

Rehab to include:

• RROM rotator cuff shoulder flexion, ABD, IR/ER, scaption.
• Endurance training (UBE).
• Scapular stabilization RROM and progress rhythmic stabilization.

Advanced Functional Strength Phase (12 weeks-on):

Goals:

• Strengthen and further stabilize RC and scap stabilizers.
• Independent long-term HEP.
• Return to normal function and sports activities.

Rehab to include:

• Aggressive RROM Rotator cuff and periscapular strengthening progressing to functional positions.
• Plyometrics progression.
• Sport specific, work specific training.