Massive Rotator Cuff Repair Protocol

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

• Pain under control with use of medication, ice, sling.
• Maintain integrity of repair.
• Supple PROM flexion-90, ABD-90, IR-45, ER-45 (rotation 0 at ABD).

• No 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 only.
• Keep incision clean and dry.

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

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

• Minimize pain .
• Allow for soft tissue healing.
• Supple PROM flexion-120, ABD-120, IR-50, ER-70 (rotation 0-45 ABD).

• No shoulder AROM.
• No lifting, sudden movements, or supporting body weight on hand.
• Continue use of sling.

• Shoulder PROM flexion, ABD, IR, ER, (rotation 0-45 ABD).
• Joint mobilization grade I-III glenohumeral and scapulothroacic.
• AROM/PROM hand, wrist, elbow.
• AAROM shoulder flexion, ABD, IR, ER to tolerance of patient (rotation 0-45 ABD).
• Flexibility Apley IR.

Intermediate Phase (6-8 weeks post-operative):

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

• Continue PROM/AAROM, flexibility PRN.
• Jt. Mobs Gr I-IV G-H.
• AROM shoulder flexion, ABD, IR, ER to tolerance beginning in gravity lessened positions then progressing against gravity as tolerated.
• Submaximal isometric shoulder IR/ER/ABD/flexion/extension
• RROM hand, wrist, elbow

• No shoulder RROM.
• No lifting objects.

Strengthening Phase (8-15 weeks ):

• Full AROM.
• 4+/5 RC scapular stabilizers.

• No RROM IR/ER rotation at 90 degrees unless supine/prone.
• No heavy lifting especially above shoulder level.

• RROM rotator cuff shoulder flexion, ABD, IR/ER.
• Scapular stabilization RROM.
• Continue PROM/AROM to achieve full ROM.
• Progress to functional position, strengthen rotator cuff at 90 degrees ABD supine/prone.
• Endurance training (UBE).

Advanced Functional Strength Phase (16 weeks-on):

• Independent long term HEP.
• Return to normal function and sports activities.

• Aggressive RROM rotator cuff functional position Ex: IR/ER at 90 degrees ABD.
• Plyometrics.
• Sports specific, work specific training