Small/Medium Rotator Cuff Repair Protocol

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

• 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).

• 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.

• 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 (2-4 weeks post-operative):

• 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.

• No shoulder AROM until 4 weeks, no RTC RROM until 6 weeks.
• No lifting, sudden movements or supporting of body weight with hand.
• Continue use of sling.

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

Intermediate Phase (4-6 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, IR-70, ER-90 (rotation at 90 ABD) apley IR T10.

• No shoulder RROM until 6 weeks.
• No lifting objects.

• Continue PROM/AAROM.
• Initiate Shoulder AROM starting in gravity lessened positions progressing to against gravity as tolerated.
• Initiate sub-maximal shoulder isometrics in GH neutral for flexion, ABD, EXT, IR, ER.
• RROM hand, wrist, elbow.

Strengthening Phase (6-12 weeks):

• Maintain full AROM.
• 4+/5 RC, scap 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, scaption.
• RROM scapular stabilization.
• Progress to functional position, strengthen rotator cuff at 90 degrees ABD supine/prone.
• Endurance training (UBE).
• Continue scapular retraction .
• Initiation of rhythmic stabilization training for IR/ER and FF/EXT.

Advanced Functional Strength Phase (12 weeks-on):

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

• Aggressive RROM Rotator cuff and periscapular structures in functional positions.
• Plyometrics with volume progression.
• Sport specific, work specific training.