Rotator Cuff Repair Protocol

PHASE 1: PROTECTIVE PHASE (Weeks 0-6)

Goals:

  • Protect integrity of the repair
  • Decrease pain and inflammation
  • Gradually increase in ROM
  • Retard muscle atrophy

Precautions:

  • No active abduction or forward flexion
  • Patients are allowed to reach to their face but are instructed to avoid external rotation or reaching above their head.
  • Sling may be discontinued as pain permits

Exercises:

  • Pendulums
  • Self-PROM Flexion in Supine to a maximum of 90 degrees
  • Scapular Isometrics (primarily retraction)
  • Elbow, Wrist, Hand AROM
  • Modalities as needed

PHASE 2: INTERMEDIATE PHASE (Weeks 6-10)

Goals:

  • Decrease pain and inflammation
  • Restore full PROM and AROM
  • Gradual increase in strength

Precautions:

  • Patients are not allowed to lift weight above the shoulder
  • Patients should not lift > 5 pounds.

Early Intermediate Phase (Weeks 5-7)

  • Continue PROM as needed to achieve and maintain full ROM
  • Initiate AAROM exercises progressing to AROM as tolerated
  • Initiate gentle rhythmic stabilization exercises
  • Strengthening exercises for the hand, wrist, elbow, and scapular musculature
  • (Note: Biceps strengthening should be deferred until 8 weeks if patient underwent tenodesis)
  • Modalities as needed

Late Intermediate Phase (Weeks 8-10)

  • Continue PROM, AAROM, AROM to achieve and maintain full ROM
  • Continue distal Upper Extremity and scapular strengthening
  • Continue rhythmic stabilization
  • Initiate strengthening exercises with weights/theraband progressing as tolerated
  • Modalities as needed

PHASE 3: ADVANCED PHASE (Weeks 10-Discharge)

Goals:

  • Maintain full, non-painful AROM
  • Improve shoulder strengthening
  • Improve neuromuscular control
  • Gradual return to functional activities

Expectations:

  • 10-12 weeks – Patient should have achieved full active and passive range of motion
  • 12-16 weeks – Patients should be nearing normal strength and full range of motion

Early Advanced Phase (Weeks 10-12)

  • Continue and advance exercises above
  • General conditioning program

Late Advanced Phase (Weeks 12-Discharge)

  • Continue all strengthening exercises
  • Continue all flexibility exercises
  • Gradual progression of functional activities per patient needs