Arthroscopic Rotator Cuff Repair Rehabilitation Protocol

  1. 1
    Phase I - Immediate Post Surgical/Maximum Protection (Weeks 1-6)

    Goals:

    • Protect integrity of repair
    • Decrease inflammation and pain
    • Improve passive range of motion (PROM)

    Precautions:

    • Maintain arm in abduction sling/brace, remove only for clothing/bathing
    • No active range of motion (AROM) of shoulder
    • No lifting of objects
    • No shoulder motion behind back
    • No excessive stretching or sudden movements
    • No supporting of any weight No lifting of body weight by hands
    • Keep incision clean and dry

     

    Week 0-4 (Phase IA):

    • PROM progressing per patient’s tolerance in Flexion and ER
    • Pendulum exercises
    • Elbow, wrist and hand ROM
    • Postural instructions to promote active scapular retraction
    • Scapular clock exercises
    • Shoulder mobilization – posteriorly
    • Ice and pain modalities as indicated

     

    Week 4-6 (Phase IB):

    • Continue PROM
    • Begin PROM in Abduction per patient tolerance
    • Shoulder mobs – posterior and caudal
    • Pec minor flexibility
    • Begin shoulder IR flexibility
    • Begin isotonic scapular retraction /protraction
    • Begin manual resistance scapular stabilization
    • Begin Sub-max isometrics
    • Shoulder flexion
    • Shoulder abduction
    • Shoulder extension
    • Ice and pain modalities as indicated

     

    Criteria for progression to the next phase (II):

    • Passive forward flexion to at least 125°
    • Passive ER in scapular plane to at least 75°
    • Passive IR in scapular plane to at least 75°
    • Passive Abduction to at least 90° in the scapular plane
  2. 2
    Phase II - Protection / AROM (Weeks 6-10)

    Goals:

    • Allow healing of soft tissue
    • Minimize stress to healing tissue

     

    Precautions:

    • No lifting
    • No supporting of body weight by hands and arms
    • No sudden jerking motions
    • No excessive behind the back movements
    • Avoid upper extremity bike or upper extremity ergometer at all times

     

    Week 6-8 (Phase IIA):

    • D/C sling per physician
    • AAROM per patient tolerance
    • Proprioception exercise
    • Ball on wall, UE swiss ball mobility –IR/ER

     

    Week 8-10(Phase IIB):

    • Begin progression of AROM per patient tolerance
    • Avoid Scapular Substitution

     

    Criteria for progression to the next phase (III):

    • Full AROM avoiding scapular substitution
    • Independent dressing ADLs
  3. 3
    Phase III - Basic Strengthening (Weeks 10-16)

    Goals:

    • Achieve/maintain full ROM
    • Gradual restoration of shoulder strength, power, and endurance
    • Optimize neuromuscular control
    • Gradual return to functional activities

     

    Precautions:

    • No heavy lifting of objects (no heavier than 5 lbs.)
    • No sudden lifting or pushing activities
    • No sudden jerking motions
    • No overhead lifting
    • Avoid upper extremity bike or upper extremity ergometer at all times

    Week 10-12 (Phase IIIA):

    • Continue stretching and passive ROM (as needed)
    • Dynamic stabilization exercises
    • Light theraband/tubing exercises
    • Shoulder IR/ER
    • Horizontal Abduction / Adduction
    • Begin Prone exercise program no weight
    • Row
    • Shoulder Extension
    • Horizontal Abduction – T exercise position
    • Lower Trap – Y exercise position
    • Begin rhythmic stabilization exercises supine

     

    Week 12-16 (IIIB):

    • Progress T-band exercises
    • Begin Diagonal Patterns
    • Begin Prone exercise program with weight
    • Row
    • Shoulder Extension
    • Horizontal Abduction – T exercise position
    • Lower Trap – Y exercise position
    • Progress Dumbbell Program with weight
    • Scaption
    • Diagonal patterns
    • Bent row
    • Prone Retraction with ER
    • Functional eccentric strengthening
    • Progress closed chain UE strengthening
    • Push up with a plus
    • Swiss ball activities
    • Trunk and lower-extremity strengthening

     

    Criteria for progression to the next phase (IV):

    • Full AROM with no scapular substitution
    • Able to tolerate the progression to low-level functional activities
    • Return of strength/dynamic shoulder stability
    • Adequate strength and dynamic stability for progression to higher demand activities
  4. 4
    Phase IV - Advanced Strengthening (Weeks 16-24)

    Goals:

    • Maintain full painless active ROM
    • Improve muscular strength, power, and endurance
    • Gradual return to full functional activities

     

    Week (16-20):

    • Continuation of functional UE/LE strengthening and endurance activity
    • Stretching program with emphasis on posterior capsule
    • Light sports (e.g., golf chipping/putting) if progressing

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