Rotator Cuff RepairRehabilitation Protocol

The intent of this protocol is to provide guidelines for the post-operative rehabilitation course after arthroscopic Rotator Cuff Repair. This protocol is based on a review of the best available scientific studies regarding shoulder rehabilitation. It is by no means intended to serve as a substitute for clinical decision making regarding the progression of a patient’s post-operative course. It should serve as a guideline based on the individual’s physical exam/findings, progress to date, and the absence of post- operative complications. If the physical therapist requires assistance in the progression of a post-operative patient they should consult with Dr. Johnson.

Phase 1 (0-4 weeks)

Immobilizer
- 0-2 weeks: Immobilized at all times
- May remove for hygiene and gentle home stretches per instruction
Range of Motion
- 0-2 weeks: None
- 2-4 weeks: begin PROM
  - Limit 90° flexion, 45° ER, 20° extension, 45° abduction, 45° ABER
Exercises
- 0-2 weeks: Pendulums, elbow/wrist ROM
- 2-4 weeks: Codman’s and posterior capsular stretches, closed chain scapula

Phase 2 (4-12 weeks)

Range of Motion
- Begin active/active assisted ROM
  - Advance to 140º FE, 135º ABD, 90º ABER and 45º ABIR
  - IF DISTAL CLAVICLE EXCISION performed avoid adduction horizontally for ~8 weeks
Exercises
- Begin active assisted
- Rotator cuff isometrics ~8weeks
- May begin resistive scapular stabilizers, biceps/triceps
  - IF BICEPS TENODESIS performed avoid resistive biceps or eccentrics for first 6 weeks

Phase 3 (12-16 weeks)

Range of Motion
- Improve to full AROM
Exercises
- Advance from Phase 2 with emphasis on glenohumeral stabilization, external rotators and latissimus eccentrics
- May start cycling/running

Phase 4 (4-6 months)

Range of Motion
- Improve to full AROM
Exercises
- eccentrics and aggressive scapular stabilization
- may begin plyometrics or overhead throwing program

Phase 5 (6+ months)

Phase 4 exercises and return to full activity as tolerated