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Rotator Cuff Repair Rehab Protocol

 

Phase I –Protective Phase (0 to 6 weeks)

  • Abduction immobilizer / sling for 6 weeds with the arm in slight abduction (45° to 60°, promotes better blood flow to the supraspinatus, minimize tension on the repair), may take off to eat, shower, and to use arm for desk work.
  • NO ACTIVE SHOULDER motion for 6 weeks.
  • Active elbow, wrist and digit ROM – use putty.
  • Pendulum exercises.
  • Supine active assisted forward elevation (FE) to pain tolerance.
  • Once patient understands the difference between active and passive motion, the patient should start home passive FE with pulleys system.
  • Passive Forward elevation up to 140°.
  • Passive external rotation up to 40°.
  • Passive abduction to 75°.
  • Use modalities to control pain and swelling (i.e. ice, HVGS, TENS).
  • Home exercise program should be established so patient performs exercises 3-5 times per day.
  • Add active assisted IR behind back and shoulder extension (Wand, T-bar exercises, etc.) at 4 weeks.

Phase II – Intermediate phase (6 to 12 weeks)

  • Discontinue shoulder immobilizer.
  • Progess from active-assisted ROM to active ROM exercises.
  • Begin strengthening / resisted motion exercises at 12 weeks.
  • Forward elevation up to 160°.
  • External rotation up to 60°.
  • Abduction to 90°.

Phase III –Strengthening (10 to 24 weeks)

  • Full ROM.
  • Progressive Resistance Exercises.  Start light, progress as tolerated.
  • Wall pushups, press-ups.
  • Total Gym – rows, presses, pullovers. 
  • Rockwood exercises – flex, abd, ext, add, IR, ER, rows, presses.
  • Can use dumbbells or theraband tubing for Rockwood exercises.
  • Cybex strength testing – goal >85% of contralateral side at 20 weeks.
  • Start sport specific rehab.

Phase IV – Return to Activities (After 6 months)

  • Work on focal deficits.
  • Establish a home program.
  • Continue sport specific rehab.
  • Improvement continues for 12 months post op.

For Detailed Rehabilitation protocols see:

  • Brotzman SB, Clinical Orthopaedic Rehabilitation, Mosby, 2003