Arthroscopic Rotator Cuff Debridement
With or Without Acromioplasty
With or Without Acromioplasty
Phase 1 (First 2 weeks post-op)
- Sling up to 10 days; encourage use of involved joints and use ice QID
- Pendulum exercises; start post-operative day 1 in sling
- Gentle pain-free isometrics post-operative day 2 (avoid stressed abduction)
- Post-operative day 3 start passive ROM; mobilization as needed, supine wand exercises, humeral glides
- Second week start active assistive ROM against gravity (wand, wall climb, pulley, etc)
- Start into flexion and progress to abduction
- Progress to active ROM against gravity (avoid impingement)
- Progressive mobilization and shoulder girdle flexibility exercises leading to full ROM
- Goal full ROM at 6 weeks
Phase 2 (3-6 weeks post-op)
- Start multiple angle isometrics in a low-medium force
- Slow speed isokinetics for internal and external rotation with dynamometer tilted at 15-30 degrees from horizontal
- Low force but high repetition program
- PNF patterns with manual resistance at 4 weeks
- Start submaximal isotonic exercises below 90 degrees of elevation
Phase 3 (Greater than 6 weeks)
- Larger arcs of motion with resistive exercise avoiding impingement
- Maintain caution with overhead exercises
- Address both muscle isolation and muscle synergy
- Full utilization of isokinteic speeds with incorporation of diagonal patterns
- Increase emphasis of isotonic exercises, especially eccentric modes with throwers
- Moderate weight, moderate repetition program
- Begin functional progressive and lead-in to overhead activities at 8-12 weeks
- Progress to high weight low repetition program if indicated AFTER returning to functional activities