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Rotator Cuff Repair

 

The physical therapy rehabilitation for rotator cuff repair will vary in length depending on degree of instability, acute versus chronic condition, strength/ROM status, and activity demands.

Phase 1 (Initial 3 weeks post-surgery)

  • Patient is immobilized for initial 3 weeks
  • Immobilizer may be removed for gentle passive ROM (flexion, abduction, external rotation) and pendulum exercises
  • No active flexion or abduction first 3 weeks
  • Start shoulder shrugs, elbow/wrist ROM, and ball squeezes

Phase 2 (3-6 weeks post-surgery)

  • No longer required to wear immobilizer
  • Modalities as needed
  • Continue passive ROM exercises
  • Add active assist (wall climbs, wand) and pain-free active ROM
  • Add joint mobilization as needed
  • Add isometric exercises
  • Active internal/external rotation exercises with rubber tubing as tolerated
  • Active shoulder extension lying prone or standing (bending at the waist); avoid the shoulder extended position by preventing arm movement beyond the plane of the body
  • Active horizontal adduction (supine) as tolerated

Phase 3 (6-8 weeks post-surgery)

  • Continue shoulder ROM exercises as needed
  • Continue active internal/external rotation exercises with rubber tubing; as strength improves, progress to free weights
    • External rotation: performed lying prone with arm abducted to 90 degrees or side lying with the arm at the side (perform through available range)
    • Internal rotation: performed supine with the arm at the side and elbow flexed 90 degrees
  • Active shoulder abduction from 0-90 degrees
  • Add supraspinatus strengthening exercise if 0-90 degrees motion available
    • The movement should be pain free and performed in the scapular plane (about 20-30 degrees forward of the coronal plane)
  • Active shoulder flexion through available ROM as tolerated

Phase 4 (2-3 months post-surgery)

  • Should have full passive and active ROM
  • Continue isotonic exercises with emphasis on eccentric strengthening of the rotator cuff
  • Add push-ups (should be pain-free); progress from wall to modified to military
  • Add shoulder bar hang exercise to increase ROM in shoulder flexion and abduction
  • Active horizontal abduction (prone)
  • Upper extremity proprioceptive neuromuscular fascilitation may be added
    • Shoulder flexion/abduction/external rotation and extension/adduction/internal rotation diagonals emphasized
  • Add strengthening exercises to the elbow and wrist
  • Add upper body ergometer for endurance and gentle plyometrics

Phase 5 (4 months post-surgery)

  • Add advanced capsule stretches, as necessary
  • Continue to progress isotonic exercises
  • Add military press exercise and total body conditioning program
  • Add progressive plyometrics including stair stepper and tilt board
  • Add pitch-back beginning with a light ball

Phase 6 (5 months post-surgery)

  • Continue strengthening program (sport specific positions)
  • Continue total body conditioning program
  • Skill mastery; begin practicing skills specific to the activities
  • May add progressive shoulder throwing program; advance through sequence as needed
  • May perform isokinetic and endurance test if needed
    • Goal 80% or greater than opposite side