0-6 WEEKS
Goals:
- Decrease pain and swelling
- Increase nutrition and healing response
- Infection prevention
Precautions:
- Sling/abduction pillow is worn for 4 weeks during the day and night
- Sling use as indicated by repair
- Remove sling for light activity and home exercise program as indicated by therapist
- Limit external rotation to neutral for 2 weeks
- No active external rotation for 4 weeks
- No active motion for 6 weeks, all planes
- No weights/PRE (progressive resistance exercise) for 12 weeks
Exercises (PROM):
- Therapist: grade I, II joint mobilizations
- Begin passive ROM exercises in clinic
- Begin active assisted ROM at 4 weeks
- Pendulum exercise without weight: clockwise, counterclockwise, side-to-side, front-back
- PROM above abduction pillow: ER, IR, flexion, extension
- Table slides
- Scapular retractions
- Wrist/elbow exercises
- Grip exercises
Other:
- Ice 3x/day for 20 minutes, or as indicated by therapist
- Continue to ice as needed and/or indicated throughout rehabilitation
- Modalities
- Continue as needed and/or indicated throughout rehabilitation
- Wound inspection
WEEK 4-6
Exercises (AROM)
- Pendulum exercises with light weight
- AAROM with cane & pulleys, to patient tolerance (flexion, abduction – ER to neutral)
- Body Blade – opposite hand, straight plane
- Shoulder shrugs – light weight/high reps
- Progress with:
- Wall climbing/finger ladder
- Scar mobility
- Joint mobilizations – grade I/II
- Quadruped rhythmic stabilization
- Body Blade – opposite hand diagonals with trunk rotation
- Biceps curls
- Shoulder extension with Theraband
- Shoulder shrugs
- UBE – active assist only
WEEK 6-8
Exercises (AROM):
- Continue with AAROM exercises
- AAROM exercises with cane
- AROM – all planes, no resistance
- UBE – forward/reverse
- Scapular retraction
- Prone extension
- Supine “holds” at 90° flexion; progress to small circles
- Side-lying “holds” at 90° abduction; progress to small circles
- Isometrics <50% effort, no pain (flexion, extension, abduction, ER)
- Biceps curls/triceps extensions with light resistances, elbow at side
WEEK 8-12
Goal: Should have full PROM; with gentle passive stretching
Exercises (AROM):
- Continue with week 6-8 exercises, adding weight/resistance as indicated by therapist
- Low-weight exercise (begin at 90° and increase to full ROM):
- flexion/extension
- abduction
- rows
- scaption
- Wall push-ups, wall push-ups plus
- Shoulder IR/ER with low resistance
- Scapular protraction (“serratus punch”)
- Prone fly
WEEK 12-16
Goal: Should have full AROM; if not, begin aggressive stretching to achieve full ROM
Exercises (Strength):
- Body Blade, involved extremity:
- one-handed grip, abduction to 90°
- two-handed grip, flexion to 90°
- Kneeling push-ups, kneeling push-ups plus
- Step-ups in kneeling push-up position
- UBE with increased resistance
- StairMaster in quadruped at level 12-15
- Treadmill in quadruped at 1.0 mph
- Plyoball:
- circles, CW & CCW, 1 minute each direction
- squares, CW & CCW, 1 minute each direction
WEEK 12-16+ (Return to sport-specific training)
- Continue with week 12-16 strength, increasing reps and resistance as tolerated
- Isokinetic testing as directed by physician
- Functional testing as directed by physician
- Push-ups, push-ups plus
- Step-ups in push-up position
- Sport-specific exercises as directed by physician and therapist
Reference: Adapted from Rehab Protocol for Medium (2-5 cm) Rotator Cuff Repair of the Department of Sports Medicine & Shoulder Surgery, Beth Israel Deaconess Medical Center, Boston, MA
Click here to download: Rotator cuff repair -medium
