Anthroscopic Rotator Cuff Repair Protocol

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The intent of this protocol is to provide the clinician with a guideline for the post-operative rehabilitation course of a patient that has undergone an arthroscopic rotator cuff repair. It is by no means a substitute for one’s clinical decision making regarding the progression of a patient’s post-operative course based on their physical exam/findings, individual progress, and/or the presence of post-operative complications. If a clinician requires assistance in the progression of a post-operative patient they should consult with the referring surgeon.

GENERAL GUIDELINES:

• Focus on protection of surgical site
• Individualized gradual progression of therapy to promote optimal level of functional independence
• Supervised physical therapy takes place for 3-6 months
• Progression of exercises will be based on surgical procedure (ex. Size of tear repaired)

GENERAL PROGRESSION OF ACTIVITIES OF DAILY LIVING (ADLs)

• Bathing: Do not let dressing get wet, have water spray below surgical site, to wash under operated arm early on bend passively at the waist to let arm passively come away from body
• You may use hand of operated arm in front of body early on but do not raise arm overhead for at least 4 weeks
• Avoid extending or placing arm behind back for at least 4 weeks
• Can expect to return to using arm with normal daily activities with dressing and self care starting around week 8
• Driving: Return within 8 weeks of surgery
• Return to normal daily activities/work as directed by PT/MD based on demands and goals.

Rehabilitation Progression

PHASE I: Week 1-2:

Goals: 

• Independence in home exercise program
• Decrease pain and inflammation
• Maintain integrity of surgical site
• Prevent muscular inhibition
• Maintain scapular and distal extremity strength

Precautions:

• Sleep in shoulder brace for 6 weeks
• Maintain arm in sling, only remove for exercise
• Avoid exceeding ROM limitations set by the surgeon
• No active range of motion of shoulder
• No lifting objects
• No shoulder motion behind back
• No excessive stretching
• No supporting of body weight on hands
• Keep incision clean and dry
• Physician or Physical Therapist will advise regarding other precautions

Exercises:

• Pendulum exercises
• Active assist range of motion (AAROM)
• External (ER) and internal rotation (IR) in scaption at 45 degrees of abduction
• Passive range of motion (PROM)
  • ER/IR in scaption at 45 degrees of abduction, ER to 20-25 degrees and IR to 30-35 degrees
  • Flexion to 115 degrees
• Elbow/hand gripping exercises
• Shoulder submaximal isometrics towards end of phase, with bent elbow

Functional Performance Test

• Demonstrate appropriate closed chain exercise for time (case by case basis for duration)
  • I.E.: bird dog; wall plank

PHASE II: Week 3-6:

Goals:

• Do not overstress healing tissue
• Gradually restore full PROM (week 4-5)
• Decrease pain and inflammation
• Continue use of brace/sling full time until discontinued by surgeon/therapist (typically around week 4-6)

Precautions:

• No excessive behind the back movements
• No sudden jerking motions
• No heavy lifting of objects (no heavier than 5 lb)

Exercises:

• Initiate active assist range of motion flexion in supine 
• Progressive PROM to tolerance
• Flexion to 140-155 degrees
• ER at 90 degrees abduction to at least 45 degrees
• IR at 90 degrees abduction to at least 45 degrees
• AAROM to tolerance
• Flexion
• ER/IR in scapular plane at 45 degrees abduction
• ER/IR at 90 degrees abduction
• Rhythmic stabilization 
• ER/IR in scapular plane
• Flexion/extension at 90-125 degrees flexion
• Begin scapular isometrics
• Continue shoulder isometrics
• Initiate prone strengthening exercises
• Initiate isotonic shoulder exercises (Week 5-6)

Functional Performance Test

• Modified push up test
• Modified row (TRX) test
• Bear position isometric hold test

Phase III:  Week 7-14:

Goals:

• Full AROM (week 10-12)
• Maintain full PROM
• Dynamic shoulder stability
• Gradual restoration of shoulder strength
• Neuromuscular control
• Gradual return to functional activities

Precautions:

• No sudden lifting of pushing activities
• No sudden jerking motions

Exercises:

• Continue stretching and PROM as needed
• Continue dynamic stabilization 
• Continue scapular strengthening
• Progress open chain shoulder exercises in all planes
• Closed chain push/pull exercises

Functional Performance Test

• Push up Test
• TRX pull up Test
• Bear crawl Test
• Lateral Raise Test

Phase IV:  Week 15-20:

Goals:

• Maintain full non-painful AROM
• Enhance functional use of upper extremity
• Continue to improve shoulder strength, power and endurance
• Gradual return to full functional activities

Exercises:

• Continue progression of shoulder girdle strengthening exercises
• Advance proprioceptive and neuromuscular activities
• Continue ROM and self-capsular stretching for maintenance
• Initiate sport specific program

Functional Performance Test

• Push up Plyometic Test
• Overhead press Test

Phase V:  Week 21-26:

Goals:

• Gradual return to strenuous work activities
• Gradual return to recreational and sport activities

Exercises:

• Continue to progress intensity of exercises
• Continue stretching if motion is tight
• Continue progression of sport specific exercises