Download PDF to print
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 with a superior labrum anterior-posterior tear. 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 rehabilitation will depend on type of SLAP tear repair (ex. Type 1 vs type 2)
GENERAL PROGRESSION OF ACTIVITIES OF DAILY LIVING (ADLs)
- You may bath/shower 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 first 4 weeks
- Avoid extending or placing arm behind back for first 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, average around 6 weeks
- Return to normal daily activities/work as directed by PT/MD based on demands and goals.
Rehabilitation Progression
PHASE I: Week 0 – 6:
Goals:
- Protect surgical site
- Decrease pain and inflammation
- Minimize side effects of immobilization
Precautions:
- Use of sling for 4 weeks during sleep and daily activities
- No isolated biceps contraction early in phase, at most progressing to elbow flexion active range of motion (AROM) no resistance
- No AROM external rotation, extension or abduction until start of week 5
- Avoid lifting objects heavier than 1-2 pounds for 4 weeks
Exercises:
- Hand gripping
- Pendulum exercises
- Cervical spine active range of motion
- Wrist/hand AROM/active assist range of motion (AAROM) (weeks 1-2)
- Gradual progression of shoulder passive range of motion (PROM) and AROM (begin week 5)
- Flexion and elevation to 90 degrees
- External rotation to 25-30 degrees
- Internal rotation to 55-60 degrees
- Begin submaximal isometrics for rotator cuff, periscapular and shoulder musculature
- Initiate proprioceptive neuromuscular facilitation (PNF) at week 3-4 within range of motion, progress in week 5-6
- Begin prone exercise strengthening for scapular musculature at week 5-6
PHASE II: Weeks 7-14:
Criteria to advance to Phase II:
- Flexion and elevation in scapular plane to >90 degrees
- Abduction >90 degrees
- External rotation 45-50 at 45 degrees abduction
- Internal rotation 45-60 at 45 degrees abduction
Goals:
- Gradually restore full AROM and PROM shoulder flexion, abduction, external rotation, internal rotation, extension to tolerance
- Preserve integrity of surgical repair
- Continue to progress gradual strengthening program
- Begin isotonic rotator cuff, periscapular and shoulder strengthening program
Exercises:
- Closed chain push/pull exercises
- Continue PNF strengthening
- Type II repairs: begin submaximal pain free biceps isometrics
- Type IV and complex repairs: continue AROM elbow flexion and extension, no biceps isometric or isotonic strengthening
Phase III: Week 14 to 20:
Criteria to advance to Phase III:
- Full painfree ROM
- Good shoulder stability
Goals:
- Establish and maintain full ROM
- Continue gradual strengthening program
Exercises:
- Continue and progress all exercises in prior phase
- Initiate interval sport program
Phase IV: Week 20-26:
Criteria for advancement to Phase IV:
- Full painfree ROM
- Satisfactory static and stability
- No pain or tenderness
Goals:
- Enhanced muscular strength, power and endurance
- Progress functional activities
- Maintained shoulder stability
Exercises:
- Progress push/pull exercises
- Progress interval sports program
- Progress PNF
- Plyometric strengthening
Phase V: Months 6-9:
Criteria for advancement to Phase V:
Goals:
- Gradually progress sport activities to unrestrictive participation
Exercises:
- Continue strengthening and stretching program