Rotator Cuff Repair Rehabiliation Protocol


PHASE I – PROTECTION PHASE (0-6 WEEKS)

GOALS:

  • Proper healing of surgical incisions
  • Pain and edema control
  • Passive abduction to 135 degrees
  • Passive flexion to 150 degrees
  • Gradual increased in ROM
  • Maintenance of distal muscle strength
  • Minimal cervical spine stiffness
  • Maintenance of full elbow and wrist ROM.
  • Patient demonstrates understanding of home exercise program

0-3 WEEKS

RESTRICTIONS:

  • No ACTIVE shoulder flexion or abduction during the first month.
  • Patient is immobilized using an abduction pillow during the initial 1-2 weeks.

INTERVENTIONS:

  • Brace or sling (as determined by physician)
  • Monitor healing of incisions.
  • Instruct in home exercises program.
  • Discuss goals of treatment with patient.
  • Pendulum Exercises
  • Active assisted ROM exercises
    a. Flexion to 125 (cane)
    b. ER/IR to 30 degrees at 45 degrees abduction (cane)
    c. Rope and Pulley – Flexion only
  • Passive ROM to tolerance
  • Sub-Maximal Isometrics (without pain)
    (at 3 weeks)
    a. Shoulder flexion
    b. Internal Rotation
    c. Elbow Flexion
    d. Elbow Extension
  • AROM
    a. Elbow flexion/extension
    b. Cervical spine (all planes)
  • PREs
    a. Hand gripping exercises
    b. Putty
  • Joint Mobilization – Grade I and II
  • Friction massage to scar tissue
  • Cryotherapy with electrical stimulation

3-6 WEEKS

INTERVENTIONS:
Continue as above with the following additions and/or modifications:

  • Discontinue use of brace or sling
  • AAROM Exercises (cane)
    a. Flexion to 145 degrees
    b. ER/IR to tolerance at 65 degree of abduction
  • Sub-Maximal Isometrics (at 4 weeks)
    a. Shoulder Abduction
    b. External Rotation
  • UBE

PHASE 2 – INTERMEDIATE PHASE (7-14 WEEKS)

By 8 WEEKS

GOALS:

  • Passive flexion/abduction 140-165 degrees
  • Passive ER to 70
  • Passive IR to 55
  • AAROM above head height
  • Decrease pain
  • Increase scar mobility
  • Able to perform ADLs (grooming, bathing, dressing) using involved upper extremity.
  • Initiate neuromuscular control exercises for scapular stabilization (in prone – rows and horizontal abduction)

RESTRICTIONS:

  • Maintain pain free range of motion
  • Patient must be able to elevate arm without shoulder and scapular hiking before initiating isotonics. If unable, maintain humeral heal stabilization exercises.

INTERVENTIONS:
Continue Phase I exercises with the following additions and/or modifications:

  • AAROM in supine progressing as tolerated.
  • PNF D1 and D2
  • AROM→progress to resistive as tolerated
    a. Flexion
    b. Abduction
    c. ER
    d. IR
    e. Scaption
    f. Scapular Stabilization
    g. Sport Specific Activities
  • Wall Push-Ups

By 10 WEEKS

GOALS:

  • Full, pain-free PROM/AROM
  • Gradual increase in strength
  • Minimize pain with overhead activities.
  • Ability to reach in front and to the side for light weight objects

INTERVENTIONS:

      Continue as above with the following additions and/or modifications:
    • AAROM

a. Flexion to tolerance
b. ER/IR to tolerance at 90 degrees abduction

  • Strengthening exercises
    a. Theraband IR/ER in neutral with towel roll under arm
    b. Initiate isotonic dumbbell strengthening
    i. Deltoid
    ii. Supraspinatus
    iii. Elbow Flexion/Extension

10-14 WEEKS

INTERVENTIONS:

  • Continue all exercises listed above
  • Full range of motion desired by 10-12 weeks
  • Initiate isokinetic strengthening in scapular plane
  • Initiate sidelying ER/IR strengthening exercises with towel roll under arm.
  • Body Blade exercises
  • Manual resistance added to PNF patterns

PHASE 3 – ADVANCED STRENGTHENING PHASE (15-26 WEEKS)

GOALS (by 17 weeks):

  • Maintain full, pain-free ROM
  • Improve strength of shoulder
    a. 75% to 80% dependent upon type of repair
  • Improve neuromuscular control
  • Increase endurance
  • Gradual return to functional activities
    a. Self management of pain associated with overhead activities
    b. Carry light weight for short time periods

GOALS (by 26 weeks):

  • Pain-free overhead activities
  • Pain-free ADLs
  • Return to previous level of functioning

INTERVENTIONS:

  • Self capsular stretches
  • Joint Mobilization as appropriate
  • Aggressive Strengthening program
    a. Shoulder flexion
    b. Shoulder abduction (to 90 degrees)
    c. Supraspinatus
    d. ER/IR
    e. Elbow flexors/extensors
    f. Scapula strengthening
    g. Military Press
    h. Modified Full Push-Ups→Full Push-Ups

PHASE 4 – RETURN TO ACTIVITY PHASE (24-28 WEEKS)

GOALS:

  • Return to recreational sport activities as tolerated

INTERVENTIONS:

  • Continue all strengthening exercises
  • Continue all flexibility exercises
  • Continue progression on interval programs
  • Initiate throwing program when appropriate