Physiotherapy Protocol Following Rotator Cuff Repair

The Four Phases of Rehabilitation Following Rotator Cuff Surgery

Modified from “Rehabilitation of the Rotator Cuff: An Evaluation-Based Approach”.

Peter J. Millett, MD, MSc, Reg B. Wilcox, III, PT, DPT, MS, James D. OHolleran, MD and Jon J. P. Warner, MD, J Am Acad Orthop Surg, Vol 14, No 11, October 2006, 599-609

Please Take this to your physiotherapist

 Key

ER               =external rotation

IR               =internal rotation

PROM        =passive range of

ROM          =range of motion

 

Phase 1: Immediate Post -Operative Period (weeks 0-6)

Goals

Maintain/protect integrity of repair

Gradually increase PROM

Diminish pain and inflammation

Prevent muscular inhibition

Precautions

Maintain arm in abduction sling/brace, remove only for exercise

No shoulder AROM, lifting of objects, shoulder motion behind back, excessive stretching or sudden movements, supporting of any weight, lifting of body weight by hands

Keep incision clean and dry for first few days for 5 days.

Exercises

Common to groups, “minimal tension repairs” and “repairs under tension”

Finger, wrist, and elbow AROM

Begin scapula musculature isometrics/sets; cervical ROM

Cryotherapy for pain and inflammation

No PROM exercises at this stage apart from “finger walks”  on a desk

May resume general conditioning program, i.e. walking, stationary bicycle, etc.

Aquatherapy/pool therapy may begin 4 weeks postoperative

Continue with full-time sling/brace until end of week 5

Between weeks 4 and 6, use sling/brace as recommended at post-op consultation

Discontinue sling/brace at end of week 6

 

MINIMAL TENSION REPAIR

Patient is immobilised in a sling with the arm at the side or abduction sling.

Sling may be removed 3-5 times per day for exercises and while resting.

Continue with full-time sling/brace until end of week 4

Commence gentle passive elevation using the opposite hand to support the limb.  Aim for full elevation of the arm by week 4.

Gentle passive external and internal rotation aiming for 50% of range by week 4 and 100% by week 6.

NO repetitive pendulum. Perform pendulums for washing your underarm, drying yours self etc.

NO abduction or extension strengthening exercises

Active elbow flexion/ extension strengthening exercises unless biceps surgery is performed which would be notified.

May squeeze a soft ball

 

CUFF REPAIR UNDER TENSION

Patient immobilised in an abduction pillow at about 45 degrees abduction.

Pillow must NOT be removed at any time in the first 3 weeks.

Continue with full-time sling/brace until end of week 6

Patient may commence gentle passive elevation of the operated limb above the level of the pillow,

aiming for full arm elevation by the end of Week 6.

May also undertake gentle passive external rotation.

Active elbow flexion/ extension strengthening exercises unless biceps surgery is performed which would be notified.

May squeeze a soft ball.

Phase 2: Protection and Active Motion (weeks 6-12) 

No theraband strengthening  at this stage

Goals

Allow healing of soft tissue

Do not overstress healing tissue

Gradually restore full PROM

Precautions

No lifting from the shoulder

No supporting body weight with hands and arms

No sudden jerking motions

No excessive behind the back movements

 

Exercises

Initiate AAROM flexion in supine position

Progressive PROM until approximately full

Gentle scapular/glenohumeral joint mobilization as indicated to regain full PROM

Initiate prone rowing to neutral arm position

Continue cryotherapy as needed

May use heat before ROM exercises

Aquatherapy okay for light AROM exercises

 

MINIMAL TENSION REPAIR

Patient may remove sling for increasing periods through the day as tolerated, and eventually discard it.

Continue range of motion programme for elevation, external and internal rotation, beginning with gravity eliminated and progressing to work against gravity.

Gentle abduction exercises only. Full abduction is not important at this stage.

 

CUFF REPAIR UNDER TENSION

Abduction pillow is gradually removed for increasing periods during the day from about four weeks. Initially done with the patient supine and when the arm is comfortable at the side thane patient may sit or stand.

Continue range of motion programme for elevation and external rotation.

When arm is able to be left out of pillow then begin passive internal rotation.

At about 8 weeks introduce active assisted movement in elevation and internal/external

rotation

NO abduction exercises active or passive

Phase 3: Early strengthening (weeks 12-16)

Goals

Continue stretching and PROM, as needed

Full AROM (weeks 10-12)

Maintain full PROM

Dynamic shoulder stability

Gradual restoration of shoulder strength, power, and endurance

Optimize neuromuscular control

Gradual return to functional activities

Precautions

Sudden lifting or pushing activities, sudden jerking motions, overhead lifting

Exercises

Dynamic stabilization exercises

Initiate strengthening program

ER and IR with exercise bands/sport cord/tubing etc

 

MINIMAL TENSION REPAIR

Work towards full active range of elevation, external and internal rotation.

Continue terminal stretching and introduce the full cuff stretching programme including

posterior and inferior stretches gradually.

Begin resistance strengthening

Avoid repetitive overhead use of the arm

Gentle active abduction but no resistance work in this arc. Full abduction is not important at this stage

 

CUFF REPAIR UNDER TENSION

Work toward a full range of active elevation, external and internal rotation.

Continue terminal stretching and introduce the full cuff stretching programme including posterior and inferior stretches gradually

Begin resistance at strengthening using Theraband. (Yellow – Green – Black)

Avoid repetitive overhead use of the arm

Gentle active abduction but no resistance work in this arc. Full abduction is not important at this stage.

Phase 4: Advanced strengthening (weeks 24+)

Goals

Maintain full non-painful AROM

Advanced conditioning exercises for enhanced functional use

Improve muscular strength, power, and endurance

Gradual return to full functional activities

Exercises

Continue stretching if motion is tight

Continue progression of strengthening

Advance proprioceptive, neuromuscular activities

Light sports (golf chipping/putting, tennis ground strokes) if doing well