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