Rotator Cuff Repair Anterior Open Approach Large Tear < 3 cm ** It is the treating therapist s responsibility along with the referring physician s guidance to determine the actual progression of the patient within the protocol guidelines. For example tendon to bone healing requires 12 weeks of healing and strengthening may need to be postponed. The following is assuming the supraspinatus was repaired adjust accordingly if another muscle was repaired. Muscle actions: Supraspinatus abduction assists external rotation with shoulder abduction, internal rotation with shoulder flexion. Subscapularis internal rotation. Teres Minor external rotation, transverse abduction and transverse extension. Infraspinatus external rotation, transverse abduction, transverse extension. If biceps tenodesis or repair has been performed. No AROM elbow flexion for 4 weeks. Begin light resistance 6 weeks. Rehab Progression summary 6 weeks Sling immobilization 0 6 weeks Passive ROM (Phase I) 6 10 weeks Active assisted ROM (Phase II) 8 12 weeks Active ROM (Phase III) 16+ weeks Strengthening (Phase IV) Phase I PROM 1 st post op visit/ 0 6 weeks Goals of treatment: Decrease pain and swelling Increase nutrition and healing response Infection prevention Page 1 of 5
PROM: Begin passive ROM exercises in clinic Pendulum exercise without weight: clockwise, counterclockwise, side to side, frontback small motions PROM: Flexion to tolerance o Abduction with neutral rotation no > 90 for 6 weeks. o Limit internal rotation based on the size of the tear. o ER limited to Neutral for 4 weeks 20 6 weeks Scapular retractions Wrist/elbow exercises; grip exercises Isometrics week 4 submaximal and pain free Patient education: Wound inspection No active ROM for 8 weeks all planes No lifting Other: Ice Modalities prn Phase II Active Assisted ROM: 6 weeks post op/ up to 10 weeks Progression dependent on quality of repair/tissue AAROM: AAROM with cane and pulleys, flexion and external rotation to patient tolerance, abduction to 90 Body blade opposite hand, straight plane Shoulder shrugs Scapular retraction Page 2 of 5
Progress with: Wall climbing/finger ladder 7 8 weeks Scar mobility Joint mobilizations grade I/II Body blade opposite hand diagonals with trunk rotation Biceps curls Phase III AROM 8 weeks post op/ up to 12 weeks Progression dependent on quality of repair/tissue AROM: AROM all planes, no resistance (start supine then progress to incline and then standing) UBE forward/reverse Prone extension to neutral Supine holds at 90 flexion; progress to small circles Side lying holds at 90 abduction; progress to small circles Other: Biceps curls/triceps with light resistance elbow at side Phase III AROM to Light Strengthening: 12 weeks post op/ up to 16 weeks Continue with Phase III exercises adding weight/resistance as indicated by therapist Shoulder internal/external rotation with low resistance Scapular protraction Phase IV Strength: 16+ weeks post op Goal: Should have full AROM. If not, begin passive stretch to achieve full ROM Page 3 of 5
Strength: Low weight exercise (begin to 90 elevation and increase to full ROM) Wall push ups, wall push ups with a plus Shoulder IR/ER with low resistance Scapular protraction (serratus punch) Prone fly Body blade, involved extremity UBE with increased resistance Ball co contraction against wall Return to sport specific training 16+ weeks post op as per MD References: Adapted from Beth Israel Deaconess Medical Center. bidmc.org/sports Cardiff and Vale University Health Board Physiotherapy protocols for shoulder Surgery. Created by DHD & DE UHL 09 09 Brotzman, S. Wilk, K. Handbook of Orthopedic Rehabilitation. 2007. Mosby Inc. Philadelphia, PA. Gunderson Health system. Rotator cuff repair Rehabilitation Program Large Massive (>5 cm) compromised tissue quality. Healthsouth www.hsedu.com/clinicalprotocols.html 2006 Page 4 of 5
Returning to Functional Activities (Guidelines only) Driving: Driving can usually be resumed at 6 8 weeks once AROM is WNL s. MD/therapist will guide you. Return to work: This will be dependent upon the patient s occupation and the demands that their work will pose on their operated arm. In all cases the MD and /or physical therapist should guide the patient. Those in sedentary work may return 6 8 weeks. Those returning to light duties may resume work at 8 10 weeks. Those in physically demanding/ manual jobs may return at 4 months Return to Leisure Activities: Swimming breast stroke 8 10 weeks other strokes 12 14 weeks except overhead stroke (with caution) Golf 3 4 months Contact/impact sports including football, martial arts 4 6 months Initiation of Active ROM exercises based on size of tear: If supraspinatus repair no active abduction for 6 weeks minimum regardless of surgical procedure. Surgical Procedure Small Tear Medium Tear Large Tear Mini Repair 4 5 wks 6 wks 7 8 wks Arthroscopic Repair 5 wks 6 wks Large7 8 wks Massive 8 12 wks Open Procedure 6 wks 6 8 wks 8 12 wks Discontinuation of the sling: (AROM limitations still persist even if sling is discontinued.) MD may remove sling earlier. Surgical Procedure Small Tear Medium Tear Large Tear Mini Repair 4 wks 4 5 wks 6 wks Arthroscopic Repair 4 wks 4 5 weeks Large 6 wks Massive 6 8 wks Open Procedure 6 wks 6 wks Large 6 wks Massive 6 8 wks Last revised: 10/14 Page 5 of 5