POST-PROCEDURE PLANS: The patient will be strict no weight bearing on the left upper extremity. Patient will start physical therapy after the first postoperative visit in 2 weeks. The patient will follow a large rotator cuff protocol. The patient will be required to wear a sling for the next eight. There will be no strengthening for 4 months.
REHABILITATION GUIDELINES FOLLOWING ROTATOR CUFF REPAIR LARGE
No strengthening for 4 months.
PROM at 2 weeks , AAROM at 6 weeks and AROM/strengthening at 4 months.
ROM Goals: Forward Flexion 90 degrees at 2 weeks, 120 degrees at 4 weeks, 140 degrees at 6 weeks, and full ROM after 6 weeks.
The weeks indicate from the time of first physical therapy appointment.
Phase 1 Protective Phase (0-8 Weeks)
0-4 Weeks
Fit brace or sling (determined by physician)
Begin pendulum exercises at 2 weeks postop
Perform passive range of motion to tolerance:
Flexion – Table Slides, Supine passive forward flexion, etc.
ER/IR (shoulder at 45° abduction)
Perform elbow range of motion
Perform hand gripping exercises
Initiate continuous passive motion (CPM)
Use submaximal isometrics:
Abductors
ER/IR
Elbow flexors
Use ice and pain modalities
Perform gentle active-assisted range of motion with L-bar at 2 weeks
Scapular positioning, Postural exercises
4-8 Weeks
Perform active-assisted range of motion with L-bar:
Flexion to 120° but can go higher as tolerated
ER/IR (shoulder 45° degrees abduction) 40°
Continue pain modalities
Phase 2 Intermediate Phase (8-14 Weeks)
Goals
Discontinue brace or sling at 8 weeks but use in crowds or at end of the day if arm tired
Establish full range of motion
Gradually increase strength
Decrease pain
8-10 Weeks
Perform active-assisted range of motion L-bar exercises:
Flexion to tolerance
ER/IR (shoulder 90° abduction) to tolerance
Begin isotonic strengthening:
Deltoid to 90°
ER/IR side-lying
Supraspinatus
Biceps/triceps
Scapular muscles
Pulleys, Wall walks, etc.
10-14 Weeks
Continue all exercises listed above (full range of motion by 12-14 weeks)
Begin neuromuscular control exercises
If patient is unable to elevate arm with shoulder hiking (scapulothoracic substitution), maintain on humeral head stabilizing exercises.
Phase 3 Advanced Strengthening Phase (15-26 Weeks)
Goals
Maintain full, non-painful range of motion
Improve strength of shoulder
Improve neuromuscular control
Gradual return to functional activities
15-20 Weeks
Continue active-assisted range of motion exercise with L-bar:
Flexion, ER, IR
Perform self-capsular stretches
ER/IR
Elbow flexors/extensors
Scapular strengthening
Begin conditioning program
CORE
21-26 Weeks
Begin aggressive strengthening program:
Shoulder flexion
Shoulder abduction (to 90°)
Supraspinatus
ER/IR
CORE
Continue all exercises listed above
Use isokinetic test (modified neutral position) for ER/IR at 180 and 300° per
second
Begin interval sport program
Phase 4 Return to Activity Phase (24-28 Weeks)
Goals
Gradual return to recreational sport activities
24-28 Weeks
Continue all strengthening exercises
Continue all flexibility exercises
Continue progression on interval program
CORE
Proprioception