Rotator Cuff Repair Protocol: Small to Medium Sized Tears

Dr. Kevin F. Bonner, MD ∙ Phone: 757-490-4802

Fax: 757-961-5705

Updated 5/2/22

*Refer to physical therapy referral for specific instructions related to patient progression*

Phase 1 (weeks 0-6): Protection

Rehabilitation Goals:

 Protect surgical repair

 Patient education

 Pain/swelling control

 Maintain distal UE ROM

 Safely and gradually restore PROM

 Patients with concomitant capsular release/MUA should be seen

5x/wk for 2 wks following surgery

Sling:

 24 hours/day except when performing prescribed home exercises and

dressing/showering (If careful, the sling can be removed while sitting

and watching TV, etc.)

Hygiene:

 Original dressing removed POD-2

 Allow steri strips to come off on their own

 Patient may shower normally, no need to keep steri-strips dry. Allow

the strips to fall off on their own. Do not lift arm in shower. Once dry,

return to wearing sling.

Interventions:

Modalities:

 Ice (10-20 minutes every waking hour during acute phase)

 May implement E-STIM for pain control PRN when not

contraindicated

 May begin MHP as needed starting 7-10 days p/o

Therapeutic Exercise:

 Pendulums

 Elbow/Wrist AROM (no active biceps if concomitant biceps tenodesis)

 Scapular retractions

 Upper trap stretching

PROM:

 Scapular plane elevation

 ER/IR in scapular plane

Precautions:

 No active involved shoulder movement

 No lifting/carrying

 Avoid heavy lifting activities with the contralateral UE

 No weight-bearing

Dr. Kevin F. Bonner, MD ∙ Phone: 757-490-4802

Fax: 757-961-5705

Updated 5/2/22

Phase 2 (weeks 6-12): Controlled Motion

Rehabilitation

Goals:

 Continue to protect surgical repair

 Minimize pain

 ROM progression

Sling:

 May begin to transition out of sling at 6 wks p/o

 (Patients may wish to sleep in sling and wear in public for a few more

weeks for comfort and protection)

Interventions:

Modalities:

 CP, MHP, and ESTIM as needed for pain/swelling control

 May begin NMES to posterior cuff if needed at 8 wks.

ROM/Mobility:

 Progress to AAROM/AROM as tolerated (begin AROM in gravity

eliminated positions progressing toward anti-gravity positions as

tolerated)

 Avoid compensation patterns

 Continue to progress PROM to tolerance with goal of full AROM/PROM

at 12 wks p/o

Strengthening:

 Begin submaximal resisted isometrics at 8 wks p/o

 Distal UE strengthening unless contraindicated by biceps tenodesis

 Dynamic stability drills

Precautions:

 No lifting/carrying

Phase 3 (weeks 12+): Strengthening

Rehabilitation

Goals:

 Continue to protect surgical repair

 Minimize pain

 ROM progression

 Improve strength

Interventions:

Modalities:

 CP, MHP, and ESTIM as needed for pain/swelling control

ROM/Mobility:

 Restore full shoulder mobility

Strengthening:

 Begin shoulder strengthening (isotonics and isokinetics)

 Initiate cuff strengthening in neutral with progression toward higher

degrees of elevation

 Limit LLA isotonic strengthening to 1-3#

 Dynamic stability drills

Notes:

Dr. Kevin F. Bonner, MD ∙ Phone: 757-490-4802

Fax: 757-961-5705

Updated 5/2/22

-This is not the more conservative “large or massive tear” protocol

-NO AGGRESSIVE MYOFASCIAL RELEASE OR SCAR TISSUE MASSAGE

-Ok to drive after two weeks if the patient feels comfortable and confident.

-Must be off all sedating pain medications (ie narcotics such as Roxicodone).