Revised 01/30/12
Rotator&Cuff&Repair&Protocol&fo r&S m a l l‐Medium&Tears&
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Surgery'date:&_______________&
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Goals:'
• Maintain&Integrity&of&the&repair&
• Gradually&increase&passive&ROM&
• Diminish&pain&and&inflammation&
• Prevent&muscular&inhibition&
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Precautions'
• No&lifting&of&objects&
• No&excessive&shoulder&extension&
• No&excessive&stretching&or&sudden&movements&
• No&supporting&of&body&weight&by&hands&
• Keep&incision&clean&and&dry&
• BICEPS&TENODESIS:&&No&resisted&elbow&flexion&/&forearm&
supination&for&6&weeks&
• Avoid&shoulder&horizontal&adduction,&extension&and&
hand&behind&back&for&10‐12&wks&post‐op&
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Phase'1:'Immediate'Post‐surgic a l'P r o te c tio n 'P h a s e ' '
(Wks'1‐3)_____________________________&
• Sling&or&abduction&brace&(physician’s&decision)&
• Avoid&shoulder&horizontal&adduction,&extension&and&
hand&behind&back&
• Pendulums&(passive,&small&litude&movements)&
• Table&slide&passive&flexion&and&scaption&(seated,&arm&
resting&on&table&with&passive&shoulder&movement&
produced&by&trunk&flexion/side&bending)&
• Active&scapular&protraction&and&depression&(limit&
retraction&and&elevation)&
• Passive&ROM&(being'sensitive'to'end'feel'and'muscle'
guarding)'
o Flexion&to&90°rees&
o Scaption&(scapular&plane)&to&90°rees&
o *External&and&internal&rotation&in&30‐40&&
degrees&of&scaption&(scapular&plane),&no&>30&
degrees&of&rotation&in&either&direction&
o For&Dr.&Bell’s&pt&ER&as&tol&unless&subscapularis&
repair.&&No&IR&&PROM&at&this&time&
• Hand&gripping/wrist&AROM/PREs&with&involved&arm&
supported;&forearm&and&elbow&AROM&if&no&biceps&
tenodesis&
• Cryotherapy&for&pain&and&inflammation&(ice&15‐20&min&
every&waking&hour)&Sleep&in&sling&until&physician&DCs&
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Phase'2:'Protection'Phase'
'(Wks'3‐6)__________________________________'
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• Continue'all'of'the'above''
• Progress&passive'ROM&(being'sensitive'to'end'feel'
and'muscle'guarding)'
o Flexion&to&at&least&105°rees&slowly&
progressing&to&full&PROM&by&6&wks&post‐
op&
o Scaption&to&at&least&105°rees&slowly&
progressing&to&full&PROM&by&6&wks&post‐
op&
o External&rotation&in&scapular&plane&no&
>45°&initially,&then&slowly&progressing&to&
full&PROM&by&6&wks&post‐op&
o Internal&rotation&in&scapular&plane&to&no&
>35°rees&initially,&then&slowly&
progressing&to&full&PROM&by&6&wks&post‐
op&
• Sleep&in&sling&until&physician&DCs&
• Begin&active&scapular&elevation&and&retraction&and&
progress&to&full&scapular&AROM&
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' *For'Dr'Sanders'≤'20'degrees'E R /IR'
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Revised 01/30/12
Phase'3:'Intermediate'Phase'
'(Wks'7‐9)_______________________________&
• Begin&active‐assisted'ROM&&&
o Supine&T‐bar&external&and&internal&
rotation&in&scapular&plane&progressing&to&
full&AROM&
o Supine'T‐bar&flexion&to&tolerance&
(therapist&provides&assistance&by&
supporting&arm)&progressing&to&full&AROM&
o Pulley&flexion&and&scaption&
o UBE&AROM&(no&resistance)&
• Begin&active&sidelying&scaption&and&external&
rotation&&
• Begin'active&flexion&and&scaption&to&90°rees&in&
standing,&initially&with&elbow&flexed&to&shorten&lever&
arm,&then&progressing&to&full&AROM&
• Progress'to&full&prone&AROM&(horizontal&abduction,&
flexion/extension,&90/90&external&rotation,&rowing)&
by&9&wks&post‐op&
• Begin&submax/pain‐free'isometrics&(very%gentle):%
(for&Dr&Bell’s&pts&begins&at&8&weeks)&
o Flexion&with&bent&elbow&
o Extension&with&bent&elbow&
o Abduction&with&bent&elbow&
o External&and&Internal&Rotation&
o Elbow&flexion&&
o Rythmic&stabilization&(manual)&isometrics&
with&proximal&hand&placements&initially&
• Continue&elbow/hand/wrist&PREs&with&involved&arm&
supported&
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Phase'4:''Light'Strengthening'Phas e '
'(Wks'9‐12)________________________________'
• Begin'hand‐behind‐back&AAROM,&AROM,&stretching&at&
10‐12&wks&post‐op'
• Begin&light&resistance'
o Begin&with&1&lb&dumbbell&for&internal&and&
external&rotation&in&side&lying,&supine&scapula&
protraction&(punches),&prone&extension&and&
rowing'
o Elastic&bands,&beginning&with&the&least&
resistance&for&external&rotation,&internal&
rotation,&extension,&scapula&retraction,&and&
scapula&protraction'
o '
o Elevation&in&the&scapular&plane&with&thumb&up&
(open&can).&&Do¬&add&resistance&if&pt&is&
unable&to&elevate&arm&without&substitution&
patterns'
o Begin&closed‐chain&exercise&such&as&wall&
ball(rolling),&quadruped&wt.&shift&'
o Conservatively&progress&to&PNF&patterns'
o Progress&to&advanced&stretching&with&emphasis&
on&posterior&shoulder&capsule'
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Phase'5:''Advanced'Strengthenin g 'P h a s e ''
(Wks'12‐16)________________________________'
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o Progress&resistance&with&dumbbells&and&elastic&bands&in&all&
planes&of&the&shoulder&and&scapula'
o Progress&closed‐chain&and&dynamic&stabilization&drills&(table&
push‐ups,&fitter,&etc)'
o Add&plyometrics&(light&medicine&ball&toss,&rebounder,&wall&
push‐up&seal&slap,&etc.)'
o Progress&PNF&drills'
o Progress&to&perturbation/dynamic&stabilization&drills&with&ball,&
body&blade&,&etc.'
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Phase'6:''Work/Sport'Specific'Phase '
'(Wks'17‐24)_________________________'
o Incorporate&work/sport&simulation&drills&into&strength,&
endurance,&&flexibility,&dynamic&stabilization,&and&
plyometric&exercises,&for&example:'
o Material&handling&tasks'
o Graduated&throwing&program'
o Overhead&work&tasks'
o Repetitive&reaching&tasks'
o Pulling/pushing&tasks'
o Racquet&sport&tasks'
o Basketball/volley&ball&tasks'
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