Rotator Cuff Repair: Fast Rehabilitation Protocol For Small Tears

Restrictions:

  • Immobilisation of the shoulder joint in a broad arm sling for 4 weeks 24 hours per day.

  • 2 weeks of night-time only sling use.

  • Shoulder abduction and flexion to maximum 60 degrees, external rotation to 20 degrees in the first 4 weeks post operatively

  • No supraspinatus stretches for minimum 10 weeks postoperatively

  • No strength training or heavy lifting for minimum 12 weeks postoperatively

  • Gradual return to sporting activity at 6 – 9 months

  • If biceps tenodesis no loading for 8 weeks

 

Patients should have a grasp of exercises and use of sling and simple ADL functions prior to discharge home

Aim to get early control of shoulder girdle and interscapular muscles

Light pendular and rotation exercises within range of motion limits

Circulation exercises

Do exercises 6 x per day

Aim for a relaxed exercises to avoid tension about the shoulder and neck

 

At 2 and 6 week follow up

Wound review

Check pain levels

Observe simple ADLs

Range of motion in flexion, abduction and rotation should be measured

Check control of shoulder girdle and interscapular muscles

 

Phase 1: 0 – 5 weeks

Goal

Focus on gentle range of motion, good circulation, and posture

Action

  • Daily active exercises. Careful pendular exercises. Active elbow flexion and extension, hand circulation exercises and scapular muscle activation

  • Passive range of motion exercises with limits: abduction 60 degrees, flexion 60 degrees and external rotation 20 degrees

  • Use of cooling therapies for swelling reduction

  • Relaxation and posture exercises to reduce tension in the neck and shoulder girdle 

Criteria to move to the next phase

  • Near non tender, near pain free for all movements, achieve range of motion as stipulated above (60/60/20). Scapulohumeral rhythm control.

 

Phase 2: From 5 weeks postoperatively onwards

Goals

Increase range of motion (free range of motion within pain limits), scapulohumeral rhythm control, gradual increased activation of shoulder girdle musculature

Action

  • Passive and active assisted scapular range of motion exercises for flexion, abduction, internal and external rotation – focus on good quality motion

  • Scapular mobility exercises

  • From week 7 begin light isometric flexed elbow rotator cuff strength

  • Active theraband exercises from week 10: check for good scapulohumeral rhythm

  • Can begin focused joint stretching and mobilisation from week 12 if range of motion is not optimal

Criteria to enter phase 3

  • Over shoulder height range of motion with good quality range of motion, little or no pain, good scapulohumeral rhythm

Phase 3: From week 12 onwards

Action

  • Start eccentric training for rotator cuff, possibly assisted concentric exercises

  • Strength for scapulothoracic musculature

  • Stretching to continue

  • Aim for normal active and passive range of motion

  • Functional training 

Criteria for moving to next phase

  • Full active range of motion. Little to no pain, good scapulohumeral rhythm and muscular control

Phase 4:

Goals

Return to work and normalise ADLs and work practices

Action

  • ADLs, work, and sports specific training

  • Increase muscle strength, power, and stamina

  • Maintain full range of motion

Timeframes

Approximately 1 year for small ruptures (1-3cm) to regain strength and up to 18 months for larger tears

Criteria for return to sport

  • Full range of motion. No pain with activity. Good muscular control.

  • Strength test 90% compared to uninjured side. 95% for contact and throwing

  • Constant score > 90% compared to uninjured side