Post-Operative Rehabilitation Protocol

Arthroscopic Rotator Cuff Repair

This post-operative protocol is designed for SMALL rotator cuff tears that are repaired by arthroscopic methods. Larger rotator cuff tears often require a longer initial period of sling immobilization prior to initiation of ROM exercises. If a longer initial period of immobilization is warranted, this will be indicated.

Days 0-7
  • Patient remains immobilized in a sling
  • No passive, active-assist, or active ROM
Weeks 2-3
  • Begin passive ROM (flexion, abduction, IR, IR)
    • Begin rotation with the arm at the side and elbow flexed to 90°
    • Progress to scapular plane and then to a 90°/90° position as tolerated
  • Begin shoulder shrugs and ball squeezes
Weeks 3-6
  • Use modalities as needed (ice, heat, electrotherapy, etc.)
  • Continue passive ROM exercises as tolerated
  • Add joint mobilization as needed
  • Begin submaximal pain-free isometrics with arm at the side
  • Begin active-assist exercises (pendulums, pulley, wand, IR towel stretch)
  • Begin active ROM exercises for shoulder internal/external rotation (arms positioned at the side with elbows extended)
Weeks 6-8
  • Patient may discontinue sling
  • Continue joint mobilizations, isometrics, passive, active-assist, and active ROM as tolerated and needed
    • Begin active shoulder abduction to 90°
    • Begin active shoulder flexion through available ROM
    • Begin active shoulder extension in prone position (preventing arm movement beyond the plane of the body)
    • Begin active horizontal adduction (supine) as tolerated
  • Begin isotonic strengthening exercises as outlined
    • Begin IR/ER strengthening using Thera-band with the arm at the side
    • Begin light dumbbell strengthening for rotation (external rotation in side or prone position with the arm abducted at 90°, internal rotation supine with the arm at the side and elbow flexed at 90°)
  • Begin scapular stabilization exercises (rows, shrugs, serratus punch)
Weeks 8-12
  • Continue joint mobilizations, isometrics, and ROM exercises as needed
    • Patient should have full PROM at 8 weeks and full AROM by 12 weeks
  • Continue active isotonic exercises with emphasis on strengthening the rotator cuff
    • Progress active horizontal abduction beyond 90°(prone)
    • Begin supraspinatus strengthening exercise at 12 weeks if pain free and adequate ROM (0°-70°)
      • Start in the scapular plane and progress from a "full can" to "empty can" (thumb up to thumb down) as pain allows
  • Upper extremity PNF (D2) patterns may be added
Weeks 12-18
  • Continue to progress isotonic strengthening exercises
    • Gradually progress from 0° to 45° to 90° of shoulder abduction as tolerated for internal rotation and external rotation strengthening
  • Begin isokinetic strengthening and endurance training (arm at side) for internal and external rotation (speeds 200 plus d/s)
  • Add military press
Weeks 18-24
  • As strength improves, continue to increase weight resistance and high speed training with isotonic and isokinetic exercises
    • Emphasize the eccentric phase in strengthening the rotator cuff
    • Perform isokinetic test at 180, 240, 300 speeds (the shoulder should be pain free and have no significant swelling)
  • Add total conditioning program including flexibility, strength, endurance, and core stabilization
Month 6+
  • Continue strengthening program and add sport-specific exercises
    • Isokinetic test results for the shoulder should demonstrate at least 80% strength and endurance (compared to the other side) before proceeding to sport-specific activities
  • Continue total body conditioning program with emphasis on the shoulder
  • Throwing athletes may begin progressive throwing program
  • Begin practicing skills specific to the activity (work, recreational activity, sport, etc.)