Rotator Cuff Repair Rehabilitation Guidelines

Rotator Cuff Repair Rehabilitation Guidelines

(Arthroscopic/Mini-Open/Open Procedures)

Introduction

These guidelines outline rehabilitation following rotator cuff repair, emphasizing gradual progression to restore function and protect the repaired tissues. The specifics may vary depending on the size of the tear and the surgical approach:

• Small (<1 cm): Faster progression may be possible.
• Medium (1–3 cm), Large (3–5 cm), Massive (>5 cm): More protection is needed, with a focus on tissue healing in the early phases.

Key Notes

• Subscapularis repair: Restrict lateral rotation to neutral; avoid resisted internal rotation for 6–8 weeks.
• Abduction pillow/brace: Often used for larger tears to reduce tension on the repair.
• Open procedures: Protect deltoid function for 6–8 weeks due to its release during surgery.

Rehabilitation emphasizes scapulohumeral rhythm (SHR), neuromuscular training, and core stability. Progress is monitored through milestones to individualize care.

Rehabilitation Phases

Phase 1: 1–14 Days

Goals:

• Protect the repair: Use a sling except during hygiene and exercises.
• Manage pain and inflammation: Analgesics, NSAIDs, ice, and posture.
• Begin passive range of motion (PROM):
  • Pendulum exercises, external/internal rotation (ER/IR) within 0–45° scaption.
• Maintain mobility: ROM exercises for the hand, wrist, elbow, and neck.
• Alignment and muscle engagement: Sub-maximal pain-free isometrics (<30% MVC) in neutral.

Precautions:

• Wear sling for 6 weeks (dependent on tear size).
• No active elbow movement away from the body.
• Avoid lifting, excessive stretching, or sudden movements.

Phase 2: 15 Days–6 Weeks

Goals:

• Progress PROM to full, pre-op levels as tolerated (pain-free).
• Introduce active-assisted ROM (AAROM) at 3 weeks.
• Introduce active ROM (AROM):
  • Large tears: Begin at 6 weeks.
  • Small tears: May begin at 4 weeks.
• Ensure dynamic stability with good SHR during PROM, AAROM, and AROM.

Milestones:

• At 3 weeks:
  • Passive flexion: 50% of pre-op range.
  • Passive ER: Neutral.
  • Pain and inflammation well managed.
• At 6 weeks:
  • Passive flexion: 100% of pre-op range.
  • Passive ER: 30°.

Precautions:

• Avoid lifting and weight-bearing on the operated limb.
• Gradually wean off the sling by 6 weeks (based on tear size).

Phase 3: 7–14 Weeks

Goals:

• Achieve full PROM with multi-directional stretching.
• Restore pre-operative AAROM and AROM with good SHR.
• Begin strengthening:
  • Scapular stabilization, cuff strengthening, and proprioceptive exercises.
  • Progress from isometrics to isotonic exercises.
• Reintroduce light functional activities and early sport-specific tasks.

Milestones:

• At 9 weeks:
  • Resolved pain and inflammation.
  • AROM to 75% of pre-op range.
• At 14 weeks:
  • Full PROM and AROM to 100% of pre-op levels.

Precautions:

• No heavy lifting or prolonged upper limb activity.

Phase 4: 3–6 Months

Goals:

• Maintain full PROM and AROM with good SHR.
• Progress to advanced strengthening:
  • Cuff, scapular, and upper limb exercises.
  • Rhythmic stabilization and proprioception training.
• Gradual progression to functional and sport-specific activities.

Milestones:

• Resolved pain and inflammation.
• Full AROM with good SHR.

Precautions:

• Avoid heavy lifting or repetitive overhead activities.

Phase 5: 6–9 Months

Goals:

• Return to strenuous work and sports as required.
• Build on strength, endurance, and dynamic stability for full functional recovery.

Milestones at 6 Months:

• Full, pain-free motion restored.
• Rotator cuff strength equal to the pre-injury state.

Contact Information

• Consultant Secretary: 07810356433
• Physiotherapy Contacts:
  • Sulis Hospital: 01761 422388
  • Circle Health Group Bath Clinic: 01225 838767
  • St. Joseph Physiotherapy: 01633 820321

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