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Phase 1: Immediate postoperative period (weeks 0-6)
- Precautions
- Keep your arm in your sling, remove only for motion exercises and therapy.
- No shoulder active motion, lifting or shoulder motion behind the back.
- No excessive stretching or sudden movements. Do not support any weight.
- Keep incision clean and dry. You may shower after your first post-operative visit.
- Goals
- Protect the Rotator Cuff Repair
- Gradually increase PROM
- Diminish pain and inflammation
- Prevent muscular inhibition
- Become independent with modified activities
- Criteria for Progression to Phase 2
- Passive forward flexion to >125°°
- Passive ER in scapular plane > 75° (if uninvolved shoulder PROM > 80°)
- Passive IR in scapular plane to > 75° (if uninvolved shoulder PROM > 80°)
- Passive abduction > 90° in the scapular plane
- Days 1 to 6
- Wear your sling full time.
- Pendulum exercises
- Actively move your fingers, wrist, and elbow
- Begin scapula musculature isometrics / sets
- Ice for pain and inflammation
- Days 3 to 6
- Begin pulley exercises in forward flexion and abduction < 90°
- Maintain proper posture, joint protection, positioning and hygiene
- Days 7 to 28
- Continue with your sling at night and during the day for comfort
- Wear your sling while out of the house to alert others to your condition
- Continue Pendulum / pulley exercises
- Begin Passive ROM to tolerance (done lying down; should be pain free)
- Flexion to 90°
- ER in scapular plane to > 35°
- IR to body / chest
- Continue elbow, wrist, and finger AROM / resisted
- Cold therapy as needed for pain control and inflammation
- May resume general conditioning program (e.g., walking, stationary bike) Aquatherapy / pool therapy may begin three weeks after surgery
Phase 2: Protection and active motion (weeks 6-12)
- Goals
- Allow healing of soft tissue
- Do not overstress healing tissue
- Gradually restore full Passive ROM by week 6
- Decrease pain and inflammation
- Criteria for progression to Phase 3
- Full AROM
- Precautions
- No lifting
- No supporting body weight with hands and arms
- No sudden movements
- Avoid upper extremity bike and ergometer
- Weeks 6-7
- Discontinue use of your sling unless out in public. Your sling is a signal to others to be careful with your shoulder
- Between weeks 4-6, begin to use your sling for comfort only
- Discontinue sling at end of week 6 as it will inhibit full return of your motion
- Initiate Active Assisted (with your other hand) ROM in supine position
- Progressive Passive ROM until approximately full ROM at weeks 5-6
- Gentle scapular / glenohumeral joint mobilization to full Passive ROM
- Initiate prone rowing to the neutral arm position
- Continue cryotherapy as needed
- Aquatherapy OK for light AROM exercises
- Ice after exercise
- Weeks 6-8
- Continue AROM, AAROM, and stretching exercises
- Begin rotator cuff isometrics – No empty can in forward plane
- Continue periscapular exercises
- Initiate AROM exercises (flexion scapular plane, abduction, ER, IR)
- * Please note: Patient must be able to elevate arm without shoulder or scapular hiking before initiating isotonics; if unable, continue glenohumeral joint exercises.
Phase 3: Early Strengthening (weeks 10-16)
- Goals
- Full Active ROM (weeks 10-16)
- Maintain full Passive ROM
- Dynamic shoulder stability
- Gradual restoration of shoulder strength, power, and endurance
- Optimize neuromuscular control
- Gradual return to functional activities
- Criteria for progression to Phase 4
- Ability to tolerate progression to the low level functional activities
- Demonstrated return of strength / dynamic shoulder stability
- Reestablishment of dynamic shoulder stability
- Demonstrated adequate strength and dynamic stability for progression to more demanding work- and sport-specific activities
- Precautions
- No lifting objects >5 pounds, sudden lifting or pushing activities, sudden jerking motions, overhead lifting
- Avoid upper extremity bike and ergometer
- Week 10
- Continue stretching and PROM, as needed
- Dynamic stabilization exercises
- Initiate strengthening program
- ER and IR with exercise bands /sports cord / tubing
- ER side-lying (lateral decubitus)
- Lateral raises*
- Full can in scapular plane * (no empty can abduction exercises)
- Prone rowing
- Prone horizontal abduction
- Prone extension
- Elbow flexion
- Elbow extension
- Week 12
- Continue all exercises listed above
- Initiate light functional activities as permitted
- Week 14
- Continue all exercises listed above
- Progress to fundamentals shoulder exercises
- *Please note: Patient must be able to elevate arm without shoulder or scapular hiking before initiating isotonics; if unable, continue glenohumeral joint exercises
Phase 4: Advanced strengthening (weeks 16-22)
- Goals
- Maintain full non-painful AROM
- Advance conditioning exercises for enhanced functional use
- Improve muscular strength, power and endurance
- Gradual return to full activities
- Week 16
- Continue ROM and self-capsular stretching for ROM maintenance
- Continue progression of strengthening
- Advance proprioceptive, neuromuscular activities
- Light sports (golf chipping / wedges, tennis ground strokes) if doing well
- Week 20
- Continue strengthening and stretching
- Continue stretching if motion is tight
- Initiate interval sports program (e.g., golf, doubles tennis) if appropriate
AAROM = active assisted range of motion
ADL = activity of daily living
AROM = active range of motion
ER = external rotation
IR = internal rotation
PROM = passive range of motion
ROM = range of motion
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