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