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Rotator Cuff Repair

Rotator Cuff Repair Rehab Protocol-Brigham and Women's Hospital

 

Phase I: 1 through 4 to 6 weeks post-op:

First 3 weeks:

  • Patient education: movement limitations, posture, proper sling fitting, joint protection, and positioning
  • Elbow/wrist/hand AROM w/ no resistance
  • PROM shoulder flexion/abduction/ER/IR
  • Light active scapular strengthening exercises 
  • STM to rotator cuff, scapular, and deltoid mm
  • Pendulum hangs
  • Modalities PRN

Weeks 3-4 or 6 as tolerated:

  • Progress pendulum hangs to pendulum circles based on tolerance
  • Progress scapular strengthening
  • Continue with PROM shoulder flex/abd/IR/ER
  • Joint mobilizations grades I and II for pain relief at GH/SC/AC/ST joints
  • Modalities PRN

Phase II: Weeks 6-12

  • Continue PROM as needed
  • Initiate AAROM program and progress to AROM as tolerated
    • Pulleys, cane exercises, table slides, wall slides etc. in multiple planes
  • Progress joint mobilizations at GH/SC/AC/ST joint to grades III and IV as needed
  • Posterior capsule stretching
  • Begin low-level closed chain shoulder exercises
  • Initiate deltoid and non-repaired mm of RTC strenthening program when appropriate (pain-free and full AROM)
  • Continue scapular strengthening/stabilization exercises 
  • Modalities PRN

Phase III: Weeks 12 through discharge:

  • Progress closed chain exercises
  • Initiate balanced progressive RTC strengthening program  
    • Ensure exercises are pain-free and are performed with no substitutions and adequate ROM
  • Dynamic scapular stabilization exercises
  • Exercises focusing on safe return to ADL's/work/recreational activies as tolerated 
  • Upon discharge, ensure patient continues HEP for at least 6-8 weeks 

 

Resources

Arthroscopic Rotator Cuff Repair Postoperative Guidelines. Brigham and Women's Hospital Web site. http://www.brighamandwomens.org/Patients_Visitors/pcs/rehabilitationservices/Physical%20Therapy%20Standards%20of%20Care%20and%20Protocols/Shoulder%20-%20Arthroscopic%20RCT%20Repair%20Protocol%20Hybrid%20Patient%20-%20Therapist.pdf