Arthroscopic Rotator Cuff Repair

Phase I (Weeks 0-4)

1. Sling immobilization with supporting abduction pillow to be worn at all times except for showering and rehab under guidance of PT
2. Range of Motion – True Passive Range of Motion Only to Patient ToleranceGoals: 140° Forward Flexion, 40° External Rotation with elbow at side, 60-80° Abduction without rotation, Limit Internal Rotation to 40° with the shoulder in the 60-80° abducted positionMaintain elbow at or anterior to mid-axillary line when patient is supine
3. Goals: 140° Forward Flexion, 40° External Rotation with elbow at side, 60-80° Abduction without rotation, Limit Internal Rotation to 40° with the shoulder in the 60-80° abducted position
4. Maintain elbow at or anterior to mid-axillary line when patient is supine
5. Therapeutic Exercise – No canes or pulleys during this phaseCodman Exercies/PendulumsElbow/Wrist/Hand Range of Motion and Grip StrengtheningIsometric Scapular Stabilization
6. Codman Exercies/Pendulums
7. Elbow/Wrist/Hand Range of Motion and Grip Strengthening
8. Isometric Scapular Stabilization
9. Heat/Ice before and after PT sessions

Phase II (Weeks 4-8)

1. Discontinue sling immobilization
2. Range of Motion4-6 weeks: Gentle passive stretch to reach ROM goals from Phase I6-8 weeks: Begin AAROM -> AROM as tolerated
3. 4-6 weeks: Gentle passive stretch to reach ROM goals from Phase I
4. 6-8 weeks: Begin AAROM -> AROM as tolerated
5. Therapeutic Exercise4-6 weeks: Being gentle AAROM exercises (supine position), gentle joint mobilizations (grades I and II), continue with Phase I exercises6-8 weeks: Progress to active exercises with resistance, shoulder flexion with trunk flexed to 45° in upright position, begin deltoid and biceps strengthening**
6. 4-6 weeks: Being gentle AAROM exercises (supine position), gentle joint mobilizations (grades I and II), continue with Phase I exercises
7. 6-8 weeks: Progress to active exercises with resistance, shoulder flexion with trunk flexed to 45° in upright position, begin deltoid and biceps strengthening**
8. Modalities per PT discretion

 Phase III (Weeks 8-12)

1. Range of Motion – Progress to full AROM without discomfort
2. Therapeutic ExerciseContinue with scapular strengtheningContinue and progress with Phase II exercisesBegin Internal/External Rotation IsometricsStretch posterior capsule when arm is warmed-up
3. Continue with scapular strengthening
4. Continue and progress with Phase II exercises
5. Begin Internal/External Rotation Isometrics
6. Stretch posterior capsule when arm is warmed-up
7. Modalities per PT discretion

 Phase IV (Months 3-6)

1. Range of Motion – Full without discomfort
2. Therapeutic Exercise – Advance strengthening as tolerated: isometrics -> therabands -> light weights (1-5 lbs),8-12 repetitions/2-3 sets for Rotator Cuff, Deltoid and Scapular StabilizersReturn to sports at 6 months if approved
3. 8-12 repetitions/2-3 sets for Rotator Cuff, Deltoid and Scapular Stabilizers
4. Return to sports at 6 months if approved
5. Modalities per PT discretion

Comments:

**IF BICEPS TENODESIS WAS PERFORMED – NO BICEPS STRENGTHENING UNTIL 8 WEEKS POST-OP