ROTATOR CUFF RECONSTRUCTION –  REHABILIATION PROGRAM

A.    MINIMAL TENSION REPAIR

Zero – Six Weeks Post Surgery

• Patient is immobilised in a sling with the arm at the side.
• Sling may be removed 3-5 times per day for exercises only.
• Commence gentle passive elevation using the opposite hand to support the limb, beginning with the patient supine then progressing to the erect position.  Aim for 180 degrees by week 4.
• Gentle passive external and internal rotation aiming for 80% of range by week 4 and 100% by week 6.
• NO pendulum exercise
• NO abduction or extension strengthening exercises (unless biceps surgery is performed which would be notified).
• May squeeze a soft ball.

Six – Ten Weeks Post Surgery

• Patient may remove sling for increasing periods through the day as tolerated, and eventually discard it.
• Continue range of motion programme for elevation, external and internal rotation, beginning with gravity eliminated and progressing to work against gravity.
• NO abduction exercises of any form

Ten – to Twenty Six Weeks Post Surgery

• Work towards full active range of elevation, external and internal rotation.
• Continue terminal stretching and introduce the full cuff stretching programme including posterior and inferior stretches gradually.
• Begin resistance strengthening
• Avoid repetitive overhead use of the arm
• Gentle active abduction but no resistance work in this arc. Full abduction is not important at this stage.

Sixteen – Twenty-six Weeks Post Surgery

• Progress to advanced stretching and strengthening programmes gradually as tolerated by patient.
• Gradually increase overhead use of the arm.
• Plan for return to work based on the type of job.

Twenty-six Weeks Post Surgery

• Return to work, manual
• Patient to continue stretching and strengthening programme for the next six months on their own.

ROTATOR CUFF RECONSTRUCTION – REHABILITAION PROGRAM

B.  CUFF REPAIR UNDER TENSION

0 - 6 Weeks post-surgery

• Patient immobilised in an abduction pillow at about 45-70 degrees abduction.

      Pillow must NOT be removed at any time.

• Patient may commence gentle passive elevation of the operated limb above the level of the pillow, aiming for 180 degrees by the end of Week 4.
• May also undertake passive external rotation.
• Active elbow flexion/ extension strengthening exercises
• May squeeze a soft ball.

Six – Eight Weeks post –surgery

• Abduction pillow is gradually removed for increasing periods during the day. Initially done with the patient supine and when the arm is comfortable at the side thane patient may sit or stand.
• Continue range of motion programme for elevation and external rotation.
• When arm is able to be left out of pillow then begin passive internal rotation.

Eight – twelve weeks post-surgery

• Continue passive elevation, internal and external rotation with terminal stretching
• At about 8 weeks introduce active assisted movement in elevation and internal/external rotation
• NO abduction exercises active or passive

Twelve- sixteen weeks post surgery

• Work toward a full range of active elevation, external and internal rotation.
• Continue terminal stretching and introduce the full cuff stretching programme including posterior and inferior stretches gradually.
• Begin resistance at strengthening using Theraband. (Yellow – Green – Black)
• Avoid repetitive overhead use of the arm
• Gentle active abduction but no resistance work in this arc. Full abduction is not important at this stage.

Sixteen – twenty six weeks post surgery

• Progress to advanced stretching and strengthening programmes as tolerated by patient
• Gradually increase overhead use of the arm
• Plan for return to work based on the type of job.

Twenty six weeks post surgery

• Return to work, manual.
• Patient to continue stretching and strengthening programme for the next 6 months on their own.