Cryo Cuff

Shoulder Information

Rehabilitation after Rotator Cuff Repair Surgery

ROTATOR CUFF REPAIR PROTOCOL Suggestion for the Treating Physiotherapist

Physiotherapy should be started the day after surgery

Click for exercises to start with

A progress chart may be of some help

Wear the sling at all times, except during these exercises until indicated otherwise

Rehabilitation Plan

General Considerations

The rehabilitation depends on the quality of tissue and integrity of repair .

Extent of repair, chronic and/or large tears will require more caution with active range of motion and resistive exercises

Repairs involving more than one tendon or large tears will require more effort to achieve range of motion

This protocol should be considered as a guideline only. Actual progression should be based on clinical presentation. Some of the exercises that are given earlier in their treatment may be appropriate throughout the rehabilitation period.
Early passive range of motion of glenohumeral joint is essential to prevent capsular adhesions and fibrosis. This is done in a range that SHORTENS the involved muscle(s).

supraspinatus: avoid passive internal rotation (past the plane of the body), horizontal adduction, and extension

subscapularis: avoid passive external rotation (excessive), horizontal adduction, and extension

Resting pain should be used to gauge progression. Overall, pain should decrease over time.

All active motions of the shoulder should be closely monitored for proper scapulothoracic mechanics and to minimize compensation or substitution.

Physical therapy will begin immediately following surgery. The early focus will be on achieving ROM before emphasizing rotator cuff resistance exercises

Do’s

Do wear the sling as specified, usually full time for 4-6 weeks, up to 8 weeks if there is a large tear

Do use your hand and forearm for eating, writing etc.

Do perform your exercises as outlined

Don’t

Don’t lift your arm for at least the first 4 weeks unless specified

Don’t leave your sling off unless performing exercises or showering for the first 4 weeks unless specified.

Don’t lift more than 5 kg above shoulder height for at least 3 to 6 months

New Protocols

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.

Back to Shoulder Impingement Syndrome And Rotator Cuff Tears Home