Rotator Cuff Repair — Large to Massive Rotator Cuff Repair (>5 cm, Compromised Tissue)

Gundersen Health System (GLSM) · Gundersen Lutheran Sports Medicine

Weight-Bearing

Sling 24 hrs/day x 6-8 wks, D/C per MD; remove for bathing, dressing and exercises; no supporting body weight through the hand or elbow

Key Restrictions

No shoulder AROM or resisted motion wks 0-6; no AAROM elevation on land until wk 6; IR and extension progressed cautiously, all PROM starts in scapular plane; PROM limits wks 0-2: abduction 0-45, ER 0-20, IR to chest, extension neutral; ER 0-50 and abduction 0-75 by wks 4-6; no behind the back movements until gentle IR stretch at wk 10; no lifting, carrying, pushing or pulling; ADLs below shoulder height wks 6-8, up to shoulder height wks 8-12; no AROM elevation until wk 8; no aggressive strengthening x 12 wks; overhead strengthening at wk 20 only with 75% isokinetic and isometric strength; subscapularis repair: extension and ER to neutral x 6 wks, no heavy IR resistance x 12 wks; open repair: extension and ER to neutral x 6 wks, no active flexion or IR resistance x 6-8 wks

Timeline & Phases

4 phases: Phase I (0-6 wks, maximum protected PROM, AAROM supine ER wk 4, aquatics wk 5), Phase II (6-8 wks, AAROM elevation, sling D/C), Phase III (8-12 wks, AROM elevation, sub-max isometrics and rhythmic stabilization), Phase IV (12+ wks, strengthening and conditioning, PNF wk 16, isokinetic testing wk 20, independent program wks 20-24); full ROM goal 12-16 wks; strength goal 75-80% by 5-6 months

Notes

Evidence-based; for large to massive (>5 cm) tears with compromised tissue quality; outlined for double-row suture bridge supraspinatus repair, mini-open or arthroscopic; companion to the Gundersen small to medium tear protocol, with a longer sling period and slower ROM progression; detailed week-by-week ROM limit tables; isokinetic ER/IR testing at 5, 7 and 12 months; return to interval throwing 6-8 months per MD; return to work/sport needs 90% isokinetic, dynamometer and functional scores; continue strengthening up to 1 year post-op

Surgeon / Author

Gundersen Lutheran Sports Medicine

Published

Updated March 2009