Rotator Cuff Repair — Small to Medium Tears (<1–4 cm)

Gundersen Health System (GLSM) · Gundersen Lutheran Sports Medicine

Weight-Bearing

Sling 24 hrs/day x 4-6 wks; remove for bathing/dressing/exercises; keep arm relaxed in sling

Key Restrictions

No AROM or resisted ROM Phase I (wks 0-4); no IR or extension initially — all PROM starts in scapular plane; no behind back movements (avoid combined ext/add/IR); no lifting/carrying; no pushing/pulling; subscapularis repair: limit extension to neutral x 6 wks, ER to neutral x 4 wks then >neutral to tolerance until wk 6, no isolated IR resistance x 12 wks; open repair: limit extension/ER to neutral x 6 wks, no active flexion x 6-8 wks, no IR resistance x 6-8 wks (deltoid detachment); Regeneten augmentation: sling 4 wks, AROM at wk 4, strengthening at wk 8; no aggressive strengthening x 12 wks; strength goal 85-90% by 5-6 months

Timeline & Phases

4 phases: Phase I (0-4 wks, max protected PROM/safe AAROM), Phase II (4-8 wks, AROM begins wk 6, sub-max isometrics), Phase III (8-12 wks, progressive strengthening), Phase IV (12+ wks, advanced/return to sport/work); strength training should continue ≥1 year post-op

Notes

Evidence-based; outlined for double-row suture bridge (trans-osseous) supraspinatus repair; covers arthroscopic and mini-open; includes separate sub-protocols for: subscapularis repair, open repair, and Regeneten augmentation; pre-op stiffness correlated to post-op stiffness (best predictor: pre-op IR behind back vertebral level); blood flow restriction (BFR) exercises noted as optional; create posterior-dominant shoulder (emphasize ER and scapular retractors); no pulleys wks 0-4; small <1 cm, medium 2-4 cm (their definitions); large/massive 5+ cm

Surgeon / Author

Gundersen Lutheran Sports Medicine

Published

Updated April 2020