Rotator Cuff Repair — Large to Massive Tears (>3 cm)

Massachusetts General Hospital · MGH Sports Medicine

Weight-Bearing

Sling with abduction pillow (30-45 deg) day and night x 6 wks; PROM begins at wk 6 (not earlier); no active shoulder ROM until wks 10-14

Key Restrictions

6-week period of full immobilization — NO PROM of shoulder Phase I (wks 1-6); only hand/wrist/elbow AROM (no active elbow x 4 wks if biceps tenodesis); no pushing/pulling; no overhead or behind back; no weight bearing through arm; subscapularis concomitant repair: no ER past 0 deg, no ABD past 90 deg Phase I; no active ROM despite minimal pain (Phase II); no IR behind back Phase II; no aggressive or painful PROM; no sudden/jerking motions Phase III; no loading healing tendon

Timeline & Phases

5 phases: Phase I (wks 1-6, full immobilization — NO ROM), Phase II (wks 6-10, PROM begins with PT: FF ≤100 deg, ER ≤30 deg, ABD ≤90 deg), Phase III AAROM (wks 10-14), Phase III AROM (wks 14-18), Phase IV strengthening (wks 18+), Phase V return to function

Notes

Key differentiator from small-medium: full immobilization wks 1-6 with zero shoulder ROM; PROM starts wk 6 not wk 0-3; AAROM not until wk 10; isometric strengthening not until wks 14-18 (submaximal only — maximal effort can overload repair); PROM criteria to advance: ≥100-120 deg FF, ≥25-45 deg ER, ≥90 deg ABD; pendulums DO NOT actively use shoulder muscles; scapular exercises begin wk 6 without sling. [Archived copy — original Massachusetts General Hospital URL retired in the Mass General Brigham site migration; Wayback snapshot 2026-07-13.]

Surgeon / Author

MGH Sports Medicine