Rotator Cuff Repair — Massive Tears (>5 cm) / Type III Protocol

Nebraska Orthopaedic Center · Dr. Aaron M. Bott MD

Weight-Bearing

Shoulder immobilizer x 8 wks (worn at all times except ROM exercises; D/C completely at wk 8; worn at night wks 0-6); no active motion x 8 wks; no active ABD x 10 wks

Key Restrictions

Massive defined as >5 cm; immobilizer 8 full weeks; no PROM until wk 2-6 phase; no active motion x 8 wks; no active ABD x 10 wks; no ER resistance in ABD/scaption x 12 wks; subscapularis repair: ER limited to 20 deg (vs 30 deg standard) wks 3-4, no IR isometrics; no swimming, running, or jumping through Phase III (12 wks); avoid impact aerobic conditioning throughout

Timeline & Phases

4 phases: Phase I (0-2 wks, immobilizer, pendulums + distal AROM only), Phase II (2-6 wks, PROM: FF ≤110 wk 3-4 → 130 wk 5-6; ER ≤30 deg at side; subscapularis: ER ≤20 deg; sub-max isometrics), Phase III (6-12 wks, AROM wk 8, active ABD wk 10, isotonic IR/ER, scapular/core), Phase IV (12 wks-6 months, progressive strengthening, sport-specific); PT starts 3-5 days post-op 1-2x/wk

Notes

Single-surgeon protocol (Dr. Bott); 2023; also indicated for exceedingly poor tissue quality regardless of tear size; explicit PROM ROM milestones per week (FF 110 wk 3-4, 130 wk 5-6); progression criteria: FF 130 deg + ER 45 deg at side by wk 6; Phase IV initiation of supraspinatus/infraspinatus strengthening at months 3-4; subscapularis variant explicitly noted in Phase II with reduced ER limit

Surgeon / Author

Dr. Aaron M. Bott MD

Published

2023