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

Ohio State University Wexner Medical Center · OSU Sports Medicine

Weight-Bearing

Sling 6 wks (vs 4-6 wks for small-medium); PT starts at wks 4-6

Key Restrictions

Large 3-5 cm; massive >5 cm; subscapularis repair (12 wks): no ER >30 deg, no cross-body ADD, no active IR or IR behind back, no supporting body weight; superior capsule reconstruction: follow protocol timeframes + lifting limit 5 lbs x 6 months; no PROM into pain; risk factors for poor outcomes: low preoperative function, poor preoperative active ER, younger age, lower education, workers comp claims

Timeline & Phases

3 phases: Phase 1 Protection (wks 4-6, PROM flexion + ER, scapular isotonic), Phase 2 (wks 6-12, AAROM wks 6-8, AROM wks 8-12, sub-max isometrics, UBE, closed chain), Phase 3 (wks 12-16+, T-band, prone strengthening, rhythmic stabilization, return to sport/work)

Notes

.edu site; large 3-5 cm, massive >5 cm (explicit definitions); covers superior capsule reconstruction variant (5 lb limit x 6 months); subscapularis precautions same as small-medium protocol; manual therapy: posterior/caudal GH mobs wks 4-6; outcome tools: DASH, QuickDASH; discharge criteria: full AROM no scapular substitution, 5/5 MMT RTC, 65-70% IR/ER isokinetic; risk factors table included; seated press-ups wks 10-12; quadruped weight shifts

Surgeon / Author

OSU Sports Medicine