Rotator Cuff Repair — Small to Medium Tear

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

Sling with limited removal in safe environments at 10-14 days Phase I; sling fully discontinued Phase II

Key Restrictions

True PROM only Phase I (no canes/pulleys); if subscapularis repaired concomitantly limit ER to 30 deg, no cross-body adduction, no active IR x12 wks; strengthening limited to 3x/week to avoid tendinitis Phase III; avoid sport-specific rehab until 18 wks; avoid overhead motion/collision sports until 6 months

Timeline & Phases

Phase I (surgery-6 wks): protect arthroscopically-repaired shoulder, cryotherapy 20 min q2h, PROM for flexion/abduction/IR to abdomen/ER to neutral, limited sling removal at 10-14 days in safe environments, true PROM only (no canes/pulleys), max ROM: FF 140 deg, ER 40 deg, abduction 80 deg without rotation, heat before/ice after PT, hand gripping, elbow/forearm/wrist ROM, side-lying scapular clock progressing to manually resisted protraction/retraction, axillary nerve desensitization, by wk3 sub-maximum rhythmic stabilization and scapular protraction supine/side-lying, by wk4 T-bar ER/IR sitting and standing T-bar abduction in scapular plane plus biceps/triceps resistive exercises, by wk5 T-bar ER/IR standing and submaximal rhythmic stabilization supine ER/IR at 45 deg abduction progressing to standing, walking/Stairmaster/stationary bike with sling on; progress to Phase II with negative impingement pain/apprehension; Phase II (6-12 wks): full shoulder ROM all planes with eventual normal scapulothoracic movement, begin scapular exercises and PREs for pecs/lats/large muscle groups, begin light end-range passive stretching, scapular PREs, prone extension/horizontal abduction to 45 deg progressing to 90 deg, prone row at 30 deg abduction to neutral progressing to 45 deg, resisted ER/IR in neutral with tubing progressing to side-lying ER, AROM in scapular plane with elbow flexed (max flex/abduction 90 deg), by wk6 isometrics with arm at side and strengthening/resisted motions, by wk10 ER strengthening at 90 deg abduction then plyometrics, walking/stationary bike, wall push-ups/4-point hand walking/step-ups; Phase III (12-18 wks): full shoulder/scapular ROM all planes, 5/5 RTC strength at 90 deg and 5/5 peri-scapular strength, strengthening limited 3x/week, avoid sport-specific rehab until 18 wks, avoid overhead motion/collision sports until 6 months, isometric strengthening with bands/light weights for RTC/deltoid/scap stabilizers, begin eccentrically resisted motions/plyometrics/weighted ball toss/proprioception/body blade, D1/D2 diagonals standing, theraband/light dumbbell IR/ER at 90 deg abduction and rowing, balance board in pushup position with rhythmic stabilization, prone swiss ball walkouts; return to throwing/overhead hitting at 6 months, throw from pitcher's mound at 9 months, return to sport generally acceptable at 6 months with surgeon/PT clearance

Notes

OSMS Rehabilitation Guidelines; for 3-5cm tear repairs; if subscapularis repaired concomitantly limit ER to 30 deg/no cross-body adduction/no active IR x12 wks; if Worker's Compensation patient needing physically demanding job return, schedule BFA at wk14-16 upon MD approval; references Ghodadra et al. (JOSPT 2009) and Ellenbecker/Manske/Kelley ISC 21.2.2 (2011)