Rotator Cuff Repair — Large to Massive Tear

Sutter Health / Palo Alto Medical Foundation · Kevin Roth MD

Weight-Bearing

N/A (upper extremity)

Key Restrictions

Sling with abduction pillow at all times wks 1-6 (remove for exercises/showering); no AROM Phase I (1-6 wks); AROM against gravity begins wk 8; no RC resistance until wk 12; biceps tenodesis modifier: no active elbow flexion until wk 4; throwing/tennis/volleyball at 10+ months with MD clearance

Timeline & Phases

Phase I (wks 1-6): sling with ABD pillow, no AROM, Codman's pendulums, table slides, cervical ROM, scapular isometrics, elbow/wrist/hand ROM | Phase II (wks 6-8): PFE 60°, PER 0° at 20° abd, therapist-assisted FE, supine passive ER with broom handle, scapular isometrics | Phase III (wks 8-10): PFE 90°, PER 20° at 20° abd, AROM against gravity begins wk 8, supine AAROM, pulley exercises, light scapular strengthening, joint/soft tissue mobilization | Phase IV (wks 10-16): progressive ROM milestones — wk 10: PFE 90-120°/PER 20-30°; wk 13: PFE 130-155°/PER 30-45°/PER@90° abd 45-60°/AFE 80-120°; wk 16: PFE 140°-WNL/PER 30°-WNL/PER@90° abd 75°-WNL/AFE 120°-WNL; strengthening begins wk 12 (light theraband RC) | Phase V (wks 16-22): full ROM, AROM/resisted pulley FE, incline dusting, ball roll on wall, T-bar AAROM/AROM FE, aquatic FE fast speed, sidelying dumbbell ER at 0° (25% MVIC), elastic ER/IR/forward punch, lat/biceps/triceps/pecs/deltoids strengthening | Phase VI (wks 22-28): endurance, scapular rows (high/mid/low), standing dumbbell ER 0°/scapular plane 10-rep max, elastic shoulder flexion, elastic throwing accelerate, elastic IR at 90° | Phase VII (wks 28+): upright FE 3-4 lbs 10-rep max, prone horizontal ABD, seated military press, elastic ER at 90°/throwing decelerate, standing dumbbell ER at 90°, RTS weight training/skiing/golf/basketball/manual labor with MD clearance | Phase VIII (10+ months): throwing sports, tennis, volleyball with MD clearance

Notes

Published 2024; modified from Thigpen et al. ASSET (American Society of Shoulder and Elbow Therapists) Consensus Statement on Rehabilitation Following Arthroscopic Rotator Cuff Repair (JSES 2016); biceps tenodesis modifier: no active elbow flexion until wk 4; 8-phase protocol with detailed passive/active ROM milestones at wks 10, 13, and 16; RC strengthening begins wk 12; no RC resistance until wk 12; throwing/tennis/volleyball at 10+ months; compare to small/medium tear protocol (same structure, earlier timeline); Kevin Roth MD Orthopedic Sports Medicine, Palo Alto CA (650-853-2943)

Surgeon / Author

Kevin Roth MD

Published

2024