Rotator Cuff Repair — Small to Medium 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 1-5 (comfort only wks 5-6; D/C wk 6); PROM Phase I (wks 1-2); AROM against gravity at wk 6; no RC resistance exercises through Phase IV; RC theraband begins wk 12; biceps tenodesis modifier: no active elbow flexion until wk 4; throwing/tennis/volleyball at 8+ months with MD clearance

Timeline & Phases

Phase I (wks 1-2): sling with ABD pillow, PROM of shoulder, Codman's pendulums, cervical ROM, scapular isometrics, elbow/wrist/hand ROM | Phase II (wks 2-4): sling with ABD pillow, PFE 60°, PER 0° at 20° abd, Codman's, therapist-assisted FE, supine passive ER with broom handle, table slides, scapular isometrics | Phase III (wks 4-6): sling continues wks 4-5 (comfort wks 5-6, D/C wk 6), PFE 90°, PER 20° at 20° abd, supine AAROM, pulley exercises, light scapular strengthening, joint/soft tissue mobilization | Phase IV (wks 6-12): unrestricted AROM against gravity at wk 6, NO RC RESISTANCE EXERCISES, progressive ROM milestones — wk 6: PFE 90-120°/PER 20-30°; wk 9: PFE 130-155°/PER 30-45°/PER@90° abd 45-60°/AFE 80-120°; wk 12: PFE 140°-WNL/PER 30°-WNL/PER@90° abd 75°-WNL/AFE 120°-WNL; towel slide/dusting/supine press-up/AROM reclined wedge, aquatic FE slow speed | Phase V (wks 8-16): RC theraband at 12 wks, 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 12-20): endurance, scapular rows, standing dumbbell ER 0°/scapular plane 10-rep max, elastic shoulder flexion/throwing accelerate/IR at 90° | Phase VII (wks 20+): upright FE 3-4 lbs, prone horizontal ABD, seated military press, elastic ER at 90°/throwing decelerate, standing dumbbell ER at 90°, RTS weight training/skiing/golf with MD clearance | Phase VIII (8+ months): throwing sports, tennis, volleyball with MD clearance

Notes

Published 2024; modified from Thigpen et al. ASSET Consensus Statement (JSES 2016); biceps tenodesis modifier: no active elbow flexion until wk 4; 8-phase protocol — same structure as large/massive protocol (rotator-cuff-repair-large-to-massive-tear-protocol-2024.pdf) but with faster timeline (Phase I 1-2 wks vs 1-6 wks, AROM at wk 6 vs wk 8, theraband at wk 12 vs wk 12 same, throwing at 8+ vs 10+ months); no RC resistance exercises in Phase IV explicitly stated; Kevin Roth MD Orthopedic Sports Medicine, Palo Alto CA (650-853-2943)

Surgeon / Author

Kevin Roth MD

Published

2024