Rotator Cuff Repair — Large Tear with Retraction (>2.5 cm)

University of Delaware Physical Therapy · UDPT Clinical Team

Weight-Bearing

Sling with ABD pillow 24 hrs/day weeks 1-3; sling (D/C ABD pillow) weeks 4-6; D/C sling weeks 7-10

Key Restrictions

No IR behind the back; no heavy resisted flexion for 6 weeks; no resisted ABD for 8-12 weeks; no resisted ER for 8-12 weeks; if subscapularis compromised (open repair): no active IR 4 weeks, no IR strengthening 6-8 weeks; passive IR/ER per surgeon; no passive IR in 0° ABD; towel stretch may begin week 7

Timeline & Phases

Weeks 1-3 (no formal PT, sling+ABD pillow); Weeks 4-6 (2-3x/week, 6-9 visits: PROM to restrictions, scapular control, rhythmic stab); Weeks 7-10 (1-3x/week, 10-21 visits: AROM progression, PREs flexion/ext/IR, NMES infraspinatus 8-12 wks PRN); Weeks 11-12 (1-3x/week, 12-27 visits: PREs all motions, dynamic stab, NMES supraspinatus 12-16 wks PRN); Weeks 13-20 (1-2x/week, 20-43 visits: MMT 5/5, full ROM); Weeks 21-36 (sport/work, interval throwing); 20-43 visits total

Notes

University of Delaware PT Clinic; large tear with retraction: supraspinatus + infraspinatus repair + subacromial decompression; typically open repair — longer healing times and potentially compromised subscapularis; most conservative of the 4 UD rotator cuff protocols; check with surgeon for exact procedure; flexion/ABD to 90° tolerance weeks 4-6; PRN NMES: infraspinatus 8-12 weeks, supraspinatus 12-16 weeks (same parameters as large tear no retraction); sport-specific and interval throwing weeks 21-36; updated May 2009

Surgeon / Author

UDPT Clinical Team

Published

Updated May 2009