Rotator Cuff Repair

Surgery as per ASD, plus repair of the torn rotator cuff.

This protocol is based on maintaining range of movement in the first phase and then gradually building strength in the middle to the last phase.

Nothing heavier than a cup of tea for the first 6 weeks in the operative hand

Pre-op

• Passive ROM Exercises are essential and should be optimised
• Maximise shoulder strength of deltoid, intact cuff muscles and scapula stabilisers

Post op

Day 1 – 2 weeks
• Early post-op exercises for discharge
• Polysling – remove 4 times daily for exercises
• Wrist/hand/finger exercises
• Pendular exercises
• Elbow flex/ext, pro/supination
• Gentle active assisted/ passive shoulder ROM in all directions as tolerated – unless a subscapularis repair has been performed or the repair is tenuious – check the operation notes
• Shoulder girdle exercises
• Scapula setting exercises

Early Closed Chain Shoulder Elevation as below to be commenced from day 1 in:

  • Work Cover patients
  • Males <50 years
  • Females < 60 years
  • Insulin and non-insulin dependent diabetics
  • Patients who did not have a full ROM pre-operatively
  • Small tears < 1cm AP foot print
Table slide. (A) Starting position. While seated at a table, the patient places the hand of the affected shoulder on a sliding surface (e.g., a magazine that slides over a smooth table surface). (B) Ending position. The patient slides the hand forward, maintaining contact with the table, while the head and chest advance toward the table.

Table slide. (A) Starting position. While seated at a table, the patient places the hand of the affected shoulder on a sliding surface (e.g., a magazine that slides over a smooth table surface). (B) Ending position. The patient slides the hand forward, maintaining contact with the table, while the head and chest advance toward the table. From: Prevention and Management of Stiffness After Arthroscopic Rotator Cuff Repair: Systematic Review and Implications for Rotator Cuff Healing, Arthroscopy. 2011 Jun;27(6):842-8.

3-6 weeks:
• Wean off sling
• Gentle isometric exercises in neutral as pain allows
• Begin shoulder active-assisted exercises in the supine position
• Review scapula-thoracic function.

6 weeks +:
• Progress to full active exercises in all ranges
• Slowly begin rotator cuff strengthening (pain free)
• Closed chain exercises for all
• Begin stretching the capsule
• Begin proprioceptive exercises

Milestones
4 Weeks:      Full passive ROM
6 Weeks:      Active assisted ROM equal to pre op level
12 Weeks:    Active ROM equal to pre op level