Large-Massive Rotator Cuff Rehab Protocol

Pre-Surgery:
ROM: must restore minimum of 80% passive ROM before surgery

Post-op day one:
Ice / cryotherapy: 10 – 15 minutes, 4X / day
Ultrasling: immobilization
ROM: begin gentle pendulums 4X / day

Post-op weeks one – four:
Ultrasling worn at all times except for exercises and bathing
ROM: pendulums; at 3 weeks, begin gentle PROM with gentle stretches (F, ER, ABD) 3 – 4times per day; at 4 weeks, limit flexion to 100, ER to 35, IR to hip (onset and pace depends on integrity of repair construct) avoid active ROM!
Strength: begin scapular isometrics,cervical ROM, (elbow/forearm) exercises

Post-op weeks five- eight:
Ultrasling: wean out completely by 6 weeks
ROM: steady progression of PROM; continue daily stretches (F, ER, AB, IR);
goal is 90 95% of full passive motion at 12 weeks following surgery (IR may lag behind), begin AAROM at 8 weeks with no resistance
Strength: periscapular, elbow, wrist, and hand strengthening only

Post-op weeks nine – twelve:
ROM: Continue stretching with goal of 85 – 90% PROM at 12 – 16 wks
Strengthening: no resistance before 12 weeks; initiate gentle cuffstrengthening program at 10 weeks; isotonic ER and IR with sports cords. Lateral raises, prone rowing/extension/horizontal abduction/extension, biceps and triceps strengthening.

Post-op weeks thirteen – sixteen:
Strength: continue slow, gradual strengthening with light resistance

Post-op week seventeen – twenty four:
Strength: continue slow, gradual strengthening with light resistance
Function: begin light activities, ie golf chipping, pitching

Greater than 24 weeks:
Function: progresses commensurate with overall cuff / periscapular strength