Rotator Cuff Repair

Most repairs are now performed arthroscopically so there is less tissue trauma and reduced risk of adhesions.

Post-op stiff shoulder is now rarely a problem, so the priority is to protect the repair from breaking down. Always be guided by the patient’s pain. Do not force, stretch or stress the repair before 6 weeks.

Protocol selection will be determined not just by the size of tear, but also the shape of the tear, strength of repair and general tissue & joint condition. Always check with the Consultant.

Educate patients about basic rotator cuff function and lever principles to reduce the risk of stressing the repair prematurely. Patients are in a sling for 6 weeks and should not drive for 6 to 8 weeks.

(1) MINOR (small): Less than 1 cm Day 1 – 2 Weeks

Mastersling with body belt
Wrist exercises
Elbow exercises
Shoulder girdle
Initiate scapula setting
Begin pendular exercises

3 Weeks – Review by Consultant

Commence Physiotherapy. DO NOT FORCE OR STRETCH
Wean off sling (may be delayed till 6 weeks)
Continue pendular exercises
Progress passive flexion in scapular plane and external rotation to neutral
Progress to assisted flexion, extension, abduction as is comfortable – internal and external rotation to neutral only.
Initiate gentle cuff isometric exercises as pain allows
Encourage normal function around waist level
May begin active exercises if appropriate - ONLY IF GUIDED BY THE CONSULTANT
Can start driving (guided by Consultant)

6 Weeks

Continue active exercises progressing into range
Commence anterior deltoid exercises as range allows
Commence rotator cuff strengthening and closed chain exercises
Start stretching limited movements
Encourage functional movement within pain limits
Begin gentle hydrotherapy if available
Proprioceptive exercises and core stability work as appropriate

(2) MEDIUM: 1cm – 3cms Day 1 to 3 Weeks

Mastersling with body belt plus abduction pad
Wrist, hand and finger exercises
Elbow exercises
Shoulder girdle
Initiate scapular setting

3 Weeks – Review by Consultant

Abduction pad removed, unless otherwise stated by Consultant
Sling retained
Begin pendular exercises

4 to 5 Weeks

Start physiotherapy. DO NOT FORCE OR STRETCH
Passive flexion in scapular plane + external rotation
Initiate gentle cuff isometrics as pain allows
Progress when comfortable to assisted exercises
Begin hydrotherapy if available

6 Weeks

Wean out of sling
Begin active exercises. Encourage functional movements at waist level
Anterior deltoid strengthening exercises as range of movement allows
Progress range adding resistance as appropriate Start rotator cuff strengthening progressively, dependent on pain
Add closed chain exercises
Begin proprioceptive skills

8 Weeks

Start driving

(3) MAJOR (large): 3cms – 5cms or MASSIVE: greater than 5 cms Day 1 to 3 Weeks

Mastersling with body belt plus abduction pad
Wrist and finger exercises
Elbow exercises
Shoulder girdle
Initiate scapula setting

3 Weeks – Review by Consultant

Abduction pad retained, unless otherwise stated by Consultant
Sling retained
Begin pendular exercises as instructed

6 Weeks

Remove abduction pan if not already done so
Commence physiotherapy. DO NOT FORCE OR STRETCH
Wean out of sling slowly
Passive flexion etc
Gentle rotator cuff isometrics, pain limiting
Begin assisted exercises
Gradually progress to active exercises
Begin hydrotherapy
Encourage normal function around waist level

8 Weeks

Start stretching if appropriate
Add resisted exercises within pain limits
Start rotator cuff strengthening
Anterior deltoid strengthening as range of movement allows
Add closed chain exercises
Begin proprioceptive skills
Encourage functional movement within pain limits
Start driving if comfortable
Consideration should always be given to the individual patients’ ability. The protocol is based on maintaining range of movement in the first phase and then gradually building strength in the middle to last phase. Progression should be tailored to the individual patient but the times quoted should be the earliest for active movement and when strengthening (resisted exercises) begins.

Return to Functional Activities

These are approximate and will differ depending upon the individual. However, they should be seen as the earliest that these activities may commence.
Driving 6-8 weeks
Swimming
Breaststroke – MINOR/MEDIUM 6 weeks, MAJOR 12 weeks
Freestyle – MINOR/MEDIUM 3 months, MAJOR unlikely to progress
Golf 3 months
Lifting No heavy lifting for 3 months. After this be guided by the strength of patient.
Return to work Dependent upon the patient’s occupation.
With minor and medium tears, patients in sedentary jobs may return at 6 weeks.
Major tears may take at least 8 weeks.
Manual workers should be guided by the surgeon.

Note: These are guideline protocols only.