Shoulder Rehabilitation

Rotator Cuff Repair Protocol (Non-Secure/Incomplete Repair)

Sling When will I go home? What can I do? What can’t I do?
6 weeks You will be discharged on the same day as the operation Range of movement within safe zone* No formal strengthening until 12 weeks, no lifting

Acute phase (0-4 weeks)

Goals

  • Reduce pain
  • Protect surgical repair
  • Optimise tissue healing
  • Minimise muscle inhibition

Rehabilitation

  • *Safe zone: commence with passive range of movement to 90° elevation, 20° external rotation
  • Progress to active assisted & active supported mobilisation within that zone
  • No range of movement outside this zone
  • No forced movement
  • Elbow, wrist and hand exercises
  • Simple scapular mobilisation exercises
  • Closed kinetic chain/proprioception exercises – low load and ensuring congruency scapula on thorax and must be pain free
  • Gentle isometrics rotator cuff
  • Criteria for progression
  • Control of pain

Intermediate phase (4-12 weeks)

Goals

  • Discard use of sling at 6 weeks
  • Preserve integrity of surgical repair
    Restore functional range of movement
    Re-educate cuff recruitment and scapular control through range
    Re-educate sensorimotor/proprioceptive function

Rehabilitation

  • Progress range of movement to restore functional range
  • No forced end range mobilisation
  • Begin active range of movement exercises from 8 week mark
  • Mobilise capsular restriction if necessary
  • Progress cuff and scapular recruitment through range
  • Progress kinetic chain integration
  • Increase functional emphasis movement pattern correction
  • Closed kinetic chain work to enhance co contraction
  • Hydrotherapy permitted from 6 weeks

Criteria for progression

  • Pain free functional range of movement
  • Good control of rotator cuff and scapular musculature through functional range

Late phase (>12 weeks)

Goals

  • Restore full active range of movement
  • Establish optimal neuromuscular control of shoulder girdle musculature
  • Restore optimal cuff and scapula control through range and under load
  • Optimise function specific power, strength and endurance
  • Transference movement pattern correction and cuff/scapula control to functional tasks
  • Return to work/sport and recreational activities

Rehabilitation

  • Progress active range of movement
  • Regain optimal range of movement into combined positions
  • Enhance neuromuscular control through range and incorporated with kinetic chain
  • Closed kinetic chain exercises with increased load
  • Functional specific strengthening and endurance exercises
  • Sports/functional specific rehab

Guidelines for return to functional activities

Driving Lifting Swimming Golf
8 weeks Light lifting 4 months, avoid heavy lifting until 6 months Breaststroke 8 weeks, freestyle 14 weeks 5-6 months

SHOULDER SPECIALIST

Mr. Devinder Garewal

MBBS, BMedSci, FRACS (Orth), FAOrthA

Mr. Devinder Garewal is an orthopaedic shoulder specialist. Devinder completed his medical qualifications from the University of Melbourne and is a Fellow of the Royal Australasian College of Surgeons and the Australian Orthopaedic Association.

Shoulder Bone Icon

Shoulder Joint

Elbow Icon

Elbow Joint

Wrist Icon

Wrist Joint

Hand Icon

Hand Joints

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