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

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