Rotator Cuff Repair (large/massive)

Download this rehabilitation protocol (PDF)

For patients and physiotherapists.

Week 0-6

Aims:

• Pain control
• Protect the rotator cuff repair
• Allow the wounds to heal
• Maintain overall mobility
• Axilla/armpit hygiene

Suggested treatment:

• Ice
• Regular pain relief
• Elbow/wrist/hand and neck ROM exercises
• Sling most of the time, off for hygiene

Week 6-12

Aims:

• Wean out of sling
• Aim to regain passive ROM
• Aim for 90° flexion and <30° by 12 weeks
• Minimal pain
• Postural awareness
• Protect rotator cuff repair – likely 19-30% of normal at 6 weeks
• Do not progress if milestones not achieved

Suggested treatment:

• Passive range of motion
• “passive” flexion – supine with assistance of contralateral arm
• “passive” ER – supine to 30°
• Aim for early “tight” sensation, no forcing or sudden stretching
• Pendular exercises
• Scapular stability/peri-scapular exercises
• Ongoing elbow/wrist/hand and neck ROM
• Functional tasks – at waist height eg eating/drinking and self care
• Can commence isometric cuff work in neutral position (pain free and scapula stable)

Restrictions:

• No targeted supraspinatus isometric work (ie abduction)
• No lifting of weights
• Avoid “wall walking” until patient can actively elevate to 130° without pain

Week 12-18

Aims:

• Minimal pain
• Increased active ROM
• Aim for 120° flexion at 18 weeks
• Increased cuff activation
• Protect cuff repair – likely 29-50% normal at 12 weeks
• Wean out of sling completely
• Passive ROM should be approx. the same as the other side

Suggested treatment:

• Progress to active assisted range of motion
• Commence with active assisted shoulder elevation
• Then addition of active assisted extension/hand behind back/abduction
• Proprioception exercises
• Cuff activity – isometric exercises, can commence progressive loading
• Progress peri-scapular muscle activity – prone if comfortable
• Build endurance
• Normal shoulder movement pattern – no hitching
• Functional tasks to include those at shoulder elevation
• Stretching allowed

Restrictions:

• No targeting of supraspinatus with abduction loading exercises
• No heavy lifting

Week 18 and beyond

Aims:

• Protect repair
• Improve endurance/power of operated shoulder
• Good dynamic proprioception
• Introduce sports specific exercises

Suggested treatment:

• Progress to endurance exercises for arm in elevated position
• Progress resistance to rotator cuff and peri-scapular strengthening exercises
• Closed chain exercises
• Plyometric exercises if needed
• Functional demands will direct rehab – sports specific rehab
• Heavy lifting allowed
• No other restrictions

Some General Questions

What to expect after surgery:

• Most patients will stay a night post operatively
• After you wake up, you may notice your whole arm feels numb from the local anaesthetic applied to the nerves of your arm – this should wear off approximately 12 hours after surgery
• The next morning, you will be seen by the medical team and physiotherapists prior to your discharge
• You will be sent home with medications or a script to help with pain relief

Time in Sling:

• Generally your sling should be on at all times (except for hygiene) in the first 6 weeks
• From 6-12 weeks, you can wean out of the sling gradually using it less and less each day. You do not need to use your sling at night/sleeping
• From 12 weeks, you should not need to use your sling at all

Return to Activity

• Driving: when adequate range of motion and pain to allow safe control of the car and to react appropriately in an emergency. Both arms must be fully functional and on the wheel for this to occur. Usually dependent on time in sling.
  Return to driving from 6 weeks post op at earliest
• Work: desk based roles should be able to return once pain has settled – usually approximately 2 weeks after surgery. Those with more manual occupations may need specific recommendations and light duties are usually recommended
• Swimming: water based exercise is very helpful after surgery. No swimming until the wounds have healed – usually 2 weeks post operatively. Breaststroke by 12 weeks and freestyle by 18 weeks.
• Golf: usually requires significant rehab and time before adequate protection of the rotator cuff repair has occurred. Usually 6 months post op
• High Risk Sports (eg racquet sports, rock climbing, football, martial arts, skiing, horse riding). These sports are dependent on ROM, control and strength. Improvement in shoulder strength can be seen up to 2 years post operatively. Strength training/heavy lifting can commence from 18 weeks
  Contact sports or those at risk of falls (skiing, horse riding) shouldn’t occur till 12 months post op

Concerns or questions?

If you have any concerns post operatively, or you would like further information, please contact Mr Lau through the VBJS on 03 5752 5020 or via email at admin@vbjs.com.au

If you need urgent medical help, call 000 or go to your nearest emergency department.

Patient information

• Rotator Cuff Repair

These notes have been prepared by Mr Simon Lau. They are general overviews and information aimed for use by his patients. They reflect Mr Lau’s views, opinions and recommendations. They do not constitute medical advice. The contents are provided for information and education purposes only. Please seek Mr Lau’s specific advice with any questions regarding medical conditions and treatment.