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

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