Rehabilitation for Small & Medium Rotator Cuff Repairs

Rotator Cuff Repair

Needing Rotator Cuff Repair?

Dr. Goradia performs rotator cuff repairs with an “all arthroscopic” technique. While many surgeons still perform open or mini-open rotator cuff repairs, we believe the advantage of 100% arthroscopic repair is that detachment of or cutting through the deltoid is avoided which results in improved post-operative pain and less scarring in most patients. The “all arthroscopic” technique is more technically difficult to perform than open or mini-open surgery. Dr. Goradia has been performing the arthrosopic technique for 15 years–not only does he perform the surgery but he also teaches courses around the country to teach this advanced procedure to other surgeons.

As with many orthopedic surgeries, the rehabilitation can be as important as the surgery itself. The rotator cuff rehabilitation process is divided into phases. These phases may overlap depending on the individual progress of each patient. The following is intended as a general guideline. It should not be followed as a cookbook recipe. Dr. Goradia works closely with his “preferred” physical therapists in order to assure that each patients’ therapy is customized to their specific surgery.

Phase I: Early Post-operative Phase for Small and Medium tears

Immobilization

  • External rotation immobilizer
  • May remove while sitting or showering after first week
  • May remove 2-3 x/day for home exercises
  • If good external rotation at 3 weeks, discontinue the pillow
  • At 3-4 weeks use sling only when out of house

Testing

  • Bilateral ROM

Rotator Cuff Rehabilitation Exercises

  • It is important to begin active scapular exercises as soon as possible including shrugs, protraction and retraction exercises.
  • The patient’s shoulder will be protected in an abduction immobilizer to allow healing of the repaired musculotendinous unit. For large and massive tears this protection is 24 hours per day. For  medium or well secured large tears the patient may remove immobilizer for HEP, bathing and while sitting. For small one anchor or side-to-side only repairs there is concern for stiffness so these patients only need an immobilier or sling for comfort and can discontinue within first week if tolerated.
  • Begin hand/wrist/elbow motion and grip strengthening to reduce stiffness/swelling and to encourage circulation.
  • Supine PROM for flexion and external rotation within painfree zone
  • Ice should be utilized after exercise during this phase to control pain and swelling.
  • Supine forward elevation in PT and at Home
  • Wand for elevation and external rotation exercises in PT and at home
  • NO PULLEYS
  • Begin submaximal isometrics at 2 weeks

Clinical Follow-Up

Patient will:

  • Return to see Dr. Goradia 1 week, 4 weeks and then monthly until released
  • Follow up with physical therapist as needed during this phase to check progress (usually 2-3 x/week)
  • Should have 75% of passive range of motion compared to the noninvolved side, measured in flexion, external rotation in neutral, and internal rotation behind the back.

If physical therapist is concerned that patient is not progressing then they should immediately contact Dr. Goradia

Phase II: Small & Medium Tears 6 weeks – 3 months

Clinical Goals

  • Passive ROM at 6 weeks equal to 75% of noninvolved side for:
    • Flexion
    • External rotation
    • Internal rotation
  • Full ROM (equal to noninvolved side) between 6 and 12 weeks
  • Begin strengthening

Testing

  • Bilateral ROM
  • Assess functional ability

Rotator Cuff Exercises

  • For medium and well secured large tears discontinue using the immobilizer at 4 weeks. The external rotation pillow can be discontinued earlier if external rotation is good.
  • For retracted large and massive tears the immobilizer is discontinued at 6-8 weeks.
  • Begin Active ROM exercises for retracted large and massive tears
    • Active assistive ROM using wand
    • Active shoulder flexibility exercises
  • Begin progressive resistance exercises as tolerated:
    • 6-10 wks: Theraband exercises; grade of tubing and exercise disposition (concentric or eccentric) will vary according to the patient’s strength and tolerance. Start with internal/external rotation with the elbow tucked at the patient’s side then progress to flexion/abduction to 90 degrees, extension and adduction.
    • 8- 12 wks: Dumbbell exercises for the rotator cuff are implemented after satisfactory

Emphasis must be made on proper scapular stabilization and control. Accurate assessment of the scapular stabilizing musculature strength and flexibility is critical to proper shoulder function.

Clinical Follow-Up

Patient will follow-up weekly with a therapist for home exercise program updates

  • The patient should have full active and passive ROM (equal to noninvolved side) with
    good scapular control
  • Adequate strength to perform pain free ADL’s and non-labor, work related activities.

Phase III: Small & Medium Tears 3 to 6 months

Clinical Goals

  • Full ROM
  • Maximize strength and function

Testing

  • Bilateral ROM
  • Strength evaluation using hand held dynamometer

Rotator Cuff Rehabilitation Exercises

  • Begin a more aggressive shoulder stretching program as indicated. This may include selfstretching or partner stretching.
  • Increase the resisted strengthening program to include heavier weight.
  • Implementation of a sport/activity specific functional progression.
  • Strengthening continued in areas of weakness as documented.
  • Generally it takes 4-6 months for return to full activity and 6-9 months to reach full rehabilitation potential.

Clinical Follow-Up

  • The patient will follow-up monthly or as needed between 3 and 6 months postop
  • The patient will return at 6 months postop to see the physician and the therapist
    • 90% strength compared to noninvolved side determined by hand held dynamometer
    • Patient should be performing pain free activities of daily living
  • Pain free with any and all activities at home, work, leisure sports or hobbies.

**As always progression through the Phases is individualized for each patient