Rotator Cuff Repair: Small to Medium Tear

Physical Therapy Protocol

Phase I – Immediate Post-Op (0 to 3 Weeks)

Goals:

• Protect surgical repair
• Reduce swelling and pain
• Maintain upper extremity ROM (elbow, hand, wrist)
• Gradually increase shoulder PROM
• Minimize muscle inhibition
• Educate patient on precautions and healing

Sling:

• Neutral rotation with abduction pillow (30–45°)
• Wear at night while sleeping

Precautions:

• No shoulder AROM or AAROM
• No lifting or weight-bearing with the operative arm
• Avoid scapular retraction with teres minor repair

Therapeutic Interventions:

• Swelling Management: Ice, compression
• PROM (shoulder): ER < 20° in scapular plane, FE < 90°
• Seated GH table slides, horizontal table slides
• AROM: Elbow, wrist, hand (PROM elbow flexion only if biceps tenodesis/tenotomy)
• Strengthening (Week 2): Scapular setting (avoid retraction if subscapularis or teres minor repair), ball squeeze

Criteria to Progress:

• 90° forward elevation PROM
• 20° ER PROM in scapular plane
• 0° IR PROM in scapular plane
• Palpable scapular and shoulder musculature activation
• No complications

Phase II – Intermediate Post-Op (4 to 6 Weeks)

Goals:

• Continue protection
• Reduce swelling and pain
• Maintain PROM
• Minimize substitution during AAROM
• Reinforce patient education

Sling:

• Continue use in neutral rotation with abduction pillow

Precautions:

• No lifting or body weight support with arm

Therapeutic Interventions:

• PROM: ER < 20°, FE < 90°
• AAROM: Shoulder flexion (e.g., cane flexion, sidelying elevation to 90°, washcloth press)
• Strengthening: Row and shoulder extension on physioball

Criteria to Progress:

• Same ROM goals as Phase I
• Minimal substitution with AAROM
• Pain < 4/10
• No complications

Phase III – Intermediate Continued (7 to 8 Weeks)

Goals:

• Gradually increase ROM (PROM, AAROM, AROM)
• Initiate AROM
• Improve scapular activation

Sling:

• Discontinue

Precautions:

• Avoid lifting >10 lbs

Therapeutic Interventions:

• PROM: ER < 30°, FE < 120°
• AAROM: Cane elevation, incline table slides, wall ball roll
• AROM: Supine flexion, salutes, wall climbs, punches
• Strengthening: Resistance band rows, lawn mowers, scapular punches, bicep curls if cleared

Criteria to Progress:

• 120° FE PROM
• 30° ER/IR PROM
• Minimal AROM substitution
• Pain < 4/10

Phase IV – Transitional (9 to 10 Weeks)

Goals:

• Advance ROM and strength
• Enhance scapular and dynamic shoulder control

Precautions:

• Avoid lifting >10 lbs

Therapeutic Interventions:

• PROM: ER < 45°, FE < 155°, ER @ 90° ABD < 60°
• AROM: Scaption and FE to 90°, supine FE with elastic band
• Strengthening: Push-up plus, resistance band punches, tripod/pointer holds

Criteria to Progress:

• 155° FE PROM
• 45° ER/IR PROM
• 60° ER @ 90° ABD
• 120° AROM FE
• Pain < 2/10
• Symmetric scapular mechanics

Phase V – Transitional Continued (11 to 12 Weeks)

Goals:

• Restore full ROM
• Return to functional activities

Therapeutic Interventions:

• Continue all prior interventions
• Stretching: ER @ 90°, IR behind back, sleeper stretch, triceps/lats, doorjam series

Criteria to Progress:

• Full, pain-free PROM and AROM
• No compensatory AROM patterns

Phase VI – Strengthening (13 to 16 Weeks)

Goals:

• Maintain ROM
• Begin RTC strengthening (MD clearance)
• Enhance functional capacity

Strengthening:

• RTC: Side-lying ER, standing IR/ER, ABD
• Scapular: T/Y/W exercises, push-up plus, resistance band dynamic hug
• Biceps: Curl if cleared

Motor Control:

• Rhythmic stabilization (IR/ER in scaption)
• PNF: D1/D2 patterns
• Wall ball stabilization, quadruped isometrics

Criteria to Progress:

• Full pain-free ROM
• ER/IR strength ≥ 85% of contralateral side
• ER/IR ratio ≥ 60%
• Negative impingement/instability signs
• Symmetric scapular mechanics
• MD clearance

Phase VII – Return to Sport (4 to 6 Months)

Goals:

• Full strength and control
• Return to high-level function or sport

Therapeutic Interventions:

• Resistance band ER/IR at 90°
• Wall slides with resistance
• PNF: D1/D2 with resistance, diagonal patterns
• Begin throwing or return-to-sport drills per MD guidance

Return-to-Sport Considerations:

• Progression individualized based on sport demands
• Coordinate with referring physician