Rotator Cuff Repair (Arthroscopic): This protocol is based on maintaining a range of movement in the first phase and then gradually building strength in the middle to the last phase.
Pre-Operative
ROM Exercises
Maximize shoulder strength of deltoid, intact rotator cuff muscles and scapular stabilizers.
First 3 weeks:
- Patient education: movement limitations, posture, proper sling fitting, joint protection, and positioning
- PROM shoulder flexion/abduction/ER/IR
- Elbow/wrist/hand AROM w/ no resistance
- Light active scapular strengthening exercises
- Pendulum hangs
- Modalities PRN(Modalities PRNrefers to “as needed” by the patient. Modalities at Harris Therapy include:*Hot Packs /Cold Packs *Transcutaneous Electric Nerve Stimulation or TENS*Electrical Stimulation*LASER)
Weeks 3-4 or 6 as tolerated
- Progress scapular strengthening
- Progress pendulum hangs to pendulum circles based on tolerance
- Continue with PROM shoulder flex/abd/IR/ER
- Joint mobilizations grades I and II for pain relief at GH/SC/AC/ST joints
- Modalities PRN(Modalities PRNrefers to “as needed” by the patient. Modalities at Harris Therapy include:*Hot Packs /Cold Packs *Transcutaneous Electric Nerve Stimulation or TENS*Electrical Stimulation*LASER)
Weeks 6-12
- Continue PROM as needed
- Progress joint mobilizations at GH/SC/AC/ST joint to grades III and IV as needed
- Initiate AAROM program and progress to AROM as tolerated
- Pulleys, cane exercises, table slides, wall slides etc. in multiple planes
- Posterior capsule stretching
- Begin low-level closed chain shoulder exercises
- Continue scapular strengthening/stabilization exercises
- Initiate deltoid and non-repaired mm of RTC strengthening program when appropriate (pain-free and full AROM)
- Modalities PRN(Modalities PRNrefers to “as needed” by the patient. Modalities at Harris Therapy include:*Hot Packs /Cold Packs *Transcutaneous Electric Nerve Stimulation or TENS*Electrical Stimulation*LASER)
Weeks 12
- Initiate balanced progressive RTC strengthening program
- Progress closed chain exercises
- Ensure exercises are pain-free and are performed with no substitutions and adequate ROM
- Dynamic scapular stabilization exercises
- Exercises focusing on safe return to ADL’s/work/recreational activities as tolerated
- Upon discharge, ensure patient continues HEP for at least 6-8 weeks
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