Meet Our Physicians       Patient Education       Patient Registration       Post-Op Instructions       Special Precautions       Rehab Protocols       Links of Interest	Planning for Surgery Rehabilitation Protocol: ROTATOR CUFF REPAIR This program is designed as a guide for both the patient and therapist for rotator cuff repairs involving the fixation of the tendon to bone, and includes those performed either open or arthroscopically. Important variables with the surgical procedure include: Tension on repair (relates to the size of the tear) Trade-off between motion and the healing of tissue PREOPERATIVE PHYSICAL THERAPY: Preoperative orientation visit, review protocol Instructions on placement of immobilizer/sling and proper icing techniques. Instruction in home exercise program (fingers, wrist, elbow and pendulum) Schedule first post-op physical therapy visit beginning 7-10 days after surgery. POSTOPERATIVE PHYSICAL THERAPY: Phase 1: Immediately post-op to 3 weeks Goals: To being movement of fingers, wrist and elbow. To decrease pain and swelling in the shoulder. To increase passive shoulder ROM. Brace: The sling/immobilizer should be worn at all times except for therapy and personal hygiene. Therapeutic exercises: Active ROM fingers, wrist and elbow with arm at side Pendulum Begin active shoulder pinches (scapular retraction) discourage shrugs Passive ROM in scapular plane below 90º (abduction and forward flexion) Wand ROM - flexion in supine position (being at 2 weeks) to 90º Avoid shoulder adduction across body and shoulder extension Passive shoulder internal and external rotation as directed by the physician Watch for signs of RSD Continue icing program Phase 2: 3 to 6 weeks Goals: To improve active shoulder ROM, functional mobility, limit pain, and begin light strengthening. May not lift more than a coffee cup. Brace: Change to sling. Discontinue at 6 weeks. Therapeutic exercises: Continue home program Active ROM forward flexion limit to 90º Active abduction in scapular plane Gravity eliminated internal/external rotation No lifting of heavy objects causing axial traction Discourage scapular compensation with forward flexion and abduction Phase 3: 6 to 10 weeks Goals: Progress Active ROM and strength towards normal ROM Therapeutic exercises: Begin overhead pulley system for AAROM Continue AAROM with overhead pulley system Begin IR stretches Begin low-level isometrics for shoulder flexion, extension, abduction, IR and ER Progress functional use of arm to allow patient to use arm in front of the body below shoulder level Avoid impingement positions Phase 4: 10 to 12 weeks Goals: Attain full ROM by 12 weeks Therapeutic exercises: Begin strengthening with rubber tubing/straps at 10 weeks Continue strengthening Scapular stabilizers Latissimus dorsi Trapezius Golfers may begin putting at 10 weeks May being formal weight-training after 12 weeks May begin light toss/throwing program after 16 weeks Golfers may begin light full swing after 16 weeks Return to full sports usually at 5-6 months but must be cleared by the physician. ***Notice*** Patients wishing to participate in activities requiring high shoulder angular acceleration (golf, tennis and baseball) should be advised that they could anticipate return after 6 months.