Road to Recovery: Rotator Cuff Repair Expectations

Undergoing rotator cuff repair can feel overwhelming, especially if it is a person’s dominant arm. Whether surgery is performed arthroscopically or openly repaired, you play a critical role in your patient’s road to recovery. In this article, we’ll review a four phase protocol you can use for patients recovering from rotator cuff repair.

In each phase, we’ll review patient goals and precautions. Then we’ll recommend patient education and rotator cuff exercises to share with your patient for each phase of their recovery.

Rotator Cuff Refreshers

Need a quick refresher on the rotator cuff? Read on! Otherwise, feel free to skip ahead to the next section.

The rotator cuff is a group of four muscles:

• Supraspinatus
• Infraspinatus
• Subscapularis
• Teres minor

The rotator cuff provides support to the shoulder joint and performs functions of elevation and rotation, helping a person reach up into cabinets, drink from a cup, and perform self-care.

The 4 Phases After Surgery

There are four main phases that constitute the post-operative rotator cuff repair rehab.

Phase 1: Immediate Post Op (0 to 3 weeks)

Goals include:

• Protecting the surgical repair
• Decreasing pain and minimizing swelling
• Gradually increasing passive range of motion (PROM)
• Educating the patient regarding precautions, including:
  • No shoulder active assisted range of motion (AAROM) or active range of motion (AROM) exercises
  • No lifting of objects
  • No weight bearing on surgical arm

Consider providing education for your patient to help them navigate this phase. You can provide instructions on:

• When to wear a sling (i.e., while outdoors or sleeping)
• How to put on and take off a sling
• When to ice the injured area

Look for resources on these topics and much more in the MedBridge Patient Education Library.

In addition, you can provide elbow, wrist, and hand exercises to start increasing your patients’ PROM. Exercises you might recommend in phase 1 include:

• Shoulder Flexion Caregiver PROM
• Supine Elbow Flexion Extension AROM
• Wrist AROM Flexion Extension

These exercises and more can be found in the MedBridge HEP Library.

Phase 2: Intermediate Post Op (4 to 8 weeks)

Goals include:

• Maintaining shoulder PROM
• Minimizing substitution with AROM

Patients should not lift objects or perform weight-bearing activities on their surgical arm during this phase. They should continue to wear a sling while sleeping until four to six weeks post op, or when cleared by their surgeon.

Patients can begin to perform AAROM exercises, including:

• Seated Shoulder Flexion AAROM with Pulley Behind
• Seated Shoulder Abduction AAROM with Pulley Behind
• Shoulder Flexion Wall Slide with Towel
• Supine Shoulder Flexion Extension AAROM with Dowel
• Sidelying Shoulder Abduction
• Standing Scapular Retraction
• Supine Shoulder Flexion Extension AAROM with Dowel

At seven weeks post op, patients can initiate AROM exercises, as tolerated, including:

• Supine Shoulder Flexion Extension Full Range AROM
• Supine Bilateral Shoulder Protraction
• Sidelying Shoulder Abduction
• Standing Shoulder Flexion Reactive Isometric
• Seated Elbow Flexion with Resistance

Phase 3: Transitional Post Op (9 to 12 weeks)

Goals include:

• Gradually increasing PROM, AAROM, and AROM
• Improving dynamic shoulder stability
• Improving scapular stability
• Initiating functional activities

Even though patients should increase range-of-motion exercises during this phase, they should not be lifting more than 10 pounds.¹

AROM and light-resistance ROM/strengthening exercises that are appropriate during this time include:

• Prone Shoulder Extension
• Standing Shoulder Flexion to 90 Degrees
• Shoulder Abduction – Thumbs Up
• Standing Shoulder Scaption
• Standing Shoulder Flexion AAROM with Dowel

Phase 4: Strengthening Post Op (13 to 16 weeks)

Goals include:

• Maintaining full and pain-free ROM
• Increasing functional exercises

Patients can start implementing progressive strengthening and stability exercises, as tolerated, during this phase, including:

• Wall Push Up
• Shoulder PNF D2 Flexion
• Prone Shoulder Horizontal Abduction
• Prone Shoulder Row
• Prone Single Arm Shoulder Y
• Standing Wall Ball Circles with Mini Swiss Ball

Discharging from Therapy

After completing at least four months of therapy, you may discharge your patient with a home exercise program to continue after discharge.

If your patient is an athlete, they can start to incorporate sport-specific activities at four to five months post op to mimic the stresses of their sport by slowly stressing the healing tissues and building better capacity. Generally, athletes can return to their sport nine to twelve months post op, but may take longer in some circumstances.

Maintenance and Full Recovery

Recovery can take time depending on each patient’s specific goals, but through continuing their strengthening program post op, they can expect to fully recover with full use of their arm six months to a year post op.