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Rotator Cuff Surgery Recovery Guide
Rehabilitation for Rotator Cuff Repairs and Other Shoulder Procedures
There are numerous variations in “rotator cuff surgery” that make it challenging to have a single rotator cuff repair protocol. Physical therapists should not follow this as a “cookbook” but rather understand principles for tissue healing, range or motion end feel and scapular mechanics.
Concomitant or Alternative Procedures
- Biceps Tenodesis without Rotator Cuff Repair (RCR) – Sling while walking for 4 weeks and biceps strengthening is not started until 8 weeks
- RCR + Biceps Tenodesis – Same as cuff protocol except sling while walking for 4 weeks and biceps strengthening is not started until 8 weeks\
- Total Shoulder- Same as medium RCR unless Dr. Goradia provides specific subscapularis restrictions
- Reverse Shoulder Replacement – Stop wearing sling the day after surgery. Immediate Active Assisted Range of Motion (AAROM) and Passive Range of Motion (PROM). No restrictions on flexion, abduction or rotation. Early focus on deltoid and scapular kinematics.
- Superior Capsular Reconstruction – Same as massive rotator cuff tears
- Acromioclavicular (AC) Joint reconstruction – Same as massive rotator cuff tears
- Superior Labrum Anterior to Posterior (SLAP) and Bankart repairs – Same as rotator cuff repair protocol except sling for 3 weeks except showering and PT. Progress to full flexion over first 6 weeks. External rotation with arm at side to 20 degrees by 3-4 weeks and progress to full at 6-8 weeks unless firm end feel, then text Dr. Goradia.
Rotator Cuff Surgery Recovery Phase I:
Initial Healing and Establishing Range of Motion
0-3 Weeks Post-Surgery
- External rotation immobilizer
- Daily compliance with HEP 4x/day
NO PULLEYS or UE Bike at any time.
Rotator Cuff Surgery Recovery Phase II
3-6 Weeks After Surgery
- Full passive knee extension and 110 degrees of flexion (90 degrees if meniscus repaired)
- Independent straight leg raise- electrical stimulation at 60 degrees knee flexion
- Weight bearing as tolerated unless meniscus repair, then surgeon may order non-weight bearing for 2 weeks
- Reduce swelling- cryotherapy and e-stim
Rotator Cuff Surgery Recovery Phase III:
Strength and Begin Restoring Function
6-12 Weeks Post Shoulder Surgery
- Restoration of full PROM and AAROM
- Significantly improved scapular mechanics
- Grade 4 strength in cuff muscles
Rotator Cuff Surgery Recovery Phase IV
3 to 4 Months After Surgery
- Full AROM
- Maximize strength and function
Rotator Cuff Surgery Recovery Phase V:
Full Return to Activities and Manual Labor
4-6 Months Post Shoulder Surgery
- Full AROM
- Maximize strength and function