Most repairs are now performed arthroscopically so there is less tissue trauma and reduced risk of adhesions.  Post-op stiff shoulder is now rarely a problem, so the priority is to protect the repair from breaking down. The protocols are based on maintaining range of movement in the first phase and then gradually building strength in the middle to last phase.

Always be guided by the patient’s pain. Do not force, stretch or stress the repair before 6 weeks.  Protocol selection will be determined not just by the size of tear, but also the shape of the tear, strength of repair and general tissue & joint condition.  If a biceps tenodesis has been performed avoid stretching into full elbow extension for 6 weeks (see protocol).

Educate patients about basic rotator cuff function and lever principles to reduce the risk of stressing the repair prematurely. Advise on importance of physiotherapy rehabilitation / advice and likely future appointments.

Consideration should always be given to the individual patients’ ability.  Progression should be tailored to the individual patient, but the times quoted should be the earliest active movement, and strengthening exercises begins.

(1) SMALL:
Day 1 – 3 Weeks

• Polysling – to be worn at all times, apart from when washing and doing specific exercises.
• Elbow, wrist, hand and finger exercises
• Neck ROM exercises
• Initiate scapula setting
• Begin pendular exercises

 
2 Weeks – Review by Consultant / team
3 Weeks

• Commence Physiotherapy. DO NOT FORCE OR STRETCH
• Wean off sling (may be delayed till 6 weeks)
• Continue pendular exercises
• Progress to active-assisted flexion, extension, abduction and rotation as comfortable.
• Initiate gentle cuff isometric exercises as pain allows
• Encourage normal function around waist level

6 Weeks

• May begin active exercises if appropriate, gently progressing into range
• Commence anterior deltoid exercises as range allows
• Commence rotator cuff strengthening and closed chain exercises
• Start gently stretching limited movements
• Encourage functional movement within pain limits
• Proprioceptive exercises and core stability work

 (2) MEDIUM/LARGE:
 Day 1 to 3 Weeks

• Polysling with body belt – to be worn at all times, apart from when washing and doing specific exercises.
• Elbow, wrist, hand and finger exercises
• Neck ROM exercises
• Initiate scapular setting

 2 Weeks – Review by Consultant / team
 
3 Weeks

• Body belt removed
• Sling retained
• Begin pendular exercises

 6 Weeks

• Wean out of sling
• Commence physiotherapy. DO NOT FORCE OR STRETCH
• Initiate gentle cuff isometrics as pain allows
• Continue pendular exercise, progress to active-assisted flexion, extension, abduction and rotation as comfortable
• Progress to active exercises, adding resistance as appropriate
• Start gently stretching limited movements
• Encourage functional movements at waist level
• Anterior deltoid strengthening exercises as range of movement allows
• Start rotator cuff strengthening progressively, dependent on pain
• Add closed chain exercises
• Begin proprioceptive exercises and core stability work

 Return to Functional Activities

These are approximate and will differ depending upon the individual. However, they should be seen as the earliest that these activities may commence.

Driving

Small tear 4-6 weeks; med/large tear 8+ weeks.  Patients should be able to put their hands at the ’10 to10′ position and perform an emergency break.

Swimming

• Breaststroke – MINOR/MEDIUM 6 weeks, MAJOR 12 weeks
• Freestyle – MINOR/MEDIUM 3 months, MAJOR unlikely to progress

Golf

3 months

Lifting

No heavy lifting for 3 months. After this be guided by the strength of patient.

Return to work

• Dependent upon the patient’s occupation.
• With minor and medium tears, patients in sedentary jobs may return at 6 weeks.
• Major tears may take at least 8 weeks.
• Manual workers should be guided by the surgeon.