Table 2 Brief physiotherapy protocol for postoperative rehabilitation of repaired large/massive rotator cuff tears
Time | Focus | Range of motion | Recommended exercises | Precautions |
|---|---|---|---|---|
0–6 weeks | Tissue healing | No passive assisted or active ROM of shoulder allowed apart from table slides | • Restricted table slides after 2nd week to 30° • AROM of elbow, wrist, hand | • No active reaching • Sling at all times |
6–12 weeks | PROM, AAROM with transition to AROM | Regain full PROM and AAROM, transition to AROM at 10 weeks | • PROM of shoulder, pendulums, scapular mobility, ball squeeze begin AAROM at 8 weeks • Isometrics and active progression at 10 weeks | • No resisted activity and lifting • Avoid overloading of supraspinatus • Must regain scapular rhythm before transition to strengthening |
12–24 weeks | AROM and progressive strengthening | Regain full AROM | • Continue PROM and AAROM as needed • Initiate strengthening and progress AROM to functional planes • Progress proprioceptive drills, rhythmic stabilization, push-ups, resistance band | • No heavy or repetitive overhead activities • Limited return to gym after 20th week if AROM with satisfactory scapular rhythm has been achieved • Free full ROM |
24 weeks–1 year | Return to sports and physical activity if ROM and strength adequate | • Progression of strengthening • Continue resistance band, proprioceptive drills and periscapular stabilization until full return to physical activity and sports | • Return to sports • Progress gym lifting |