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lVledical Center
separtment *lf *ril'lopaedic $urgery & ffie!^labfi{itati*rr
ftrfisdi*inb
Scott E. Barbash MD
Assistant Professor
Division of Sports Medicine
Office: 718-270-4073
Fax: 718-270-2393
Appts: 718-270-2045
***Please
fax reports Attn: Scott Barbash MD or send hard with patient for review
bilitatio
Rotator Cuff Repair
Patient will wear an abduction pillow brace/sling for 6 weeks post-r
Unless othenruise specified, do not begin pr uniil patient has
seen D for 2 week post-op visit.
PHASE I:
Days 0-14
. May remove sling for genfle pendulum exercise 2_3 )s per
o Elbowlhand gripping and ROM exercises: perform 4 ti mes t
o Cryotherapy as needed.
Weeks 2-4
PR0M - Flexion to 900, Abduction to g0o, ER 300, IR
300. (ER/lR in scapular
plane, Flexion/extension at g0 o flexion in scapular pJ
a Rhythmic stabilization drills.
o Continue all isometric contractions and use of
o lnitiate scapular isometrics.
a Screen posture
o May begin joint mobilizations grade I and Il for pain
Weeks 4-5
o PROM - Flexion lo l20o,Abduction to 1200, ER 300, 450, Ex 300,
a ER/lR in scapular plane and at 900 abduction.
o lnitiate ER/lR strengthening using exercise tubing at of abd (use towel roll under arm).
a lnitiate manual resistance ER in supine in scapulir p e (light tance).
a Progress scapular strengthening.
a lnitiate prone rowing with arm at 300 of abduction to arm
o lnitiate prone shoulder extension with elbow flexed to
Deparlment of Orthopaedic Surgery & tion Medicine
State 6'!lt{vens$ty
a>S ffiew ym*"k S*w i ,," .:;o
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450 Clarkson Avenue, Box 30, Brooklyn, Ny 718-270-2045
o Continue use of ice as needed. May use heat prior tc, ROM exercises.
o Rhythmic stabilization exercises (flexion at 450, 900, 1000 and ER/lR at multiple angles).
Weeks 5-6
o Advance PROM in all directions as tolerated.
o Joint mobilizations: gentle scapular/glenohumeral joirt mobilization as indicated to regain full
PROM,
o AAROM and stretching exercises to gain full motion,
o Shoulder flexion
r ER at 900 abduction.
o lnitiate AROM exercises.
c Shoulder flexion in scapular plane to 900 of flexion.
c Shoulder abduction to 900.
o Progress isotonic strengthening exercise program.
o IR/ER tubing (towel under arm).
o Side-lying ER (towel under arm).
o Prone rowing at 450 abduction.
o Prone horizontal abduction (flexed elbow) at 900 abd rction,
o Brceps curls (isotonics with very light resistance).
o Slowly progress strengthening to prevent inflammatic n of tendc n.
Criteria to advance to Phase ll:
r Full PROM.
o Flexion PROM: >1250.
r ER PROM in scapular plan to >750 (if uninvolved shculder PROM >80.).
r lR PROM in scapular plan to >75'(if uninvolved shoulder PROM >80.).
o Abduction PROM to >900 in scapular plane.
PHASE II:
Week 7
o Maintaln full ROM in all planes.
o Continue dynamic stabilization drills.
o Progress AROM and light strengthening program with the additron of
o ER/lR tubing
o Lateral raises to 900 of abduction*
o Full can in scapular plan to 900 elevation*
o Prone extension
o Prone serratus punch.
r Elbow flexion and extension
c Must be able to elevate arm without shoulder or scapular hiking before initiating
isotonics; if unable, continue dynamic rhythmic stabilization glenohumeraljoint
exercises.
o Progress joint mobilizations to grades lll and lV to adlress capr;ular restrictions as indicated
for all shoulder girdle joints.
Weeks 8-9
Depailment of Orthopaedic Surgery & Rehabiliiation Medicine
State [.]nivens$t5r of Nerru Yq]rk Sowy'astat* Med$sa$ *ent*r
450 Clarkson Avenue, Box 30, Brooklyn, N\'11203 o Phone 718-270-2A45
r Continue as above
r lnitiate light functional activities if physician permits
o ln pain free ROM; starting at waist level activities, progression ,o shoulder level activities, then
overhead activities.
Week 10
r Continue with all exercises listed above.
o Progress to fundamental shoulder exercises.
o Strengthening Exercises: addition of the following
o Standing lateral raise to g0o
r Prone Horizontal Abduction - T's.
o Prone Scaption - Y's.
o Initiate isotonic resistance (0.5k9 weight) during flexion and abduction if patient exhibits
non-painful normal motion without substitution patterns.
Weeks 11-14
o Progress all exercises.
o Continue ROM and flexibility exercises,
o Stretch posterior capsule with cross body adduction stretching.
o Progress strengthening program (increase 0,5k9/10 days if nor-painful).
c No residual pain should be present following exercises.
Criteria to advance to Phase lll:
c FullAROM and PROM,
o Pain free with all strengthening exercises.
e Dynamic shoulder stability.
PHASE III:
Weeks 15-20
c Continue ROM and stretching to maintain full ROM.
e Self-capsularstretches
o Sleeper stretch
o Behind the back lR with towel
e Cross body stretch
r Doonruay ER stretch
o Progress shoulder strengthening exercises
Fundamental shoulder exercises including:
o Diagonals with resistance band in D2 pattern.
o Push up plus on wall (progress to floor).
o Dynamic hug with band.
o lR at 900 with band.
o Standing forward punch with band.
o ER (supported and unsupported at 900)with weight q band.
r Biceps curls
Depafiment of Orthopaedic Surgery & Rehabiliiation Medicine
State [.34'r6versitSu txf N*w Ymr$c Sqrlenstmts R4*dl*mE #*nter
450 Clarkson Avenue, Box 30, Brooklyn, N\'11203 r Phone 718-270-2A45
Weeks 20.24
o Continue all exercises listed above.
o Gradually increase resistance (patient should not exribitpain during or after exercise and no
substitution pattern).
Criteria to advance to Phase lV:
r Maintenance of full painJree ROM.
o Functional use of upper extremity.
r Full muscular strength and power.
PHASE lV: Return to Activity Phase (Weeks 24-36)
Weeks 24-26
r Continue fundamental shoulder exercise program (a. least 4 tirnes weekly).
o Continue stretching if motion is tight.
o continue progression to sport and/or work activity/pa rticipation
Department of Orthopaedic Surgery & Rehabiliiation Medicine
State [-Ha's6veu'mfity *f N*w V*rk S*w+ns**t* ile$$c*i fienter
450 Clarkson Avenue, Box 30, Brooklyn, N\' 11203 r Phone 718-270-2A45
