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Rotater Cuff Repair Protocol


Principles

Repair is weakest at 3 weeks and remains weak for 3 months

Functional improvement should be expected over 12 months

The repair and deltoid reattachment are stressed in active abduction

Adhesions and disuse atrophy must be avoided

The protocol may be modified for larger tears and for fragile repairs. Post-operative instructions must always be checked before pursuing the standard protocol.

 

Pre-operatively

Range of movement and muscle strength are assessed

Post-operative protocol explained

Physiotherapy outpatient appointment arranged

 

Day 1-3

Polysling with body belt

Removal and replacement of body sling taught

Elbow, radioulnar, wrist and hand maintenance exercises

Pendular exercises and passive flexion in the scapular plane

Patients are usually discharged on 1 st or 2 nd day post-op.

 

Up to 4 weeks

Continue with treatment as above

Passive movements in all directions as pain allows. Do not force or stretch at this stage

Shoulder girdle exercises and scapular setting

Advise re. cervical range of movement exercises and posture

 

At 4 weeks

Begin assisted range of movement exercises e.g. pulleys and stick exercises

 

At 6 weeks

Wean off sling

Commence stretching to regain full range of movement

Active exercises

Gentle ADL but no heavy lifting

 

At 8 weeks

Progress to exercise with added resistance if this is appropriate for the patient's strength. Rotator cuff strengthening through range

Closed chain proprioceptive work such as rhythmic stabilisations in 4 point kneeling

 

Return to functional activities

 

Return to function will differ with each individual. The following is an approximate guide but should be seen as the earliest that these activities can commence.


Driving

Patients can begin driving when they have pain free active movement and good strength and control.

 

Sports

Swimming Breast stroke 8-10 weeks

 

Freestyle 12-14 weeks

Heavy contact sports 6 months

 

Return to work

Dependent on patient's job. Patients in sedentary jobs may return to work in 6-8 weeks. Manual workers should be guided by the surgeon.

 

Authors Clare Connor MCSP and Claire Kellaway MCSP

Review date October 2003

 

 

 

 

 

Shoulder Conditions

Elbow Conditons