Arthroscopic Rotator Cuff Repair

Post Op Protocol

Dr Maguire has a very strict protocol for post-op physio for Shoulder Arthroscopic Rotator Cuff Repair.

***** Please note which tendons were repaired *****

NOTE whether Supraspinatus, Subscapularis or Infraspinatus repaired.

The Operative Notes should accompany you on discharge in a folder with other documents including your physio referral. PLEASE give this information to the physio to individualise your rehab.

Also NOTE if a BICEPS TENODESIS was performed!!

Day 1 to day 7

- In hospital ICE / cryo-cuff every 2-3 hours

- Do not put up with pain

- If no contraindications use this pain relief regime

- PCA overnight then change to the following in am:

        - Paracetamol 1gram four times a day

        - Ibuprofen 400mg three times a day

        - 10 to 20 mg of TARGIN (Oxycontin) twice a day

        - 5-10 mg of Endone as required up to 3 hourly

- Ensure Fluid intake and bowel softening agents

        - Prevent constipation from Endone/Targin

- Remain in sling unless doing physio 

- Gentle pendulum exercises 


- Hand, wrist, elbow ROM as tolerated

- External rotation to neutral (0 Degrees only)

- Protect Biceps if Tenodesis performed

        - Support Elbow

        - No active contraction of biceps

- Scapula exercises (shrugs, protaction, retraction, rolls)

        - As frequently as tolerated

Weeks 2 to 6

- Continue exercises above

- Wean off Targin and Endone after first week

- Abduction sling on unless showering, eating or sitting

- Sling ALWAYS on for sleeping and when mobilising

- Gentle Pendular movements (Assisted)

- PROM (Passive Range of Motion) only!

- PROM Supine FE gently up to 140 (only 10 reps max)

- Table slides into FE as tolerated (only 10 reps max)

Figure 1. Table slide. (A) Starting position. While seated at a table, the patient places the hand of the affected shoulder on a sliding surface (e.g., a magazine that slides over a smooth table surface). (B) Ending position. The patient slides the hand forward, maintaining contact with the table, while the head and chest advance toward the table.

- External Rotation (ER) to 30 degrees (only 10 reps max)

        - If large subscapularis tear ER to neutral till wk 6

- Internal rotation to buttock (only 10 reps max)

- Warm-up before exercises

        - Walk for 1 minutes

        - Warmth to shoulder (warm pack or warm shower)

- ICE after exercises for 30 mins

- Use core muscle exercises and lower limb exercises from Day 1 post Op

        - e.g. Kibler Kinetic Chain Theory

- Protect Biceps if Tenodesis performed

        - Support Elbow

        - No active contraction of biceps

- Aerobic exercise (walking or stationary exercise bike)

Weeks 7 to 12

- Continue above exercises

- Discontinue sling after 6 wks unless massive tear (8wks)

- Small RCTs <=1cm begin Assisted AROM at 7wks

- Medium RCTs 1 to 3cm begin Assisted AROM at 8 wks

- Large RCTs 3 to 5 cm begin Assisted AROM at 9 wks

- Massive RCTs > 5cm begin Assisted AROM at 10 wks

-  Assisted AROM includes "wall walking" for FE

- Push PROM to achieve FROM (Full Range of Motion)

- Isometric contractions of Rotator Cuff at Week 8

- Start gentle theraband work 2 wks after Assisted AROM

        - Only for cuff muscles not repaired

        - e.g. Medium Tear at 10 wks

- Start gentle theraband work on musles repaired 

        - 4 wks after Assisted AROM started

        - e.g. Medium Tear at 12 wks

After 12 weeks to 6 months

- Continue above exercises

- Begin Gym program

- May start running and pool work

- Progress from gentle breastroke to freestyle

- Avoid heavy lifting for 6 months

        - Lift with arms close to body

        - This avoids the "Lever Arm Effect"

- If significant stiffness or pain at 12 wks may consider corticosteroid injection

6 months to 12 months

- If stiffness persists for 12 months may consider arthroscopic capsular release

© Maguire Upper Limb Pty Ltd 2014 Ph: 07 5531 2222